In Scientific Man vs. Power Politics (1946), Hans Morgenthau celebrated the noble role of the statesman, whose tragic destiny entailed accepting the agonizing moral burden of committing lesser evils as the inescapable price for securing the greater good. In this elitist vision, the statesman is primarily accountable to personal conscience rather than to the poorly informed, undisciplined judgment of any democratic electorate. In focusing on the statesman's pivotal role, Morgenthau glossed over the ways the New Deal and the Second World War had transformed the institutional context within which American presidents made foreign policy. As he shifted his attention to American policy toward Vietnam in the late 1950s and the 1960s, however, his view of presidential leadership and the executive branch changed significantly. Morgenthau came to see the growth of the national security state and the unaccountable exercise of executive power as a twin threat to the foundations of republican government. His critique emphasized the pathologies of policymaking insulated within this state apparatus. He learned that one problem with the lesser-evil approach is that the moral distinctions on which it is predicated are relative and contingent in practice: that which was once proscribed from the policymaker's toolbox can readily become the prescribed instrument after the justifying precedent has been established.

Hans Morgenthau's concept of “the national interest” first appeared, somewhat like thunder out of China, in the essay “The Primacy of the National Interest” as part of a forum in the Spring 1949 issue of The American Scholar titled “The National Interest and Moral Principles in Foreign Policy.” As William Scheuerman observes, “The concept of the ‘national interest’ first takes on a special analytic status in this essay.” In the essay, the national interest is first presented as a necessary corrective to what Morgenthau had already characterized in Scientific Man vs. Power Politics as legalism, moralism, and sentimentalism in American politics, and as a more effective guide to foreign policy than the American tradition seemed able to provide.

Hans J. Morgenthau is generally considered to have been a political realist and the transmitter of continental Realpolitik into American letters. But he has also been claimed as an idealist, as a constructivist, and as an ethicist. Some of these claims make sense if we understand that Morgenthau was trained as a lawyer in the German historical tradition. Others can be made sense of if we understand that—self-consciously a “European”—he was continuously adapting his ideas to an American audience and, in the process, being socialized into an American experience. The essays in this roundtable illustrate the “Americanization” of Morgenthau.

Hans Morgenthau's Scientific Man vs. Power Politics appeared in 1946, one year after he received tenure at the University of Chicago. Thus, the monograph demarcates the beginning of Morgenthau's career in the United States, to which he had emigrated nine years earlier. Three main aspects seem important for understanding this work. The first is Morgenthau's bewilderment about American political culture and, as he perceived it, its cheerful optimism about the betterment of politics, society, and humanity in general. The second aspect is the nature of the argument: Scientific Man is a dogmatic tract, an attempt to hammer home certain philosophical positions—positions that were largely unpopular in the U.S. social sciences in the 1940s (and later)—rather than a reflective scholarly elaboration of certain philosophical commitments. The third is Morgenthau's place between two academic cultures: Morgenthau's language in his American writings partly stems from, but also tries to leave behind, his European academic socialization. The monograph thus reflects the author's peculiar situation, as he inhabits two sometimes crucially different semantic and cultural contexts, but fails to bridge or broker them.

It seems natural to think that the same prudential and ethical reasons for mutual respect and tolerance that one has vis-à-vis other human persons would hold toward newly encountered paradigmatic but nonhuman biological persons. One also tends to think that they would have similar reasons for treating we humans as creatures that count morally in our own right. This line of thought transcends biological boundaries—namely, with regard to artificially (super)intelligent persons—but is this a safe assumption? The issue concerns ultimate moral significance: the significance possessed by human persons, persons from other planets, and hypothetical nonorganic persons in the form of artificial intelligence (AI). This article investigates why our possible relations to AI persons could be more complicated than they first might appear, given that they might possess a radically different nature to us, to the point that civilized or peaceful coexistence in a determinate geographical space could be impossible to achieve.

Collating the concepts of vulnerability through five regional perspectives on bioethics from the United States, Europe, Latin America, Africa, and Asia, this article proposes a means of integration between the different approaches in order to seek a theoretical and normative basis for the field of global bioethics. It argues that only through opening continuous, critical, and self-critical dialogue within the international bioethical community will it be possible to achieve a sufficiently global understanding of vulnerability that is capable of identifying the means needed for addressing the conditions that leave certain groups and individuals more susceptible to “wounding” than others.

Electronic health records, data sharing, big data, data mining, and secondary use are enabling exciting opportunities for improving health and healthcare while also exacerbating privacy concerns. Two court cases about selling prescription data, the Sorrell case in the U.S. and the Source case in the U.K., raise questions of what constitutes “privacy” and “public interest”; they present an opportunity for ethical analysis of data privacy, commodifying data for sale and ownership, combining public and private data, data for research, and transparency and consent. These interwoven issues involve discussion of big data benefits and harms and touch on common dualities of the individual versus the aggregate or the public interest, research (or, more broadly, innovation) versus privacy, individual versus institutional power, identification versus identity and authentication, and virtual versus real individuals and contextualized information. Transparency, flexibility, and accountability are needed for assessing appropriate, judicious, and ethical data uses and users, as some are more compatible with societal norms and values than others.

This article discusses the suggestion of having the notion of solidarity as the foundational value for welfare scheme reforms. Solidarity is an emerging concept in bioethical deliberations emphasizing the need for value-oriented discussion in revising healthcare structures, and the notion has been contrasted with liberal justice and rights. I suggest that this contrast is unnecessary, flawed, and potentially counterproductive. As necessary as the sense of solidarity is in a society, it is an insufficient concept to secure the goals related to social responsibility. The discussion on solidarity is also based on a questionable sense of nostalgia. Furthermore, solidarity and liberal justice share essential objectives concerning welfare schemes; therefore, the question arises whether the proper comparison should in the first place be within justice and solidarity.

The medical team found the patient to lack medical decisionmaking capacity. However, the team felt that the patient was still able to respond appropriately to some situations. KS had displayed a consistent refusal of all medical treatments that made her uncomfortable or caused pain. During her sister’s visits, the patient would be much more receptive to eating. A meeting was planned with the patient’s sister in which the ethicist explained that the patient was not able to make her own decisions. The patient’s sister agreed that she would honor the patient’s wishes but would let the team make any decisions outside of what she knew about the patient’s preferences. The patient’s sister agreed and was willing to be at the patient’s bedside as much as she could to encourage her eating. If the patient’s condition worsened, it was discussed that the team honor the patient’s wishes and not force a feeding tube on her. The patient’s code status was also addressed, and KS’s sister felt comfortable in communicating to the team that the patient would not want to be resuscitated if medical treatments would not be able to improve her current quality of life. A natural passing away would be most amenable to the patient. The patient was discharged to her nursing home with a physician order for life-sustaining treatment (POLST) form signed by the sister documenting a do-not-resuscitate code status with comfort-focused treatments.

This case presents several fundamental ethical issues. The first issue is the patient’s refusal of treatment (a nasogastric tube [NGT] insertion). Second, the patient’s refusal of a seemingly beneficial treatment, combined with her medical history, ultimately necessitates an assessment of her decisionmaking capacity. Third, the sister’s reluctance to participate in decisionmaking requires a discussion of appropriate surrogate decisionmakers. Finally, the main ethical component to this case is a cultural one, which should be addressed appropriately.

This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.

Educators in bioethics have struggled to find valid and reliable assessments that transcend the “reproduction of knowledge” to target more important skill sets. This manuscript reports on the process of developing and grading a minimal-competence comprehensive examination in a bioethics master’s degree program. We describe educational theory and practice for the creation and deployment of scoring rubrics for high-stakes performance assessments that reduce scoring inconsistencies. The rubric development process can also benefit the program by building consensus among stakeholders regarding program goals and student outcomes.

We describe the Structure of the Observed Learning Outcome taxonomy as a mechanism for rubric design and provide an example of how we applied that taxonomy to define pass/fail cut scores. Details about domains of assessment and writing descriptors of performance are also presented. Despite the laborious work required to create a scoring rubric, we found the effort to be worthwhile for our program.

In 1996, Sandra Jensen became the first person with Down syndrome to receive a heart-lung transplant. Although it took place almost 20 years ago, her experience continues to shed light on contemporary challenges that individuals with neurodevelopmental disorders face in securing access to transplantation. While overt discrimination has decreased, barriers persist in physician referrals, center-specific decisionmaking regarding wait-listing, and the provision of accommodations for optimizing the assessment and medical management of these individuals. These issues arise from the persistent biases and assumptions of individuals as well as those of a healthcare system that is inadequately positioned to optimally serve the medical needs of the growing number of individuals with functional impairments. More data and greater transparency are needed to understand the nature and extent of ongoing access problems; however, long-term solutions will require changes at the healthcare professional, regional transplant center, and national levels.

Although recent literature on professionalism in healthcare abounds in recommended character traits, attitudes, or behaviors, with a few exceptions, the recommendations are untethered to any serious consideration of the contours and ethical demands of the healing relationship. This article offers an approach based on the professional’s commitment to trustworthiness in response to the vulnerability of those seeking professional help. Because our willingness and ability to trust health professionals or healthcare institutions are affected by our personality, culture, race, age, prior experiences with illness and healthcare, and socioeconomic and political circumstances—“the social determinants of trust”—the attitudes and behaviors that actually do gain trust are patient and context specific. Therefore, in addition to the commitment to cultivating attitudes and behaviors that embody trustworthiness, professionalism also includes the commitment to actually gaining a patient’s or family’s trust by learning, through individualized dialogue, which conditions would win their justified trust, given their particular history and social situation.