Moral capacity is an important feature of what it means to be human. In this volume, the contributors have taken on the daunting task of trying to distinguish between legal and moral capacity. This distinction is difficult at times for clinicians, philosophers and legal scholars alike. Part of the challenge of defining moral capacity lies in the difficulty of adequately categorizing it. For this reason, the editors have chosen to divide the book into three parts. The first looks at the (...) concepts involved in the discussion of moral capacity; the second considers the role of moral capacity in the lives of professionals; and the final part reflects on case studies of moral capacity or incapacity illustrating the challenge that moral capacity presents - its definition lying between two seemingly incommensurable models, those of the threshold and continuum. This volume takes a multidisciplinary approach to the subject, and ties the disciplines of medicine, philosophy and law into the health context. It will be of interest to medical health professionals as well as researchers working in the areas of philosophy and law. (shrink)
As a medical student doing a rotation, I was feeling positive as we knocked on the door of an elderly lady who I'd seen just 2 days earlier. Even though seriously ill for many months, this patient had always lived life in her own way, refusing to go to a nursing home. It was clear that her condition had deteriorated rapidly, and the nurse informed me privately that she was dying, sooner rather than later.
Our global knowledge of different cultures and the diversity of values increases almost daily. New challenges arise for ethics. This is especially true in the field of bioethics because the technological progress of medicine throughout the world is causing dramatic interactions with traditionally held values. Science and technology are rapidly advancing beyond discussions and corresponding political struggles over human rights, leaving those debates behind. This rapid development of science is at odds with the principle of sustained development that calls for (...) measured and thoughtful planning, such that no new idea should rupture the delicate fabric of communities, environment, and cultural evolution. (shrink)
This book offers a rich variety of thoughtful explorations on the nature of the human person especially as related to health care, medicine, and mental health. Rarely are so many different viewpoints collected in one place about the intriguing puzzle that is the concept of person, human dignity, and the special place human beings hold in the goals of healing and the social structures of medical delivery. Ramifications of the theory of personhood are presented for bioethics, genetics, individuality, uniqueness, international (...) law, feminism, and human rights in health care. Intended for professionals in the fields of philosophy of medicine, law, and bioethics, this book will also appeal to psychologists and medical anthropologists. (shrink)
Fifty years ago, 23 Nazi physicians were defendants before a military tribunal in Nuremberg, charged with crimes against humanity. During that trial, the world learned of their personal roles in human experimentation with political and military prisoners, mass eugenic sterilizations, state-ordered euthanasia of the and the program of genocide we now know as the Holocaust. These physicians, and their colleagues who did not stand trial, were universally condemned in the free world as ethical pariahs. The term became the paradigm for (...) total defection from the most rudimentary elements of medical morality. The caduceus literally became the instrument of the swastika. (shrink)
Persons of diminished capacity, especially those who are still legally competent but are de facto incompetent should still be able to participate in moderately risky research projects that benefit the class of persons with similar diseases. It is argued that this view can be supported with a modified communitarianism, a philosophy ofmedicine that holds that health care is a joint responsibility that meets foundational human needs. The mechanism for obtaining a substituted consent I call ``community consent,'' and distinguish this from (...) the usual family or surrogate consent for treatment. Care givers are included in the community that might consent for an individual who has no identifiable family members. (shrink)
At the end of this century there are so many occasions, so many residues of the most violent of times, that challenge the very idea of forgivenessNorthern Ireland, Bosnia, the Tutsis and Hutus, the Shiite and Suni Moslems, the settlers and African immigrants in South Africa, indigenous populations against the dominant culture. The open violence and rapaciousness of human enmity can be viewed now in the displacement of masses of people in Kosovo. Said the U.N. High Commissioner for Refugees, Sadako (...) Ogata, about the Kosovo crisis: that this century, as in its darkest hours, should end with the mass deportation of innocent people.”. (shrink)
Nationwide, almost 11% of women abuse drugs during their pregnancy. In some communities, these numbers are as high as 25–30%. Drug abuse is not limited to the poor or to African Americans, but is seen among affluent and white Americans as well. It is widespread, irrespective of race or social class. Annually, nearly 375,000 infants are exposed to drugs in America. Because of the terrible suffering caused by these births, and the conflicts caregivers experience in the treatment of these infants, (...) Trollope's quote is very apropos. Although caregivers have good motives in trying to rescue these babies and helping place them in a nurturing environment, despair about this objective is always close to the surface. (shrink)
The emergence of new obstetrical and neonatal technologies, as well as more aggressive clinical management, has significantly improved the survival of extremely low birth weight (ELBW) infants. This development has heightened concerns about the limits of viability. ELBW infants, weighing less than 1,000 grams and no larger than the palm of one's hand, are often described as of late twentieth century technology. Improved survivability of ELBW infants has provided opportunities for long-term follow-up. Information on their physical and emotional development contributes (...) to developing standards of practice regarding their care. (shrink)
The behavior of people in the presence of scarce resources has long been a source of ethical concern and debate. Many of the responses, ranging from outright brutality and cheating on the one hand to altruism, nobility, and sacrifice on the other, were most recently demonstrated in the movie Titanic. It should come as no surprise, then, that rational efforts to allocate the very scarce life-saving resource of organs are sometimes circumvented by these natural human impulses and sheer human creativity. (...) This is especially true when the organs in question are required for continued life and cannot be temporarily or permanently replaced by technology. Thus the focus of this paper will be on the competition for livers. (shrink)
We appreciated the important commentary provided by Michelle Oberman on our paper, (CQ Vol. 6, No. 1). For the most part we agree with Oberman's analysis of the issues, but there are seven points of variance, either of conception, emphasis, or accuracy. We wish to clarify these and welcome the chance her commentary provided to offer aspects of the social situation surrounding the case we presented.
In Márquez's OfLoveandOtherDemons Abrenuncio the physician and the Marquis discuss the outbreak of rabies that is the centerpiece of the book, since the Marquis' daughter has been bitten by a rabid dog. Abrenuncio notes that the poor.
The problem of developing a moral philosophy of medicine is explored in this essay. Among the challenges posed to this development are the general mistrust of moral philosophy and philosophy in general created by post-modernist philosophical and even anti-philosophical thinking. This reaction to philosophical systematization is usually called antifoundationalism. I distinguish different forms of antifoundationalism, showing that not all forms of their opposites, foundationalism, are alike, especially with regards to claims made about the certitude of moral thought. I conclude that (...) we are correct to mistrust absolutist principles in a moral philosophy of medicine, but can find some center within the practice of medicine itself for a moral foundation. (shrink)
The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a gift of life and a commodity exchange. The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We (...) argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources. (shrink)
Biology has been advancing with explosive pace over the last few years and in so doing has raised a host of ethical issues. This book, aimed at the general reader, reviews the major advances of recent years in biology and medicine and explores their ethical implications. From birth to death the reader is taken on a tour of human biology - covering genetics, reproduction, development, transplantation, aging, dying and also the use of animals in research and the impact of human (...) populations on this planet. In each chapter there is a sketch of a field's most recent scientific advances, combined with discussions of the ethical and moral principles and implications for social frameworks and public policy raised by those advances. Anybody interested or concerned about the ethical dilemmas caused by advances in science and medicine should read this book. (shrink)
There are several branches of ethics. Clinical ethics, the one closest to medical decisionmaking, can be seen as a branch of medicine itself. In this view, clinical ethics is a unitary hermeneutics. Its rule is a guideline for unifying other theories of ethics in conjunction with the clinical context. Put another way, clinical ethics interprets the clinical situation in light of a balance of other values that, while guiding the decisionmaking process, also contributes to the very weighting of those values. (...) The case itself originates ideas, not only about which value ought to predominate in its resolution, but also provides the origin of clinical rules that can be used in other cases. These are interpretive rules. Some examples of these rules are presented as well. (shrink)