How one goes about teaching medical ethics greatly depends upon one's interpretation of the discipline itself. Before discussing pedagogical isslIes, the primary focus ofthe paper, I will address the question of what "philosophical" medical ethics is and is not. I will then suggest some alternative approac:hes forincluding such material in a variety of different contexts, including courses geared toward philosophy students, those focusing on undergraduate students preparing for careers in one of the health care professions, and those actually within professional (...) schools, primarily medical schools, with which I am mostfamiliar. I will end with remarks on the implications of medical etllics for medicine and for philosophy. (shrink)

The habit of giving a gratuity became so frequent at the end of the 1950's that counter-measures were enacted. These have been completely ineffective. Although granting and accepting gratuities is forbidden by law, the wages of doctors have been fixed since 1954, for so long that accepting gratuities has come to be considered part of the wages, even in semi-official comments and in the media. The author is of the opinion that, in view of this anomaly, a fundamental transformation of (...) the health provision system (sickness insurance) is needed. The doctor should be paid according to the number of patients in his or her charge, instead of the mere number of the sick. By transforming the provision of medical care in this way, the giving and accepting of gratuities for doctors could be terminated, not only in law but also in the economy. Keywords: gratuity, Hungary, Marxism-Leninism, medical ethics, remuneration CiteULike Connotea Del.icio.us What's this? (shrink)

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) (...) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country. (shrink)

Those considering careers in medicine and other health and humanitarian disciplines as well as those concerned about the growing presence of militarized ...

Two issues in Cowley’s book Medical Ethics, Ordinary Concepts and Ordinary Lives are discussed. The first is methodological and it concerns the relation between the personal and the impersonal perspectives. An apparent problem is represented by some uncertainties in the interpretation of their relation in Cowley’s proposal. In some cases presented by Cowley, although the agents do not give up the requirements of the personal perspective, their actions correspond to the requirements of the impersonal perspective. The question is how did (...) the agent make the decision? The other issue is that the personal perspective, as described in some cases, seems to be concerned only by reasons relevant to the subject herself. The question is whether such a perspective may be properly called moral, or it rather deserves to be qualified as prudential, egocentric or egoistic.The second issue regards organ donation, where Cowley contrasts the cultural discourse endorsed by people personally involved because of their links to the dead person, and the bioethicists’ discourse. Some empirical data seem to challenge this distinction. (shrink)

Interplay Between Scientific Theories and Researches on the Diseases of the Nervous System in the Nineteenth-Century, Paris Content Type Journal Article Category Original Paper Pages 339-352 DOI 10.1007/s12376-009-0033-5 Authors Jean-Gaël Barbara, Université Curie CNRS, UMR 7102 Paris France Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4.

The article questions the assumption that conjoined twins are necessarily two people or persons by employing arguments based on different points of view: non-personal vitalism, the person as a sentient being, the person as an agent, the person as a locus of narrative and valuation, and the person as an embodied mind. Analogies employed from the cases of amputation, multiple personality disorder, abortion, split-brain patients and cloning. The article further questions the assumption that a conjoined twin's natural interest and wish (...) is separation. I first contend that separation is such a radical procedure as to render the post-separation person different from the pre-separation one. Therefore, it is not possible to benefit the pre-separation twin by the act of separation. The article concludes with a critical evaluation of the tendency in bioethics to regard ethical challenges as rivalry between individuals competing for scarce resources. (shrink)

This article considers the ethical implications of prospective payment from the perspective of physicians and other health care practitioners. It focuses on the argument that prospective payment creates ethical conflict by giving physicians an economic incentive to do less for their patients. This argument is criticized in two respects. First, available evidence is reviewed which suggests that the incentives actually created by different prospective payment schemes and their effect on "optimal" patterns of practice is uncertain. Further, it is pointed out (...) that ethical conflict originates in the dual role of physicians as agents and suppliers of service. Recognizing that such conflict exists under any payment mechanism, a better focus for the ethical evaluation of prospective payment is suggested that considers whether the incentive to do less is likely to have adverse effects on physician decisions, relative to decisions made under other payment mechanisms. Keywords: incentives, utilization, conflict of interest, efficiency, justice, agent CiteULike Connotea Del.icio.us What's this? (shrink)

Written by three experts in the field, this book explores the understanding of human wellness and disease as fostered through the collaborative contributions of ...

The Socratic method has a long history in teaching philosophy and mathematics, marked by such names as Karl Weierstra, Leonard Nelson and Gustav Heckmann. Its basic idea is to encourage the participants of a learning group (of pupils, students, or practitioners) to work on a conceptual, ethical or psychological problem by their own collective intellectual effort, without a textual basis and without substantial help from the teacher whose part it is mainly to enforce the rigid procedural rules designed to ensure (...) a fruitful, diversified, open and consensus-oriented thought process. Several features of the Socratic procedure, especially in the canonical form given to it by Heckmann, are highly attractive for the teaching of medical ethics in small groups: the strategy of starting from relevant singular individual experiences, interpreting and cautiously generalizing them in a process of inter-subjective confrontation and confirmation, the duty of non-directivity on the part of the teacher in regard to the contents of the discussion, the necessity, on the part of the participants, to make explicit both their own thinking and the way they understand the thought of others, the strict separation of content level and meta level discussion and, not least, the wise use made of the emotional and motivational resources developing in the group process. Experience shows, however, that the canonical form of the Socratic group suffers from a number of drawbacks which may be overcome by loosening the rigidity of some of the rules. These concern mainly the injunction against substantial interventions on the part of the teacher and the insistence on consensus formation rooted in Leonard Nelson's Neo-Kantian Apriorism. (shrink)

Through the Looking Glass: Past Futures of Brain Research Content Type Journal Article Category Original Paper Pages 329-338 DOI 10.1007/s12376-009-0030-8 Authors Cornelius Borck, University of Luebeck Institute for the History of Medicine and Science Studies Koenigstr. 42 23552 Lübeck Germany Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4.

Am I Still Me? Personal Identity in Neuroethical Debates Content Type Journal Article Category Original Paper Pages 393-406 DOI 10.1007/s12376-009-0034-4 Authors Cordula Brand, University of Tübingen International Centre for Ethics in the Sciences and Humanities (IZEW) Wilhelmstr. 19 72074 Tübingen Germany Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4.

This article seeks to examine how religious ideas that are not the focus of a particular halakhic question become the crux of the ruling, thereby molding it and dictating its bias. We will attempt to demonstrate this through a study of Jewish medical ethics, based on some of the rulings of one of the greatest halakhic decisors of the previous generation: Rabbi Eliezer Yehuda Waldenberg (1915–2006). Rabbi Waldenberg molds his rulings on the basis of a religious principle asserting that the (...) legitimacy of any medical procedure is qualified and limited. Rabbi Waldenberg rejects certain accepted medical practices, including plastic surgery, in vitro fertilization, and organ transplants. Even if these procedures are regarded by other halakhic decisors as being legitimate, for Rabbi Waldenberg they are ethically and religiously improper, and therefore they are halakhically forbidden. (shrink)

Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods: Dyads (n=240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial Registration: ISRCTN89993391. (shrink)

Bioethics and the stages on life's way -- Bioethical challenges in the new millennium -- The covenantal aspect of Christian marriage -- The use and abuse of human embryos -- The sacredness of newborn life -- On addictions and family systems -- The hope of glory : from a physical to a spiritual body -- Care in the final stage of life.

How should modern medicine's dramatic new powers to sustain life be employed? How should limited resources be used to extend and improve the quality of life? In this collection, Dan Brock, a distinguished philosopher and bioethicist and co-author of Deciding for Others (Cambridge, 1989), explores the moral issues raised by new ideals of shared decision making between physicians and patients. The book develops an ethical framework for decisions about life-sustaining treatment and euthanasia, and examines how these life and death decisions (...) are transformed in health policy when the focus shifts from what is best for a patient to what is just for all patients. Professor Brock combines acute philosophical analysis with a deep understanding of the realities of clinical health policy. This is a volume for philosophers concerned with medical ethics, health policy professionals, physicians interested in bioethics, and undergraduate courses in biomedical ethics. (shrink)

In this paper questions are raised about the use of Halakhic material discussions of medical ethics. Three ways in which one might use Halakhic material in such discussions are distinguishes: (a) as a source for ideas about medical ethics which can be defended independently of their origin; (b) as a basis for mandating certain forms of behaviour for members of the Jewish faith; (c) as the basis for claims about the Jewish view on disputed topics in medical ethics. The first (...) two raise no methodical problems. The third use raises a number of theoretical and practical issues, with which the paper is concerned. Several problems stem from the fact that Halakhah distinguishes between obligations, fulfilment of which is required for all people. With rare exceptions, the obligations imposed up on the Jewish people are more stringent. The pitfall lurking the in third of the three uses is that authors using Halakhic material may correctly conclude that obligations that are supposed to fall only upon the Jewish people fall upon all people. An analysis of this problem follows, along with a plea for a responsible use of Halakhic material in the third way, so as to avoid certain real pitfalls. CiteULike Connotea Del.icio.us What's this? (shrink)