DOCSLIB.ORG

This Work Is Protected by Copyright and Other Intellectual Property Rights

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
This Work Is Protected by Copyright and Other Intellectual Property Rights View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Keele Research Repository This work is protected by copyright and other intellectual property rights and duplication or sale of all or part is not permitted, except that material may be duplicated by you for research, private study, criticism/review or educational purposes. Electronic or print copies are for your own personal, non- commercial use and shall not be passed to any other individual. No quotation may be published without proper acknowledgement. For any other use, or to quote extensively from the work, permission must be obtained from the copyright holder/s. The ethical demands on the developed world of HIV in sub-Saharan Africa Norman James Gourlay D. Med. Eth. 2013 Keele University 1 SUBMISSION OF THESIS FOR A RESEARCH DEGREE Part I. DECLARATION by the candidate for a research degree. To be bound in the thesis Degree for which thesis being submitted D Med Eth Title of thesis The ethical demands on the developed world of HIV in sub-Saharan Africa This thesis contains confidential information and is subject to the protocol set down for the submission and examination of such a thesis. No Date of submission 28th November 2012 Original registration date November 2002 (Date of submission must comply with Regulation 2D) Name of candidate Norman James Gourlay Research Institute Law, Politics and Justice Name of Lead Supervisor Dr J Hughes I certify that: (a) The thesis being submitted for examination is my own account of my own research (b) My research has been conducted ethically. Where relevant a letter from the approving body confirming that ethical approval has been given has been bound in the thesis as an Annex (c) The data and results presented are the genuine data and results actually obtained by me during the conduct of the research (d) Where I have drawn on the work, ideas and results of others this has been appropriately acknowledged in the thesis (e) Where any collaboration has taken place with one or more other researchers, I have included within an ‘Acknowledgments’ section in the thesis a clear statement of their contributions, in line with the relevant statement in the Code of Practice (see Note overleaf). (f) The greater portion of the work described in the thesis has been undertaken subsequent to my registration for the higher degree for which I am submitting for examination (g) Where part of the work described in the thesis has previously been incorporated in another thesis submitted by me for a higher degree (if any), this has been identified and acknowledged in the thesis (h) The thesis submitted is within the required word limit as specified in the Regulations Total words in submitted thesis (including text and footnotes, but excluding references and appendices) 59,992 Signature of candidate ………………………………… Date 28th November 2012 2 Abstract HIV/AIDS is a major health problem for sub-Saharan Africa. There are identifiable prevention and treatment regimes which would greatly ameliorate the situation, but these are beyond the resources of the sub-Saharan countries themselves. The research focus of this thesis is an investigation of the responsibility that the developed world has towards supplying help to combat this disease process. A series of arguments are adduced in support of the contention that the developed world has responsibility in this area and that that legitimate responsibility is very demanding indeed. These arguments are drawn firstly from a consideration of beneficence, secondly, from considerations of distributive justice, and finally from a consideration of reparative justice and rights based arguments. With beneficence the accent was upon Singer and his child in the pond thought experiment. With distributive justice the focus was upon contractualism, primarily considering Rawls, but then extending this both into health and in a cosmopolitan direction. Where reparative justice and rights based arguments were concerned the arguments were constructed from Pogge, Shue and Ooms. Major objections to this position were considered and largely rejected arising from the question of over-demandingness, from libertarianism and from a consideration of Murphy and the question of fairness in a non-ideal situation. However it was accepted that there is a place for partiality in moral obligations and that there are reasonable moral duties and prerogatives with regards to self and the needs of 3 those in close relationships with the moral agent involved. Major writers involved in these countervailing arguments included Scheffler and Cullity. The original extreme demand provisionally accepted was counterbalanced by a consideration of partialist obligations. Nonetheless the overall moral position would be such that the needs outlined in the Millennium Development Goals in regard to HIV/AIDS fall easily within the limits of moral obligations of the developed world. 4 Contents Abstract .................................................................................................................................. 3 Contents ................................................................................................................................. 5 Section One .......................................................................................................................... 10 Introduction to HIV/AIDS in sub-Saharan Africa ........................................................... 10 Chapter One ......................................................................................................................... 11 The Research Question .................................................................................................... 11 Introduction .............................................................................................................................. 11 The research questions ............................................................................................................. 13 Why focus on healthcare aid? .................................................................................................. 14 In healthcare, why focus specifically on the HIV/AIDS epidemic? ............................................ 16 The relationship between established need and the duty to help ........................................... 20 Structure of the argument ........................................................................................................ 22 Methodology ............................................................................................................................. 24 Chapter Two ......................................................................................................................... 32 The Empirical Background .............................................................................................. 32 HIV clinical introduction ............................................................................................................ 32 The social effects of HIV ............................................................................................................ 34 Are there practical answers to the problem of HIV/AIDS in sub-Saharan Africa? .................... 36 Prevention ................................................................................................................................. 37 Treatment ................................................................................................................................. 40 Estimated costs ......................................................................................................................... 45 Historical giving ......................................................................................................................... 46 Availability of resources ............................................................................................................ 47 Empirical summary.................................................................................................................... 49 5 Chapter Three ....................................................................................................................... 51 Common Morality ............................................................................................................ 51 Why is there a shortfall? ........................................................................................................... 51 Why is the shortfall not fully addressed? ................................................................................. 52 Characteristics of common morality ......................................................................................... 55 How does common morality apply to HIV? .............................................................................. 57 Importance of common morality .............................................................................................. 59 Section One - Conclusions ................................................................................................... 61 Section Two ......................................................................................................................... 63 Arguments in favour of much greater responsibility ....................................................... 63 Chapter Four ........................................................................................................................ 64 Peter Singer - The
Load more

Recommended publications
  • The Ethical Consistency of Animal Equality
    1 The ethical consistency of animal equality Stijn Bruers, Sept 2013, DRAFT 2 Contents 0. INTRODUCTION........................................................................................................................................ 5 0.1 SUMMARY: TOWARDS A COHERENT THEORY OF ANIMAL EQUALITY ........................................................................ 9 1. PART ONE: ETHICAL CONSISTENCY ......................................................................................................... 18 1.1 THE BASIC ELEMENTS ................................................................................................................................. 18 a) The input data: moral intuitions .......................................................................................................... 18 b) The method: rule universalism............................................................................................................. 20 1.2 THE GOAL: CONSISTENCY AND COHERENCE ..................................................................................................... 27 1.3 THE PROBLEM: MORAL ILLUSIONS ................................................................................................................ 30 a) Optical illusions .................................................................................................................................... 30 b) Moral illusions ....................................................................................................................................
    [Show full text]
  • The Definition of Effective Altruism
    OUP CORRECTED PROOF – FINAL, 19/08/19, SPi 1 The Definition of Effective Altruism William MacAskill There are many problems in the world today. Over 750 million people live on less than $1.90 per day (at purchasing power parity).1 Around 6 million children die each year of easily preventable causes such as malaria, diarrhea, or pneumonia.2 Climate change is set to wreak environmental havoc and cost the economy tril- lions of dollars.3 A third of women worldwide have suffered from sexual or other physical violence in their lives.4 More than 3,000 nuclear warheads are in high-alert ready-to-launch status around the globe.5 Bacteria are becoming antibiotic- resistant.6 Partisanship is increasing, and democracy may be in decline.7 Given that the world has so many problems, and that these problems are so severe, surely we have a responsibility to do something about them. But what? There are countless problems that we could be addressing, and many different ways of addressing each of those problems. Moreover, our resources are scarce, so as individuals and even as a globe we can’t solve all these problems at once. So we must make decisions about how to allocate the resources we have. But on what basis should we make such decisions? The effective altruism movement has pioneered one approach. Those in this movement try to figure out, of all the different uses of our resources, which uses will do the most good, impartially considered. This movement is gathering con- siderable steam. There are now thousands of people around the world who have chosen
    [Show full text]
  • CONSEQUENTIALISM Brad Hooker
    37 CONSEQUENTIALISM Brad Hooker The definition of consequentialism A consequentialist theory evaluates things exclusively in terms of consequences. For example, beliefs could be evaluated in terms of the consequences of holding them (an approach often called pragmatism). The most common forms of con- sequentialism, however, focus on the evaluation of acts and sets of rules. And the rest of this chapter will stick to that focus. The most familiar kind of consequentialism is the kind of utilitarianism maintaining that an act is morally right if and only if no alternative act has con- sequences containing greater welfare (or net benefit), impartially assessed. In uti- litarians’ impartial assessment of welfare, a benefit (i.e. addition to someone’s welfare) or harm (loss to welfare) to any one individual gets the same weight as the same size benefit or harm to anyone else. Thus, benefits and harms to everyone count equally, no matter what his or her ethnic group, religion, wealth, education, political views, talent, or conscientiousness; all that matters is the size of the benefits and harms. This kind of utilitarianism is maximizing in the sense that it calls for an act with unsurpassed consequences (anything less than the best isn’t good enough, according to act-utilitarianism). And this theory is direct in the sense that the acts are assessed solely and directly by their own consequences (not, for example, by whether the acts are allowed by the rules with the best consequences). Thus the theory is known as maximizing act-utilitarianism. While maximizing act-utilitarianism is the most familiar form of con- sequentialism, defining consequentialism so that this is the only form is a naive mistake.
    [Show full text]
  • Downloadable%20File/New Published Maps and Institutional Affiliations
    Swazo et al. Philosophy, Ethics, and Humanities in Medicine (2020) 15:7 https://doi.org/10.1186/s13010-020-00091-6 RESEARCH Open Access A Duty to treat? A Right to refrain? Bangladeshi physicians in moral dilemma during COVID-19 Norman K. Swazo1*, Md. Munir Hossain Talukder2 and Mohammad Kamrul Ahsan2 Abstract Background: Normally, physicians understand they have a duty to treat patients, and they perform accordingly consistent with codes of medical practice, standards of care, and inner moral motivation. In the case of COVID-19 pandemic in a developing country such as Bangladesh, however, the fact is that some physicians decline either to report for duty or to treat patients presenting with COVID-19 symptoms. At issue ethically is whether such medical practitioners are to be automatically disciplined for dereliction of duty and gross negligence; or, on the contrary, such physicians may legitimately claim a professional right of autonomous judgment, on the basis of which professional right they may justifiably decline to treat patients. Methods: This ethical issue is examined with a view to providing some guidance and recommendations, insofar as the conditions of medical practice in an under-resourced country such as Bangladesh are vastly different from medical practice in an industrialized nation such as the USA. The concept of moral dilemma as discussed by philosopher Michael Shaw Perry and philosopher Immanuel Kant’s views on moral appeal to “emergency” are considered pertinent to sorting through the moral conundrum of medical care during pandemic. Results: Our analysis allows for conditional physician discretion in the decision to treat COVID-19 patients, i.e., in the absence of personal protective equipment (PPE) combined with claim of duty to family.
    [Show full text]
  • A Consequentialist Response to the Demandingness Objection
    1 A CONSEQUENTIALIST RESPONSE TO THE DEMANDINGNESS OBJECTION Nicholas R. Baker, Lee University INTRODUCTION We usually believe that morality has limits; that is, that there is some limit to what morality may reasonably demand of moral agents. We suppose that there are supererog­ atory actions that are just that, supererogatory. We often think that while morality may require some positive and negative obligations, there are at least some actions that are simply permissible.1 This is what the demandingness objection to consequentialism is about; it draws upon our intuitions on these issues in order to show how counter-intuitive the implications of some versions of normative ethics can be. In this paper I will outline and defend the demandingness objection as it applies to act-consequentialism (hereafter AC), then I will argue that rule-consequentialism (hereafter RC), as conceived of by Brad Hooker, is also susceptible to this objection; finally, I will attempt to amend RC so that it may escape the demandingness objection. THE DEMANDS OF ACT CONSEQUENTIALISM Shelly Kagan states in the early parts of his text, The Limits of Morality, that, “[T]here are [. .] what we might think of as limits imposed on morality – for it is typically believed that there are limits to what morality can demand of us.”2 He goes on to further suggest that, “[I]t is generally held that although morality does sometimes require us to make sacrifices, we are not morally required to make our greatest possible contributions to the overall good. There is a limit to moral requirement.”3 While Kagan himself argues for a withholding of judgement as to whether or not these limits do exist, I will be arguing that these limits do, in fact, exist.
    [Show full text]
  • A Defense of a Sentiocentric Approach to Environmental Ethics
    University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 8-2012 Minding Nature: A Defense of a Sentiocentric Approach to Environmental Ethics Joel P. MacClellan University of Tennessee, Knoxville, [email protected] Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Ethics and Political Philosophy Commons Recommended Citation MacClellan, Joel P., "Minding Nature: A Defense of a Sentiocentric Approach to Environmental Ethics. " PhD diss., University of Tennessee, 2012. https://trace.tennessee.edu/utk_graddiss/1433 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Joel P. MacClellan entitled "Minding Nature: A Defense of a Sentiocentric Approach to Environmental Ethics." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the equirr ements for the degree of Doctor of Philosophy, with a major in Philosophy. John Nolt, Major Professor We have read this dissertation and recommend its acceptance: Jon Garthoff, David Reidy, Dan Simberloff Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) MINDING NATURE: A DEFENSE OF A SENTIOCENTRIC APPROACH TO ENVIRONMENTAL ETHICS A Dissertation Presented for the Doctor of Philosophy Degree The University of Tennessee, Knoxville Joel Patrick MacClellan August 2012 ii The sedge is wither’d from the lake, And no birds sing.
    [Show full text]
  • Willpower Satisficing
    This is a repository copy of Willpower Satisficing. White Rose Research Online URL for this paper: https://eprints.whiterose.ac.uk/122819/ Version: Accepted Version Article: Chappell, Richard Michael orcid.org/0000-0003-3322-4935 (2019) Willpower Satisficing. Noûs. pp. 251-265. ISSN 1468-0068 https://doi.org/10.1111/nous.12213 Reuse ["licenses_typename_other" not defined] Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ WILLPOWER SATISFICING (Forthcoming in Noˆus) Richard Yetter Chappell∗ University of York Abstract Satisficing Consequentialism is often rejected as hopeless. Perhaps its greatest problem is that it risks condoning the gratuitous prevention of goodness above the baseline of what qualifies as “good enough”. I propose a radical new willpower-based version of the view that avoids this problem, and that better fits with the motivation of avoiding an excessively demanding conception of morality. I further demonstrate how, by drawing on the resources of an independent theory of blame- worthiness, we may obtain a principled specification of what counts as “good enough”. 1 Satisficing as Constrained Maximizing Satisficing Consequentialism starts from the idea that, rather than requiring the best, it is enough to do good enough. It has been motivated in a few different ways. Economists introduced ‘satisficing’ as a heuristic to minimize ∗Special thanks to Eden Lin for extensive helpful comments. For helpful discussion and comments I also thank Selim Berker, Brian Berkey, T.
    [Show full text]
  • Contemporary Moral Theories: Introduction to Contemporary Consequentialism Syllabus [Kian Mintz-Woo]
    Contemporary Moral Theories: Introduction to Contemporary Consequentialism Syllabus [Kian Mintz-Woo] Course Information In this course, I will introduce you to some of the ways that consequentialist thinking leads to surprising or counterintuitive moral conclusions. This means that I will focus on issues which are controversial such as vegetarianism, charity, climate change and health-care. I have tried to select readings that are both contemporary and engaging. Hopefully, these readings will make you think a little differently or give you new ideas to consider or discuss. This course will take place in SR09.53 from 15.15-16.45. I have placed all of the readings for the term (although there might be slight changes), along with questions in green to help guide your reading. Some weeks have a recommended reading as well, which I think will help you to see how people have responded to the kinds of arguments in the required text. Please look over the descriptions and see which readings you are most interested in presenting for class for our first session on 10.03.2016. (Please tell me if you ever find a link that does not work or have any problems accessing content on this Moodle page.) I have a policy that cellphones are off in class; we will have a 5-10 minute break in the course and you can check messages only during the break. As a bonus, I have included at least one fun thing each week which relates to the theme of that week. Marking The course has three marked components: 1.
    [Show full text]
  • Gitlesen Master 2016--DUO
    Doing the Best We Can’t Evaluative Conflict and the ‘Ought’ Implies ‘Can’ Principle Daniel Parmeggiani Gitlesen Thesis presented for the degree of MASTER OF PHILOSOPHY Supervised by Ole Martin Moen Department of Philosophy, Classics, History of Art and Ideas Faculty of Humanities University of Oslo Spring 2016 II One must perform the lower act which one can manage and sustain: not the higher act which one bungles. Self-knowledge will lead us to avoid occasions of temptation rather than rely on naked strength to overcome them. We must not arrogate to ourselves actions which belong to those whose spiritual vision is higher or other than ours. ―Iris Murdoch, The Bell, 193, 195. For if the moral law commands that we ought to be better human beings now, it inescapably follows that we must be capable of being better human beings. ―Immanuel Kant, Religion Within the Boundaries of Mere Reason, 94. III © Daniel Parmeggiani Gitlesen 2016 Doing the Best We Can’t: Evaluative Conflict and the ‘Ought’ Implies ‘Can’ Principle http://www.duo.uio.no/ Trykk: Allkopi IV ABSTRACT The aim of this thesis is to defend global consequentialism from its main objection, specifically the objection that it allows evaluative conflict. Global consequentialism differs from traditional forms of consequentialism in that it does not only focus on one type of thing, like acts or rules. Act consequentialism focuses on the right acts directly, and evaluates rules indirectly according to whether they lead to the right acts or not. Rule consequentialism focuses on what the right rules are, and evaluates acts indirectly by appealing to whether they conform to the right rules.
    [Show full text]
  • What the Wild Things Are: a Critique on Clare Palmer's
    53 BETWEEN THE SPECIES What the Wild Things are: A Critique on Clare Palmer’s “What (If Anything) Do We Owe Animals?” ABSTRACT In this critique of Clare Palmer’s “What (if anything) do we owe wild animals?”, I develop three points. First, I consider the case study which opens her essay and argue that that there are good empirical reasons to think that we should assist domesticated horses and not wild deer. Then, I critique Palmer’s claim that “wildness is not a capacity,” arguing that wildness connotes certain capacities which wild animals generally have and which domesticated animals gener- ally lack. Lastly, I develop what I call the “supererogation problem” against Palmer’s preferred contextualist view, claiming that while the contextualist view doesn’t obligate us to eliminate predators and oth- erwise redesign nature in the name of wild animal welfare, it may nonetheless allow such interventions. This suggests that the problem with both utilitarian and contextualist views arises from their shared theory of value and not their theory of obligation. Joel P. MacClellan University of Tennessee, Knoxville [email protected] Volume 16, Issue 1 Jun 2013 © Between the Species, 2013 http://digitalcommons.calpoly.edu/bts/ 54 Joel P. MaClellan The issues Clare Palmer addresses in “What (if Anything) Do We Owe Wild Animals?” are timely and important. Since its inception in the 1970’s, animal ethics has been primarily concerned with our treatment of domesticated animals, particu- larly in agriculture, research, and entertainment. By contrast, the moral issues concerning wild animals have been treated largely as secondary, and such treatments are often inadequate.
    [Show full text]
  • Pragmatism and Effective Altruism: an Essay on Epistemology and Practical Ethics John Aggrey Odera University of Pennsylvania
    University of Pennsylvania ScholarlyCommons Penn Humanities Forum Undergraduate Research Undergraduate Humanities Forum 2018-2019: Stuff Fellows 5-2019 Pragmatism and Effective Altruism: An Essay on Epistemology and Practical Ethics John Aggrey Odera University of Pennsylvania Follow this and additional works at: https://repository.upenn.edu/uhf_2019 Part of the Arts and Humanities Commons Odera, John Aggrey, "Pragmatism and Effective Altruism: An Essay on Epistemology and Practical Ethics" (2019). Undergraduate Humanities Forum 2018-2019: Stuff. 2. https://repository.upenn.edu/uhf_2019/2 This paper was part of the 2018-2019 Penn Humanities Forum on Stuff. Find out more at http://wolfhumanities.upenn.edu/annual-topics/stuff. This paper is posted at ScholarlyCommons. https://repository.upenn.edu/uhf_2019/2 For more information, please contact [email protected]. Pragmatism and Effective Altruism: An Essay on Epistemology and Practical Ethics Abstract This paper hopes to provide an American Pragmatist reading of the Effective Altruism philosophy and movement. The criticism levied against Effective Altruism here begins from one of its founding principles, and extends to practical aspects of the movement. The utilitarian leaders of Effective Altruism consider Sidgwick’s ‘point of view of the universe’ an objective starting point of determining ethics. Using Quality Adjusted Life Years (QALYs), a popular measure in contemporary welfare economics, they provide a “universal currency for misery” for evaluating decisions. Through this method, one can calculate exactly the value of each moral decision by identifying which one yields more QALYs, and, apparently, objectively come to a conclusion about the moral worth of seemingly unrelated situations, for example, whether it is more moral to donate money so as to help women suffering from painful childbirth-induced fistulas, or to donate to starving children in famine-ridden areas.
    [Show full text]
  • WILLPOWER SATISFICING (Forthcoming in Noˆus)
    WILLPOWER SATISFICING (Forthcoming in No^us) Richard Yetter Chappell∗ University of York Abstract Satisficing Consequentialism is often rejected as hopeless. Perhaps its greatest problem is that it risks condoning the gratuitous prevention of goodness above the baseline of what qualifies as \good enough". I propose a radical new willpower-based version of the view that avoids this problem, and that better fits with the motivation of avoiding an excessively demanding conception of morality. I further demonstrate how, by drawing on the resources of an independent theory of blame- worthiness, we may obtain a principled specification of what counts as \good enough". 1 Satisficing as Constrained Maximizing Satisficing Consequentialism starts from the idea that, rather than requiring the best, it is enough to do good enough. It has been motivated in a few different ways. Economists introduced ‘satisficing’ as a heuristic to minimize ∗Special thanks to Eden Lin for extensive helpful comments. For helpful discussion and comments I also thank Selim Berker, Brian Berkey, T. Ryan Byerly, Dorothea De- bus, Daniel Elstein, Carl Fox, Johan Gustafsson, Tom Hurka, Brian McElwee, Tristram McPherson, Tom O'Shea, Philip Pettit, Doug Portmore, Peter Singer, Jack Spencer, He- len Yetter-Chappell, commenters on philosophyetc.net and peasoup.us, anonymous referees, and audiences at the Universities of Manchester, Southampton, and York, the 2013 Rocky Mountain Ethics Congress and the 2016 International Society for Utilitarian Studies conference. 2 of 30 search costs (Simon 1956)|a mere means to maximizing expected value, in effect. Michael Slote (1984) presents it as the radical view that it can be rational to gratuitously pick worse options.
    [Show full text]