The concept of reproductive health promises to play a crucial role in improving women's health and rights around the world. It was internationally endorsed by a United Nations conference in 1994, but remains controversial because of the challenge it presents to conservative agencies: it challenges policies of suppressing public discussion on human sexuality and regulating its private expressions. Reproductive Health and Human Rights is designed to equip healthcare providers and administrators to integrate ethical, legal, and human rights principles in protection (...) and promotion of reproductive health, and to inform lawyers and women's health advocates about aspects of medicine and healthcare systems that affect reproduction. Rebecca Cook, Bernard Dickens, and Mahmoud Fathalla, leading international authorities on reproductive medicine, human rights, medical law, and bioethics, integrate their disciplines to provide an accessible but comprehensive introduction to reproductive and sexual health. They analyse fifteen case-studies of recurrent problems, focusing particularly on resource-poor settings. Approaches to resolution are considered at clinical and health system levels. They also consider kinds of social change that would relieve the underlying conditions of reproductive health dilemmas. Supporting the explanatory chapters and case-studies are extensive resources of epidemiological data, human rights documents, and research materials and websites on reproductive and sexual health. In explaining ethics, law, and human rights to healthcare providers and administrators, and reproductive health to lawyers and women's health advocates, the authors explore and illustrate limitations and dysfunctions of prevailing health systems and their legal regulation, but also propose opportunities for reform. They draw on the values and principles of ethics and human rights recognized in national and international legal systems, to guide healthcare providers and administrators, lawyers, governments, and national and international agencies and legal tribunals. Reproductive Health and Human Rights will be an invaluable resource for all those working to improve services and legal protection for women around the world. -/- Updates to this book, and information on translations to French, Spanish, Portuguese, Chinese and Arabic are now available at www.law.utoronto.ca/faculty/cook/ReproductiveHealth.html. (shrink)
Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in (...) the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements. (shrink)
Medical research involving human subjects raises complex ethical, legal and social issues. Investigators sometimes find that their obligations with respect to a research project come into conflict with their obligations to individual patients. The ethical conduct of research rests on 3 guiding principles: respect for persons, beneficience, and justice. Respect for persons underlies the duty to obtain informed consent from study participants. Beneficence demands a favourable balance between the potential benefits and harms of participation. Justice requires that vulnerable people not (...) be exploited and that eligible candidates who may benefit from participation not be excluded without good cause. Studies must be designed in a way that ensures the validity of findings and must address questions of sufficient importance to justify the risks of participation. In any clinical trial there must be genuine uncertainty as to which treatment arm offers the most benefit, and placebo controls should not be used if effective standard therapies exist. Researchers have a responsibility to inform themselves about the ethical, legal and policy standards that govern their activities. When difficulties arise, they should consult the existing literature and seek the advice of experts in research ethics. (shrink)
This Major Reference series brings together a wide range of key international articles in law and legal theory. Many of these essays are not readily accessible, and their presentation in these volumes will provide a vital new resource for both research and teaching. Each volume is edited by leading international authorities who explain the significance and context of articles in an informative and complete introduction.