It used to seem so simple. In the old days (the seventies and eighties of the last century), most political philosophers who were inclined to call themselves “egalitarian” thought that one or another version of this argument established at least the approximate truth about economic justice.

The term “therapeutic misconception” was coined in 1982 by Paul Appelbaum, Loren Roth, and Charles Lidz. Appelbaum and his colleagues interviewed participants in several psychiatric studies, including a drug trial with a placebo control arm. Appelbaum's group found that many people were unaware of the differences between participating in a study and receiving treatment in the clinical setting. Rather than understanding these differences, study participants tended to believe that therapy and research were governed by the same primary goal: to advance the individual patient's best interests. Appelbaum's group labeled this mistaken belief the therapeutic misconception.

Do differences in income or wealth matter, morally speaking? This essay addresses a broader issue than this question seems to pose. But this broader issue is, I believe, the salient philosophical issue which this question actually poses. Let me explain. Narrowly read, the question at hand is concerned only with inequality of income or wealth. It asks us to consider whether inequality of income or wealth as such is morally problematic. On this construal, the question invites us to consider whether the bare fact that Joshua has a greater income or net worth than Rebekah is a morally defective social state of affairs. Is there at least a significant moral presumption on behalf of equality of income or wealth such that, if an inequality of income or wealth obtains vis-à-vis Joshua and Rebekah, that inequality ought to be nullified unless some impressive positive justification for the inequality can be provided? On this narrow reading, the salient issue is whether there exists in particular an egalitarian presumption with respect to income or wealth. But I believe that the genuinely salient issue here is whether there exists in general an egalitarian presumption with respect to whatever factual condition of individuals one is supposed to attend to when assessing social states of affairs. The crucial question is not whether income or wealth or utility or well-being is the condition the unequal distribution of which is as such morally problematic.

The physician who upholds the Hippocratic oath is supposed to be loyal to his or her patients. This requires choosing only the therapy that the physician believes is best for the patient. However, knowing what is best requires randomized clinical trials. Thus, clinicians must be willing to recruit their patients to be assigned at random to one of two therapies (or perhaps to a therapy or a placebo) in order to determine which is best based on the highest standards of pharmacological science.

“Should differences in income and wealth matter?” is a paralyzingly big question. Does it refer to some differences? All differences? Daily differences, periodic ones, initial ones? Do they matter regardless of how income and wealth are acquired? Regardless of what can be done with them? Regardless, indeed, of what ‘mattering’ means?

Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole-brain death” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple organ procurement for transplantation requires the organ donor first to be dead, the concept of brain death is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole-brain death stands independently as the most accurate biological representation of the demise of the human organism.

Public statements by various international groups emphasize that decisions to undergo genetic screening, either for disease-carrier status or for predisposition-to-disease status, and decisions about the use of the resulting information should be made voluntarily by the party to be screened. For example, the World Medical Association, in its Declaration on the Human Genome Project, says, “One should respect the will of persons screened and their right to decide about participation and about the use of the information obtained.” Giving this principle a name, “voluntarism,” the Council for International Organizations of Medical Sciences, in its Declaration of Inuyama (the host city for the conference), announced that “voluntarism should be the guiding principle in the provision of genetic services.

In this essay, I shall discuss ethical issues that arise with our increasing ability to affect the genetic makeup of the human population. These effects can be produced directly by altering the genotype (through germ-line or somatic changes), or indirectly by aborting, not conceiving, or treating individuals because of their genetic makeup in ways made possible by genetic pharmacology. I shall refer to all of these sorts of procedures collectively as the Procedures. Some of the ethical issues the Procedures raise are old, arising quite generally when we can affect the well-being of people, even in the absence of the ability to affect them in the ways just described. My examination of these issues is prompted by the recent at-length discussion of them, From Chance to Choice (henceforth CC), by Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler.