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The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore, no secondary “double” effect is brought about. In my article, I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that the prevailing view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm.

Palliative sedation is a well-recognized and commonly used medical practice at the end of life for patients who are experiencing refractory symptoms that cannot be controlled by other means of medical management. Given concerns about potentially hastening death by suppressing patients’ respiratory drive, traditionally this medical practice has been considered ethically justifiable via application of the ethical doctrine known as the Principle of Double Effect. And even though most recent evidence suggests that palliative sedation is a safe and effective practice that does not hasten death when the sedative medications are properly titrated, the Principle of Double Effect is still commonly utilized to justify the practice of palliative sedation and any risk—however small—it may entail of hastening the death of patients. One less common clinical scenario where the Principle of Double Effect may still be appropriate ethical justification for palliative sedation is when the practice of palliative sedation is pursued concurrently with the active withdrawal of life-sustaining treatment—particularly the practice of compassionate extubation. This case study then describes an unconventional case of palliative sedation with concurrent compassionate extubation where Principle of Double Effect reasoning was effectively employed to ethically justify continuing to palliatively sedate a patient during compassionate extubation.

Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.

Background Palliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a “good action” with a potentially “bad effect,” is frequently employed to provide an ethical justification for this practice. Main text We argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians’ discomfort with the complex moral, intentional, and causal aspects of end-of-life care. Conclusions We are concerned that this misapplication of the doctrine of double effect can consequently impair physicians’ ethical reasoning and relationships with patients at the end of life.

The death of a patient taking opioids can generate strong feelings of guilt. « Have I hastened my patient's death by my administration of opioids ? » Doubts may arise in certain situations, despite the proven safety of appropriate opioid use in the management of dyspnea and pain in the palliative care setting. Fearing the harms of opioid administration, some medical practitioners may undertreat patients, forsaking them to suffering. Other doctors, desperate to relieve their excruciating suffering at all cost, may in fact have recourse to euthanizing acts. This article seeks to answer this ethical dilemma with an overview of the double effect principle.La mort d’un patient en situation palliative sous opioïde génère parfois un fort sentiment de culpabilité. « Ai-je précipité le décès du patient avec mon traitement opioïde ? » Bien que la littérature soit très claire quant à la sécurité des opioïdes utilisés correctement pour la gestion de la dyspnée ou de la douleur en soins palliatifs, il se peut que, dans certaines situations, on puisse en douter. Le médecin, face à sa crainte de nuire en administrant des opioïdes, pourrait être tenté de sous-traiter le patient, au risque de l’abandonner à sa souffrance. D’un autre côté, l’impuissance face à l’intensité de la souffrance du patient pourrait amener le médecin à vouloir le soulager à tout prix, au risque d’un geste euthanasiant. Cet article propose un aperçu du principe du double effet, comme élément de réponse à ce dilemme éthique.

Continuous deep sedation (CDS) has the effect of making the patient unconscious until death, and that it has this effect is clearly an undesirable aspect of CDS. However, some authors have recently maintained that many physicians do not intend this effect when practicing CDS. According to these authors, CDS is differentiated into two types; in what is called “gradual” CDS (or CDS as a result of proportionate palliative sedation), physicians start with low doses of sedatives and increase them only gradually, whereas in “rapid” CDS (or palliative sedation to unconsciousness), physicians rapidly administer a heavy dose that clearly induces unconsciousness from the beginning. The claim is that the physicians intend permanent unconsciousness only if they rapidly administer a heavy dose, but they do not intend it when the unconsciousness is the result of a gradual increase of sedatives. This paper attempts to refute these claims based on a close examination of the protocol of gradual CDS. If my argument is valid, the doctrine of double effect would not be useful in justifying most, if not all, cases of CDS.

Recent developments in biogerontology—the study of the biology of ageing—suggest that it may eventually be possible to intervene in the human ageing process. This, in turn, offers the prospect of significantly postponing the onset of age-related diseases. The biogerontological project, however, has met with strong resistance, especially by deontologists. They consider the act of intervening in the ageing process impermissible on the grounds that it would (most probably) bring about an extended maximum lifespan—a state of affairs that they deem intrinsically bad. In a bid to convince their deontological opponents of the permissibility of this act, proponents of biogerontology invoke an argument which is grounded in the doctrine of double effect. Surprisingly, their argument, which we refer to as the ‘double effect argument’, has gone unnoticed. This article exposes and critically evaluates this ‘double effect argument’. To this end, we first review a series of excerpts from the ethical debate on biogerontology in order to substantiate the presence of double effect reasoning. Next, we attempt to determine the role that the ‘double effect argument’ is meant to fulfil within this debate. Finally, we assess whether the act of intervening in ageing actually can be justified using double effect reasoning.

An 8 month old infant was found to be unresponsive at home by his mother. Despite, initial signs of life the infant was in full asystolic cardio-respiratory arrest on arrival to A&E. There was no past medical history of note and they had been well on the day of presentation. Full resuscitation was carried out, with return of spontaneous circulation at 30 min. The infant was transferred to PICU for ongoing management. Despite multiple investigations, no cause was found for the cardiac-arrest, with brain MRI sadly revealing a severe hypoxic-ischaemic injury. Sedation and ventilation were weaned off, but the infant did not demonstrate independent respiratory effort. Following discussion with both parents, a decision was made to withdraw life-sustaining treatment. The infant was extubated on an infusion of morphine and midazolam, dying soon afterwards. The PICU trainee felt distress; she intended to alleviate suffering, but did morphine and midazolam hasten the infant’s death? This vignette has been drawn from authors’ experiences and does not represent a real case. This case vignette is taken as a representative scenario where the ‘Doctrine of Double Effect’ (DDE) might be used to alleviate the paediatric intensive care unit (PICU) trainee’s distress. In this piece, the authors’ aim to describe the widely known DDE and demonstrate that it is no longer needed to ethically justify good end-of-life practices and the delivery of compassionate and excellent palliative care. ‘Primum non-nocere ’ —first do no harm is a fundamental principle on which …

Principlist Bioethics by Beauchamp and Childress has reached a prominent status in contemporary Bioethics. Nevertheless, it includes some important theoretical problems: some lacks when defining some concepts, a tendency to ethical relativism, etc. Among the ethical alternative approaches from which such problems can be solved, we think that the most appropiate is the Natural Law theory. It offers a reasoned reflection on the concept of good and on human basic goods and their relation with moral general principles. From such goods, this ethical theory supports the existence of actions that are always maleficent acts, that is, intrinsically and universally evil acts. The article applies the Natural Law theory to issues related to the protection of human life (abortion, euthanasia, self-defense and genetic manipulation)..

Aberrant degradation of proteins is associated with many pathological states, including cancers. Mass spectrometric analysis of the tumor peptidome has the potential to provide biological insights on proteolytic processing in cancer. However, attempts to use the tumors peptidome information in cancer research have been fairly limited to date, largely due to the lack of effective approaches for robust peptidomics identification and quantification, and the prevalence of confounding factors and biases associated with sample handling and processing. To address this need, we have recently developed an effective and robust analytical platform as well as a novel informatics approach for comprehensive analyses of tissue peptidomes. The ability of this new peptidomics pipeline for high-throughput, comprehensive, and quantitative peptidomics analysis, as well as the suitability of clinical ovarian tumor samples with postexcision delay limited to less than 60min before freezing for peptidomics analysis, has been demonstrated. These initial analyses set a stage for further determination of molecular details and functional significance of the peptidomic activities in ovarian cancer.

The role of district nurses in the effective management of pain in palliative care has been strengthened by the Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, prescribing controlled drugs brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith considers the principle of double effect that seeks to ensure that patients in intractable pain receive the analgesia they require to manage that pain while district nurses avoid liability and prosecution under the law of murder.

The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient's death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing

Combined oral contraceptives (COC) have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching.

Casey and Salzmann’s application of the Rule of Double Effect (RDE) to the therapeutic and prophylactic uses of combined oral contraceptives (COC) has a limited sphere of influence. Its use is confined to communities that possess a certain degree of consensus about the approval and disproval of certain acts. This article discusses why it is important to identify the community or communities to whom Casey and Salzman’s (2014) arguments are directed and for whom their conclusions are intended. Furthermore two questions arise in response to Carey and Salzmann’s conclusion: Does RDE function identically with respect to both the therapeutic and prophylactic uses of COC? And second does the appeal to RDE function identically with respect to both prescribers and users of COC?

This paper provides an overview of the various dual-use concepts applied in national and international non-proliferation and anti-terrorism legislation, such as the Biological and Toxin Weapons Convention, the Chemical Weapons Convention and United Nations Security Council Resolution 1540, and national export control legislation and in relevant codes of conduct. While there is a vast literature covering dual-use concepts in particular with regard to life sciences, this is the first paper that incorporates into such discussion the United Nations Security Council Resolution 1540. In addition, recent developments such as the extension of dual-use export control legislation in the area of human rights protection are also identified and reviewed. The discussion of dual-use concepts is hereby undertaken in the context of human- and/or national-security-based approaches to security. This paper discusses four main concepts of dual use as applied today in international and national law: civilian versus military, peaceful versus non-peaceful, legitimate versus illegitimate and benevolent versus malevolent. In addition, the usage of the term to describe positive technology spin-offs between civilian and military applications is also briefly addressed. Attention is also given to the roles civil society and research ethics may play in the governance of dual-use sciences and technologies.

In several countries, the debate about the legalization of active euthanasia and/or assisted suicide has been going on for thirty years. Although universal considerations are brought to bear on the issue (respect for autonomy, right to privacy, and medical integrity), the cultural context influences the way in which the discussion unfolds, both in the medical community and in society at large. Whether or not a ‘‘French exception’’ truly exists, the French are fond of invoking it, in education, politics, and culture, to mention just a few. Indeed, the term does provide us with some insight into certain aspects of the euthanasia debate, and more generally the treatment of end-of-life issues, that are specific to the French context. One contingent reason adds some urgency to this analysis: the French debate may well be drawing to a close in the near future. The current president, Franc xois Hollande, has promised to take up the issue and legalize ‘‘medical assistance to end one’s life with dignity in cases of incurable diseases causing unbearable and intractable physical and psychological suffering’’ (campaign pledge number 21). In order to make a more informed decision, he commissioned Dr. Didier Sicard, the former president of the National Consultative Ethics Committee (CCNE), to draft a report that was delivered to the president on December 18, 2012. In this article I describe the history and the intellectual underpinnings of the French debate. The 2005 Leonetti End-of-Life Act, named for Jean Leonetti, the conservative member of parliament who authored an earlier report on the issue, was a significant turning point in a debate that can now be divided into three main stages. I shall review the period prior to the 2005 End-of-Life Act, the main provisions of the law itself, and its consequences, both in medical practice and in the ethical debate. I draw two broad lessons from this brief history. First, the euthanasia debate in France is founded on principles of solidarity and justice rather than autonomy and individual rights. Second, the paternalistic tradition in medical care does not preclude the possibility of legalizing ‘‘active aid in dying’’ in the future, if only as an ethical ‘‘exception,’’ most notably in the form of assisted suicide, as recommended in the Sicard report. On the contrary, doctors’ responsibility toward their patients as an element of the social contract—what the French call ‘‘living together’’—might support the decision to hasten death in certain situations.

The "doctrine of double effect" has a pleasing ring to it. It is regarded by some as the cornerstone of any sound approach to end-of-life issues and by others as religious mumbo jumbo. Discussions about "the doctrine" often generate more heat than light. They are often conducted at cross-purposes and laced with footnotes from Leviticus. © 2011 Cambridge University Press.

While the Doctrine of Double Effect (DDE) remains controversial in ethical circles, it continues to be recognised in common law courts. In 2015, the High Court of New Zealand became the latest to acknowledge the existence of the DDE, in a case that challenged the prohibition on physician assisted dying. In so doing, the possibility was raised that the DDE could potentially be used in an untraditional way to provide a prima facie justification of "facilitated aid in dying" (FAID) in some cases.In this article, we develop and offer justification for this line of reasoning. If it can be shown that FAID sometimes satisfies the conditions for DDE, this, we suggest, may have significant implications for the aid in dying debate, not only in New Zealand, but more widely. Even if all of the elements of the DDE are not met in such cases, though, we suggest that one of those elements - the doctor's intent in providing FAID - may not always be such as to attract moral blame or criminal culpability.

The general aim of the present study is to discriminate between mouse genotoxic and non-genotoxic hepatocarcinogens via selected gene expression patterns in the liver as analyzed by quantitative real-time PCR (qPCR) and statistical analysis. qPCR was conducted on liver samples from groups of 5 male, 9-week-old B6C3F(1) mice, at 4 and 48h following a single intraperitoneal administration of chemicals. We quantified 35 genes selected from our previous DNA microarray studies using 12 different chemicals: 8 genotoxic hepatocarcinogens (2-acetylaminofluorene, 2,4-diaminotoluene, diisopropanolnitrosamine, 4-dimethylaminoazobenzene, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, N-nitrosomorpholine, quinoline and urethane) and 4 non-genotoxic hepatocarcinogens (1,4-dichlorobenzene, dichlorodiphenyltrichloroethane, di(2-ethylhexyl)phthalate and furan). A considerable number of genes exhibited significant changes in their gene expression ratios (experimental group/control group) analyzed statistically by the Dunnett's test and Welch's t-test. Finally, we distinguished between the genotoxic and non-genotoxic hepatocarcinogens by statistical analysis using principal component analysis (PCA) of the gene expression profiles for 7 genes (Btg2, Ccnf, Ccng1, Lpr1, Mbd1, Phlda3 and Tubb2c) at 4h and for 12 genes (Aen, Bax, Btg2, Ccnf, Ccng1, Cdkn1a, Gdf15, Lrp1, Mbd1, Phlda3, Plk2 and Tubb2c) at 48h. Seven major biological processes were extracted from the gene ontology analysis: apoptosis, the cell cycle, cell proliferation, DNA damage, DNA repair, oncogenes and tumor suppression. The major, biologically relevant gene pathway suggested was the DNA damage response pathway, resulting from signal transduction by a p53-class mediator leading to the induction of apoptosis. Eight genes (Aen, Bax, Btg2, Ccng1, Cdkn1a, Gdf15, Phlda3 and Plk2) that are directly associated with Trp53 contributed to the PCA. The current findings demonstrate a successful discrimination between genotoxic and non-genotoxic hepatocarcinogens, using qPCR and PCA, on 12 genes associated with a Trp53-mediated signaling pathway for DNA damage response at 4 and 48 h after a single administration of chemicals.

Biotechnological research poses a special security problem because of the duality between beneficial use and misuse. In order to find a balance between regulating potentially dangerous research and assuring scientific advancement, a number of assessments have tried to define which types of research are especially open to misuse and should therefore be considered dual-use research of special concern requiring rigorous oversight. So far, there has been no common understanding of what such activities are. Here we present a review of 27 assessments focusing on biological dual-use issues published between 1997 and 2008. Dual-use research activities identified by these assessments as being of special concern were compiled and compared. Moreover, from these 27 assessments, the primary research publications explicitly identified as examples of concerning research activities were extracted and analyzed. We extracted a core list of 11 activities of special concern and show that this list does not match with the reasons why primary research publications were identified as being of special concern. Additionally, we note that the 11 activities identified are not easily conducted or replicated, and therefore the likelihood of their being used in a high-tech mass casualty bioterrorism event should be reevaluated.

As media reports have made widely known, in November 2009, the ethics committee of St. Joseph's Hospital in Phoenix, Arizona, permitted the abortion of an eleven-week-old fetus in order to save the life of its mother. This woman was suffering from acute pulmonary hypertension, which her doctors judged would prove fatal for both her and her previable child. The ethics committee believed abortion to be permitted in this case under the so-called principle of double effect, but Thomas J. Olmsted, the bishop of Phoenix, disagreed with the committee and pronounced its chair, Sister Margaret McBride, excommunicated latae sententiae, "by the very commission of the act." In this article, I take the much discussed Phoenix case as an occasion to subject the principle of double effect to another round of philosophical scrutiny. In particular, I examine the third condition of the principle in its textbook formulation, namely, that the evil effect in question may not be the means to the good effect. My argument, in brief, is that the textbook formulation of the principle does not withstand philosophical scrutiny. Nevertheless, in the end, I do not claim that we should then "do away" with the principle altogether. Instead, we do well to understand it within the context of casuistry, the tradition of moral reasoning from which it issued.

Does the position of the Roman Catholic Church on contraception also imply that the usage of condoms by HIV-discordant couples is illicit? A standard argument is to appeal to the doctrine of double effect to condone such usage, but this meets with the objection that there exists an alternative action that brings about the good effect-namely, abstinence. I argue against this objection, because an HIV-discordant couple does not bring about any bad outcome through condom usage-there is no disrespect displayed for the generative function of sex. One might retort that the badness of condom usage consists in thwarting the unitive function of sex. I argue that also this objection cannot be upheld. In conclusion, if there are no in-principle objections against condom usage for HIV-discordant couples, then policies that deny access to condoms to such couples are indefensible. HIV-discordant couples have a right to continue consummating their marriage in a manner that is minimally risky and this right cannot be trumped by utilitarian concerns that the distribution of condoms might increase promiscuity and along with it the HIV infection rate.

This paper argues that the current stock of anti-personnel cluster bombs are temporally indiscriminate, and, therefore, unjust weapons. The paper introduces and explains the idea of temporal indiscriminateness. It argues that to honor non-combatant immunity-in addition to not targeting civilians-one must adequately target combatants. Due to their high dud rate, cluster submunitions fail to target combatants with sufficient temporal accuracy, and, thereby, result in avoidable serious harm to non-combatants. The paper concludes that non-combatant immunity and the principle of discrimination require a moratorium on the use of current cluster munitions.

The difficulty in discovering a difference between killing and letting die has led many philosophers to deny the distinction. This paper seeks to develop an argument defending the distinction between killing and letting die. In relation to Rachels' cases, the argument is that (a) even accepting that Smith and Jones may select equally heinous options from the choices they have available to them, (b) the fact that the choices available to them are different is morally relevant, and (c) this difference in available choices can be used to distinguish between the agents in certain circumstances. It is the principle of justice, as espoused by Aristotle, which requires that equal things are treated equally and that unequal things are treated unequally that creates a presumption that Smith and Jones should be treated differently. The magnitude of this difference can be amplified by other premises, making the distinction morally relevant in practical reality.

Against the ideal of value-free science I argue that science is not--and cannot be--value-free and that relevant values are both cognitive and moral. I develop an argument by indicating various aspects of the value-ladenness of science. The recognition of the value-ladenness of science requires rethinking our understanding of the rationality and responsibility of science. Its rationality cannot be seen as merely instrumental--as it was seen by the ideal of value-free science--for this would result in limiting the autonomy of science and reducing scientists to "minds to hire". The scientific rationality must be seen as practical rationality which takes into account the full horizon of values. The scientific responsibility must also be broaden in scope and type. On this basis I draw three practical conclusions concerning the organization of research and training of young scientists, appealing to Plato's claim that those most capable of healing are also those most capable of harming.

The technological advances of the 20th century resulted in the creation of the Internet and its introduction into everyday life on a global scale. The Internet provides access to information and the sale and purchase of goods. Medications are also subject to trade. Their sale is conducted by online pharmacies and their global turnover amounts to hundreds of billions of dollars. Medications ordered over the Internet are sent by mail all over the world. Considering the events of recent years, we cannot exclude the risk of a terrorist attack through online pharmacies. Terrorists can establish such companies, legally or illegally, or acquire ones already existing. Parcels, which are highly trusted by the customers of online pharmacies, can, for example, be contaminated with dangerous materials. The sale of online medications in the international system is potentially dangerous and requires international regulation.

Well-intended efforts to diagnose a child's developmental delay may have unintended negative consequences for a child and his family. Consequently, clinicians may feel caught in a moral dilemma: between doing the good they seek and avoiding the harm they foresee. The dilemma is that when investigating global developmental delay it is not possible to avoid all the anticipated negative outcomes of genetic testing and concurrently fulfill our obligations to do the good from which these harmful effects result. It is imperative to recognize dilemmas especially where the moral questions or relevant facts are not as clear cut as in ethics textbooks and to bring their moral questions into a structured dialogue with the patient and his or her family. A modified principle of double effect is a useful method for deliberating about these moral cases. Three case examples illustrate the utility of the principle of double effect when investigating global developmental delay.

Here we describe how more important findings were obtained in a delirium study by using an informal assessment of mental capacity, and, in those who lacked capacity, obtaining consent later when or if capacity returned or a proxy was found. From a total of 233 patients 23 patients lacked capacity as judged by our informal capacity judgment and 210 did not. Of those who lacked capacity, 13 agreed to enter in the study. Six of them regained capacity later. When these 13 participants were excluded from analysis, significant findings were no longer evident. These results show that by the inclusion of subjects who lacked capacity the results of analyses of the condition from whish they suffer are altered. We suggest that this approach to the study of delirium is more ethical than the usual system of strict exclusion of people who lack capacity to give consent and for whom assent is not available.

There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed.

Israel has a long history of concern with chemical and biological threats, since several hostile states in the Middle East are likely to possess such weapons. The Twin-Tower terrorist attacks and Anthrax envelope scares of 2001 were a watershed for public perceptions of the threat of unconventional terror in general and of biological terror in particular. New advances in biotechnology will only increase the ability of terrorists to exploit the burgeoning availability of related information to develop ever-more destructive bioweapons. Many areas of modern biological research are unavoidably dual-use by nature. They thus have a great potential for both help and harm; and facilitating the former while preventing the latter remains a serious challenge to researchers and governments alike. This article addresses how Israel might best (1) prevent hostile elements from obtaining, from Israel's biological research system, materials, information and technologies that might facilitate their carrying out a biological attack, while (2) continuing to promote academic openness, excellence and other hallmarks of that system. This important and sensitive issue was assessed by a special national committee, and their recommendations are presented and discussed. One particularly innovative element is the restructuring and use of Israel's extensive biosafety system to also address biosecurity goals, with minimal disruption or delay.