The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medicalethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of (...) fee-for-service medicine to a system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medicalethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)
This book examines the extremely important issue of the consistency of medical involvement in ending lives in medicine, law and war. It uses philosophical theory to show why medical doctors may be involved at different stages of the capital punishment process. The author uses the theories of Emmanuel Kant and John S. Mill, combined with Gerwith's principle of generic consistency, to concretize ethics in capital punishment practice. This book does not discuss the moral justification of capital punishment, (...) but rather looks at the possible forms of involvement and shows why consistency would demand medical involvement. The author takes a general approach, using arguments that may apply universally. The book broaches different academic fields, such as medicine, ethics, business, politics and defense. The Ethics of Medical Involvement in Capital Punishment is of interest to students, teachers, lecturers and researchers working in the areas of capital punishment, medical, legal and business ethics, and political philosophy. (shrink)
Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff (...) seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record. (shrink)
Bioethics as politics -- Bioethics and the politics of expectations -- Engendering consent : bioethics and biobanks -- Missing the big picture : bioethics and stem cell research -- Testing times : bioethics and "do-it-yourself" genetics -- Governing uncertainty : the politics of nanoethics -- Beyond bioethics.
Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious voices, (...) traditions, and models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers. (shrink)
This is a comprehensive and practical guide to the ethical issues raised by different kinds of medical research, and is the first such book to be written with the needs of the researcher in mind. Clearly structured and written in a plain and accessible style, the book covers every significant ethical issue likely to be faced by researchers and research ethics committees. The author outlines and clarifies official guidelines, gives practical advice on how to adhere to these, and (...) suggests procedures in areas where official recommendations are vague or absent. This invaluable handbook will help researchers identify and address the ethical issues at an early stage in the design of their studies, to avoid unnecessary delay and to safeguard the wellbeing of patients and healthy volunteers. It will also be extremely useful to members of research ethics committees. (shrink)
Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue, Tom Koch argues that bioethics has failed to deliver on its promises.
The doctor patient relationship starts with a story. Doctors' notes, a patient's chart, the recommendations of ethics committees and insurance justifications all hinge on written and verbal narrative interaction. The "practice" of narrative profoundly affects decision making, patient health and treatment and the everyday practice of medicine. In this edited collection, the contributors provide conceptual foundations, practical guidelines and theoretical considerations central to the practice of narrative ethics.
The problem of ethics in medical care as seen from the bioengineering results from the almost incredible technological achievements based on scientific research: On the one hand there is inadequate handling of technology and fear on the part of the patient; on the other hand there is admiration on the part of the physicians and the nursing staff. This article will survey the points of criticism concerning ethical behavior and will present and evaluate general problems of mechanization in (...)medical care. General phenomena of human interaction, and especially problems related to medical care, will be discussed. It will be necessary to develop clinical medical technology, aiming primarily at realizing the patient's concern. After analyzing these concerns, it is necessary for the clinical medical engineer to develop an invisible technology. Criteria for such an invisible technology (function, design, automatic control, methods of implantation, whether chronic application is necessary) are being demonstrated by particular devices (artifical heart, functional electro-stimulation, diaphragmatic pace-maker). (shrink)
The American term Bioethics has been adopted over the last ten years and the development of Bioethics committees on the American model testifies this influence, even before the official appointment of a National Committee in 1983. This phenomenon acknowledged as the emergence of French bioethics is in fact the final outcome of a long-lasting crisis in the medical profession, in quest for a new style of ethics, breaking with the traditional professional ethics (French Déontologie, through the Ordre (...) des Médecins). Among other factors of conceptual and institutional change, the increase of biomedical research comes first: a major consequence is the sharing of moral responsibilities in decision-making with outsider scientists and finally the involvement of the whole population as potential moral subjects.The designation of these events as the emergence of French bioethics is hardly appropriate for an account of this dramatic shift in ethical norms and roles in medicine. This paper attempts to review the intellectual roots of the recent evolution and to summarize present and prospective trends. (shrink)
This book is intended as a practical introduction to the ethical problems which doctors and other health professionals can expect to encounter in their practice. It is divided into three parts: ethical foundations, clinical ethics, and medicine and society. The authors incorporate new chapters on topics such as theories of medicalethics, cultural aspects of medicine, genetic dilemmas, aging, dementia and mortality, research ethics, justice and health care (including an examination of resource allocation), and medicine, (...)ethics and medical law. MedicalEthics also covers issues having to do with the beginning and end of life, as well as ethical questions surrounding the human body and the use of human tissue, confidentiality and AIDS, care of the mentally ill, and the implications of genetic technology. Each chapter presents a range of ethical views, drawing both from traditional philosophy and the most recent contemporary trends. The theoretical discussion is extended and illustrated by case studies and examples. This book is a non-technical guide to ethics written with the needs of medical students and medical practitioners in mind. It will also appeal to students and practitioners of allied health professions, and for all users of health care services. (shrink)
Feminist ethics and medicalethics are critical of contemporary moral theory in several similar respects. There is a shared sense of frustration with the level of abstraction and generality that characterizes traditional philosophic work in ethics and a common commitment to including contextual details and allowing room for the personal aspects of relationships in ethical analysis. This paper explores the ways in which context is appealed to in feminist and medical (...) class='Hi'>ethics, the sort of details that should be included in the recommended narrative approaches to ethical problems, and the difference it makes to our ethical deliberations if we add an explicitly feminist political analysis to our discussion of context. It is claimed that an analysis of gender is needed for feminist medicalethics and that this requires a certain degree of generality, i.e. a political understanding of context. (shrink)
All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: (...) designing the trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)
This book offers an in-depth analysis of the wide range of issues surrounding "passive euthanasia" and "allow-to-die" decisions. The author develops a comprehensive conceptual model that is highly useful for assessing and dealing with real-life situations. He presents an informative historical overview, an evaluation of the clinical settings in which treatment abatement takes place, and an insightful discussion of relevant legal aspects. The result is a clearly articulated ethical analysis that is medically realistic, philosophically sound, and legally viable.
A physician says, "I have an ethical obligation never to cause the death of a patient," another responds, "My ethical obligation is to relieve pain even if the patient dies." The current argument over the role of physicians in assisting patients to die constantly refers to the ethical duties of the profession. References to the Hippocratic Oath are often heard. Many modern problems, from assisted suicide to accessible health care, raise questions about the traditional ethics of medicine and the (...)medical profession. However, few know what the traditional ethics are and how they came into being. This book provides a brief tour of the complex story of medicalethics evolved over centuries in both Western and Eastern culture. It sets this story in the social and cultural contexts in which the work of healing was practiced and suggests that, behind the many different perceptions about the ethical duties of physicians, certain themes appear constantly, and may be relevant to modern debates. The book begins with the Hippocratic medicine of ancient Greece, moves through the Middle Ages, Renaissance and Enlightenment in Europe, and the long history of Indian and Chinese medicine, ending as the problems raised modern medical science and technology challenge the settled ethics of the long tradition. (shrink)
Should a brain-dead woman be artificially maintained for the sake of her fetus? Does a physician have the right to administer a life-saving transfusion despite the patient's religious beliefs? Can a family request a hysterectomy for their retarded daughter? Physicians are facing moral dilemmas with increasing frequency. But how should these delicate questions be resolved and by whom? A Casebook of MedicalEthics offers a real-life view of the central issue involved in clinical medicalethics. Since (...) the analysis of cases plays a critical role in this study, the authors have assembled a broad collection of histories encountered in their work as medicalethics educators and consultants. The cases are developed in substantial detail to reflect the rich medical and psychosocial complexity involved, and each is brought to a decision point at which a course of action must be chosen. Among the issues examined are conflicts between patients' wishes and respect for their well-being, tensions concerning duties to patients unable to care for themselves and obligations to family members, and clashes between patient care obligations and the interests of other persons, including physicians, third parties, and the general public. The book also includes commentaries that combine general discussion of ethical principles with specific analysis of the cases examined in the text, as well as various options for resolving conflicts. Readers are invited to assess the comparative merits and liabilities of these approaches. An ideal text for undergraduate and medical school courses, A Casebook of MedicalEthics brings readers to the forefront of medicine, where they share in the determination of crucial ethical decisions. (shrink)
This collection brings together original essays demonstrating the cutting edge of philosophical research in medicalethics. With contributions from a range of established and up-and-coming authors, it examines topics at the forefront of medical technology, such as ethical issues raised by developments in how we research stem cells and genetic engineering, as well as new questions raised by methodological changes in how we approach medicalethics.
The Cambridge World History of MedicalEthics is the first comprehensive scholarly account of the global history of medicalethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medicalethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship (...) between medicalethics and the state, which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medicalethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medicalethics; and the first comprehensive bibliography of the history of medicalethics. An extensive index guides readers to topics, texts, and proper names. (shrink)
The practice of clinical medicine is inextricably linked with the need for moral values and ethical principles. The study of medicalethics is, therefore, rightly assuming an increasingly significant place in undergraduate and postgraduate medical courses and in allied health curricula. Making Sense of MedicalEthics offers a no-nonsense introduction to the principles of medicalethics, as applied to the everyday care of patients, the development of novel therapies and the undertaking of pioneering (...) basic medical research. Written from a practical rather than a philosophical perspective, the authors call upon their extensive experience of clinical practice, research and teaching to illustrate how ethical principles can be applied in different "real-life" situations. Making Sense of MedicalEthics encourages readers to understand the principles of medicalethics as they apply to clinical practice; explore and evaluate common misconceptions; consider the ethics underlying any medical decision; and as a result, to realize that a good appreciation of medicalethics will help them to practice more effectively in the future. (shrink)
How is the concept of patient care adapting in response to rapid changes in healthcare delivery and advances in medical technology? How are questions of ethical responsibility and social diversity shaping the definitions of healthcare? In this topical study, scholars in anthropology, nursing theory, law and ethics explore questions involving the changing relationship between patient care and medicalethics. Contributors address issues that challenge the boundaries of patient care, such as: · HIV-related care and research · (...) the impact of new reproductive technologies · preventative healthcare · technological breakthroughs that are changing personal-caring relationships. Chapters range from a consideration of the practicalities of nursing and family healthcare to a debate about ‘universal human needs’ and patients’ rights. This book is a provocative exploration of the ways in which healthcare models are socially constructed. It will be of interest to policy-makers, medical practitioners and administrators, as well as students of sociology, anthropology and social policy. (shrink)
This interactive independent teaching and learning tutorial can be used by individuals or small groups and takes a problem-based-learning approach to the complex legal and ethical issues raised by six scenarios. Based on real cases clearly demonstrating the problems arising from recent medical advancements, the cases cover reproductive technology, consent, genetic screening, participation in research trials, paternity and confidentiality. Additional features of the CD-ROM are a comprehensive glossary, cross-references to The Cambridge MedicalEthics Workbook and definitions from (...) the Dictionary of MedicalEthics. (shrink)
Disciplining doctors : medical courts of honour and professional conduct -- Medical confidentiality : the debate on private versus public interests -- Patient information and consent : self-determination versus paternalism -- Duties and habitus of a doctor : the literature on medicalethics.
This new edition of Law and MedicalEthics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.
Introduction -- Historical perspectives of medicalethics -- The medicalethics Renaissance: a brief assessment -- Risk disclosure/'informed consent' -- Consent, control and minors: Gillick and beyond -- Sterilisation/best interests: legislation intervenes -- The end of life: total abrogation -- Medicalethics in government-commissioned reports -- Conclusion.
Thus far in the development of the discipline of medicalethics, the overriding concern has been with solutions to specific problems. But discussion is hampered by lack of understanding of the scope and methodology of medicalethics, and its scientific and philosophical basis. In Underpinnings of MedicalEthics Edmond A. Murphy, James J. Butzow, and Edward L. Suarez-Murias offer much-needed clarification of the purview, ontological basis, and methodology of a medicalethics that (...) is to be comprehensive and yet readily accepted by all. The authors begin by describing the scope of the analysis and discussing possible ethical systems and paradigms. They then deal with the structures and concepts necessary in the formulation of a coherent philosophy: normality and disease, scientific and juridical law, certainty and certitude, decisions. Finally, they introduce particular human dimensions, such as quality of life, pain, and responsibility. Throughout, case examples illustrate the authors' theoretical framework. (shrink)
This rich collection, popular among teachers and students alike, provides an in-depth look at major cases that have shaped the field of medicalethics. The book presents each famous (or infamous) case using extensive historical and contextual background, and then proceeds to illuminate it by careful discussion of pertinent philosophical theories and legal and ethical issues.
The Blackwell Guide to MedicalEthics is a guide to the complex literature written on the increasingly dense topic of ethics in relation to the new technologies of medicine. Examines the key ethical issues and debates which have resulted from the rapid advances in biomedical technology Brings together the leading scholars from a wide range of disciplines, including philosophy, medicine, theology and law, to discuss these issues Tackles such topics as ending life, patient choice, selling body parts, (...) resourcing and confidentiality Organized with a coherent structure that differentiates between the decisions of individuals and those of social policy. (shrink)
In responding to Thomas Magnell's notion of 'collapsing goods', I draw attention to how medical and health ethics practices are not innocent, but political; and to suggest something about their relation to the moral climate. More specifically, I show that to take them as innocent, or as politically neutral, is not only a misunderstanding, but one that is likely to impact on the moral climate as well as being already a reflection of it. Ethics, and the (...) various practices and understandings of health and medicalethics in particular, may well turn out to be collapsing goods. (shrink)
Machine generated contents note: Introduction Chapter 1: The basics of ethical decision-making Chapter 2: Hospital ethics committees and clinical ethicists Chapter 3: The settings of health care ethical dilemmas Chapter 4: Advance directives Chapter 5: Do Not Resuscitate orders and "Code Blue" Chapter 6: Non-beneficial medical interventions Chapter 7: Quality of life and treatment burdens Chapter 8: Patient privacy and confidentiality Chapter 9: Refusing medical treatment Chapter 10: Health care at the end of life Chapter 11: Transplant (...)ethics Chapter 12: Neuroethics Chapter 13: Ethics and reproductive technology Chapter 14: Genetics and ethics Chapter 15: Pediatric ethics Chapter 16: Participating in a research study Appendix A: Resource List Appendix B: Glossary Index. (shrink)
This is a practical introduction to the range of ethical questions which doctors and other health-care professionals may be expected to encounter in practice. The books covers both the traditional "end of life" issues and also deals with medical research and consent issues, confidentiality and AIDS, resource allocation, care of the mentally ill, and the doctor/patient relationship. Each chapter canvasses a range of ethical views, drawing both from traditional philosophical responses and the most recent contemporary responses. Theoretical discussion is (...) extended and enlivened by the use of hypothetical and actual examples, suitable both for private study or group discussion. While the needs of medical students for a non-technical guide to ethics have been kept firmly in mind, the clarity of writing and avoidance of specialist medical and philosophical terminology ensure that it will be of value to students of nursing and related disciplines, and accessible to the lay reader. (shrink)
The case of Terri Schiavo, a young woman who spent 15 years in a persistent vegetative state, has emerged as a watershed in debates over end-of-life care. While many observers had thought the right to refuse medical treatment was well established, this case split a family, divided a nation, and counfounded physicians, legislators, and many of the people they treated or represented. In renewing debates over the importance of advance directives, the appropriate role of artificial hydration and nutrition, and (...) the responsibilities of family members, the case also became one of history's most extensively litigated health care disputes. The Case of Terri Schiavo assembles a team of first-hand participants and content experts to provide thoughtful and nuanced analyses. In addition to a comprehensive overview, the book includes contributions by Ms. Schiavo's guardian ad litem, a neurologist and lawyer who participated in the case, and scholars who examine issues related to litigation, faith, gender, and disability. The volume also includes a powerful dissent from the views of many scholars in the bioethics community. The book is intended for students, health care professionals, policy makers, and other in search of carefully reasoned analyses of the case that will shape our view of death and end-of-life medical care for decades. (shrink)
Mason and McCall Smith's classic textbook discusses the relationship of medical practice and ethics with the operation of the law. The subjects covered include natural and assisted reproduction, the impact of modern genetics on medicine, medical confidentiality, consent to medical treatment, the use of resources and problems surrounding death in the new medical era. It is of significance to anyone with an interest in the ethical and legal practice of medicine.
Providing health care in the most cost-effective way has become a priority in recent years. This book tackles the important issue of the potential conflict between economic expediency and the welfare of individual patients. Contributors examine different attitudes to this complex problem, along with a variety of legal and historical perspectives. The book addresses particular aspects of health care, such as medical expert systems, general practice, medical education, and clinical decision-making where the direct involvement of doctors in (...) allocating scarce and expensive resources is perhaps most obvious. (shrink)
Amid the controversies surrounding physician-assisted suicides, euthanasia, and long-term care for the elderly, a major component in the ethics of medicine is notably absent: the rights and welfare of the survivor's family, for whom serious illness and death can be emotionally and financially devastating. In this collection of eight provocative and timely essays, John Hardwig sets forth his views on the need to replace patient-centered bioethics with family-centered bioethics. Starting with a critique of the awkward language with which philosphers (...) argue the ethics of personal relationships, Hardwig goes on to present a general statement on the necessity of family-centered bioethics. He reflects on proxy decisions, the effects of elder care on the family, the financial and lifestyle consequences of long-term care, and physician-assisted suicide from the perspective of the family. His penultimate essay, "Is There a Duty to Die?" carries the idea of family-centered ethics to its logical, controversial, conclusion; comments upon this essay from Daniel Callahan, Larry Churchill, Joanne Lynn, and journalist Nat Hentoff offer differing views on this highly charged subject. As advances in medicine prolong patient's lives, the welfare of those ultimately responsible for medical care-the family-must be addressed. Hardwig's courageous and illuminating essays set forth a new direction in bioethics: one that considers the welfare of everyone concerned. (shrink)
United States military medicalethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non-therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of (...) trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medicalethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medicalethics are not established. Looking to the future, medicine and medicalethics have not articulated a vision for an ongoing military-civilian dialogue to ensure that standards of medicalethics do not evolve simply in accord with military exigency. (shrink)
New Waves in Ethics brings together the leading future figures in ethics broadly construed, with essays ranging from meta-ethics and normative ethics to applied ethics and political philosophy. Topics include new work on experimental philosophy, feminism, and global justice, incorporating perspectives informed from historical and contemporary approaches alike. An ideal collection for anyone interested in the most important debates in ethics and political philosophy, as well as those with an interest in the (...) latest significant contributions from the leading new generation of philosophers working in ethics. (shrink)
Biomedical research on humans is an important part of medical progress. But, when lives are at risk, safety and ethical practices need to be the top priority. The need for the committees that regulate and oversee such research -- institutional review boards, or IRBs -- is growing. IRB members face difficult decisions every day. Evaluating the Science and Ethics of Research on Humans is a guide for new and veteran members of IRBs that will help them better understand (...) the issues involved and the tasks they will be required to perform. The most important purpose of an IRB is to protect the lives of human participants. For three major research areas -- drugs, medical devices, and genetic information -- Dennis J. Mazur shares the methods he has found useful in protecting human participants through the systematic review of scientific protocols and informed consent forms and through adherence to the federal regulations that apply. New members will gain understanding of how proposed research projects are to be reviewed from both scientific and ethical dimensions, how and when to ask key questions of principal investigators, how to work with principal investigators and research teams to ensure the best protection of human participants, and why to schedule regularly spaced reviews of a project that may have adverse outcomes. Based on Mazur's thirty years of research experience, this accessible and informative guide will give all IRB members the tools they need to protect human lives and facilitate the research process. (shrink)
Foundations of medicalethics and law -- Professionalism and medicalethics -- The doctor, the patient, and society -- Ethics and law at the beginning and end of life -- Healthcare commissioning and resource allocation -- Introduction to sociology and disease -- Experience of health and illness -- Organization of health care provision in the UK -- Inequalities in health and health care provision -- Epidemiology and public health -- Clinical governance.
There have been serious controversies in the latter part of the 20th century about the roles and functions of scientific and medical research. In whose interests are medical and biomedical experiments conducted and what are the ethical implications of experimentation on subjects unable to give competent consent? From the decades following the Second World War and calls for the global banning of medical research to the cautious return to the notion that in controlled circumstances, medical research (...) on human subjects is in the best interest of the given individual and the broader population, this book addresses the key implications of experimentation on humans. This volume covers major ethical themes within biomedical research providing historical, philosophical, legal and policy reflections on the literature and specific issues in the field of research on human subjects. Focusing on special populations (the elderly, children, prisoners and the cognitively impaired) it represents the most up-to-date review of the special ethical and legal conflicts that arise with relation to experimentation on subjects from these groups. In the light of current initiatives for law reform pertaining to research ethics the world over, this volume provides a timely, comprehensive and provocative exploration of the field. The volume has been carefully organized to present important philosophical perspectives on organizing principles that should underlie any practical application. A forward-looking historical review of the regulatory regimes of principal jurisdictions, including of the legal controls already in place, provides the backdrop for future policy initiatives. Additionally, in the light of global restructuring of health care systems, several chapters have been devoted to epidemiological research and related issues. (shrink)
This book is a critical, forward-looking and interdisciplinary text. Its chief aim is to advance understanding of medical law by reference both moral theory and the regulatory context. The first chapter seeks to map competing approaches within moral objectivism and outline the pressures created by the impact of market forces and medical tourism, political interests, medical and professional interests, changing perceptions of medicine, developing technologies, limited resources and the impact of increasingly direct (international and domestic) recognition (...) of human rights. Chapters 2 to 16 apply the analytical tools presented in chapter 1 to the topics of medical law and seek to demonstrate the need for a moral epistemology of the type defended in chapter 17. (shrink)
Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians is a concise and practical guide to ethical decision-making in medicine. The text is aimed at second- and third-year one-semester ethics courses offered in medical schools, health sciences departments, and nursing programs. By taking an applied approach rather than a theoretical approach, this text serves the needs of medical and nursing students, residents, and practicing physicians by sorting through questions of moral principles relevant (...) to the diverse and growing number of healthcare professionals. The many topics covered include truth telling, refusal of treatment, assisted suicide, managing error, and reproductive choice. (shrink)
Tough Decisions presents many of the complex medical-ethical issues likely to confront practitioners in critical situations. Through fictional but true-to-life cases, vividly described in clinical terms, the authors force the reader to choose among different courses of action and to confront a range of possible consequences. A two-year-old has been diagnosed with a malignant brain tumor. Who should be allowed to make decisions about the child's surgery and subsequent therapy, and on what basis? A family history of Huntington's disease (...) emerges when a fiancee seeks genetic counseling. Who should be informed? An elderly patient suffers a cardiac arrest. Should "do-not-resuscitate" orders always be followed? How should legal liability affect medical decisions? Other ethical issues considered include surgical complications, patient autonomy, rights of the retarded, informed consent, euthanasia, and the fair allocation of finite resources. Each case presented conveys the drama and pressure of weighing alternatives, and the realistic consequences of the choices made. The authors show that ethical decision-making is not limited to "matters of life and death", and that it is not the decision but the ethical process by which it is made that gives the decision moral integrity. With realistic detail, Tough Decisions brings to life and makes the student share in the many complexities of ethical decision-making when the health and lives of patients are at stake. (shrink)
In 1985, philosopher Samuel Gorovitz spent seven weeks at Boston's Beth Israel, one of the nation's premier teaching hospitals, where he was given free run as "Authorized Snoop and Irritant-at-Large." In Drawing the Line, he provides an intense, disturbing, and insightful account of his observations during those seven weeks. Gorovitz guides us through an operating room and intensive care units, and takes us to meetings where surgeons discuss the mishaps of the preceding week, where internists map out their approaches to (...) troublesome cases, where the administration discusses competition in the health care market. He follows as residents walk the ragged edge of physical exhaustion, as experienced physicians wrestle with the uncertainties of their demanding profession, as nurses struggle to care for perpetually declining patients. Most important, he examines the ethical questions that permeate their lives--deeply troubling questions such as who should be making life and death decisions--and how should they be made? How should scarce medical resources be allocated? What rules should govern the use of fetal tissue in research and treatment? Where should we draw the line, and how? When Samuel Gorovitz published Doctors' Dilemmas, a previous look at medicalethics, it was hailed by Norman Cousins as "stimulating and valuable...the product of a beautifully formed (and informed) mind." Studs Terkel called it "quite remarkable...a very exciting book indeed." In Drawing the Line, Gorovitz offers an unusual look at contemporary health care, combining a moving, hard-hitting glimpse of daily reality at a major hospital with the thoughtful, provocative reflections of a highly respected philosopher. (shrink)
Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed (...) in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. (shrink)
How do the hard facts of political responsibility shape and constrain the demands of ethical life? That question lies at the heart of the problem of 'dirty hands' in public life. Those who exercise political power often feel they must act in ways which would otherwise be considered immoral: indeed, paradoxically, they sometimes feel that it would be immoral of them not to perform or condone such acts as killing or lying. John Parrish offers the first wide-ranging account (...) of how this important philosophical problem emerged and developed, tracing it - and its proposed solutions - from ancient Greece through the Enlightenment. His central argument is that many of our most familiar concepts and institutions - from Augustine's interiorized ethics, to Hobbes's sovereign state, to Adam Smith's 'invisible hand' understanding of the modern commercial economy - were designed partly as responses to the ethical problem of dirty hands in public life. (shrink)
The value foundation for a global society -- Ethics and international business -- Human rights concepts and principles -- Political involvements by business -- The foreign production process -- Product and export controls -- Marketing motives and methods -- Culture and the human environment -- Nature and the physical environment -- Business guidance and control mechanisms -- Deciding ethical dilemmas.
We argue that a turn toward virtue ethics as a way of understanding medical professionalism represents both a valuable corrective and a missed opportunity. We look at three ways in which a closer appeal to virtue ethics could help address current problems or issues in professionalism education—first, balancing professionalism training with demands for professional virtues as a prerequisite; second, preventing demands for the demonstrable achievement of competencies from working against ideal professionalism education as lifelong learning; and third, (...) avoiding temptations to dismiss moral distress as a mere “hidden curriculum” problem. As a further demonstration of how best to approach a lifelong practice of medical virtue, we will examine altruism as a mean between the extremes of self-sacrifice and selfishness. (shrink)
Although the use of new health technologies in healthcare and medicine is generally seen as beneficial, there has been little analysis of the impact of such technologies on people's lives and understandings of health and illness. This book explores how new technologies not only provide hope for cure and well-being, but also introduce new ethical dilemmas and raise questions about the "natural" body. Focusing on the ways new health technologies intervene into our lives and affect our ideas about normalcy, the (...) body and identity, New Health Technologies explores: how new health technologies are understood by lay people and patients how the outcomes of these technologies are communicated in various clinical settings how these technologies can alter our notions of health and illness and create "new illness." Written by authors with differing backgrounds in phenomenology, social psychology, social anthropology, communication studies and the nursing sciences, this book is essential reading for students andacademics of medical sociology, health and allied studies, and anyone with an interest in new health technologies. (shrink)
Businesses that produce bioscience products—gene tests and therapies, pharmaceuticals, vaccines, and medical devices—are regularly confronted with ethical issues concerning these technologies. Conflicts exist between those who support advancements in bioscience and those who fear the consequences of unfettered scientific license. As the debate surrounding bioscience grows, it will be increasingly important for business managers to consider the larger consequences of their work. This groundbreaking book follows industry research, development, and marketing of medical and bioscience products across a variety (...) of fields, including biotechnology, pharmaceuticals, and bio-agriculture. Compelling and current case studies highlight the ethical decisions business managers frequently face. With the increasing visibility and public expectation placed on businesses in this sector, managers need to understand the ethical and social issues. This book addresses that need and provides a framework for incorporating ethical analysis in business decision making. (shrink)
Although euthanasia is seen as the problem of the individual will and as one’s right to privacy, to a better quality of life or to a dignified death, it has major institutional implications. They are closely related to the juridical system, to the way of understanding state involvement in protecting the individuals and respecting their freedoms, to the institutional system of health care, to the government rules that establish social, political or professional practices. The public debate around the topics (...) related to the human condition, like euthanasia, grants a special force to public communication, to organizational communication, to communication in professional environments, to physician-patient communication and, more generally, to interpersonal communication. In this text we emphasize the importance of public debate on euthanasia from the perspective of organizational ethics, of medical deontology, of patients’ rights, but especially of elaborating public policies and national programs, and we underline the importance of the need to establish protocols for health care, as well as to build a framework of democratic communication. (shrink)
The eagerly-awaited second volume of The Cambridge Translations of Medieval Philosophical Texts will allow scholars and students access for the first time in English to major texts in ethics and political thought from one of the most fruitful periods of speculation and analysis in the history of western thought. Beginning with Albert the Great, who introduced the Latin west to the challenging moral philosophy and natural science of Aristotle, and concluding with the first substantial presentation in English of (...) the revolutionary ideas on property and political power of John Wyclif, the seventeen texts in this anthology offer late medieval treatments of fundamental issues in human conduct that are both conceptually subtle and of direct practical import. Special features of this volume include copious editorial introductions, an analytical index, and suggestions for further reading. This is an important resource for scholars and students of medieval philosophy, history, political science, theology and literature. (shrink)
Mainstream philosophical discussions of ethics usually involve either a search for a problem-solving theory (such as utilitarianism), or an exploration of ontological status (of things like obligations or reasons). This book will argue that such efforts are often misplaced. Instead, the proper starting point should always be the actual words and deeds of ordinary people in ordinary disagreements; for the ethical concepts in play can only derive their full meaning within the context of ordinary human lives. This will require (...) a better understanding of the 'ordinary', and of what it means to lead a life. (shrink)
Introduction : confronting numbness -- Basic facts about HIV/AIDS -- Ethical foundations -- Ethics and the beginning of life -- Ethics and relationships -- Ethics and the end of life -- Ethics and society -- Ethics and global structures -- Creating the future -- Appendix I : the mystery of God and suffering -- Appendix II : preparing now for the hour of death.
In a world of rapid technological advances, the moral issues raised by life and death choices in healthcare remain obscure. Life and Death in Healthcare Ethics provides a concise, thoughtful and extremely accessible guide to these moral issues. Helen Watt examines, using real-life cases, the range of choices taken by healthcare professionals, patients and clients which lead to the shortening of life. The topics looked at include: euthanasia and withdrawal of treatment; the persistent vegetative state; abortion; IVF and cloning; (...) and life-saving treatment of pregnant women. (shrink)
Since its inception as an international requirement to protect patients and healthy volunteers taking part in medical research, informed consent has become the primary consideration in research ethics. Despite the ubiquity of consent, however, scholars have begun to question its adequacy for contemporary biomedical research. This book explores this issue, reviewing the application of consent to genetic research, clinical trials, and research involving vulnerable populations. For example, in genetic research, information obtained from an autonomous research participant may have (...) significant bearing on the interests of family members who have not consented to the study. This casts doubt on the adequacy of consent for such studies. This book also questions the assumptions that informed consent is essential and that it satisfactorily protects the principle of individual autonomy. It reviews recent empirical studies that challenge the possibility of truly informed consent and highlights the extent to which consent is governed by social norms and expectations. It also investigates how consent might be of secondary importance in some circumstances, for example when a research project appears to protect a public or community interest. (shrink)
General Practice and Ethics explores the ethical issues faced by general physicans in their everyday practice, addressing two central themes: the uncertainty of outcomes and effectiveness in general practice and the changing pattern of general practitioners' responsibilities.
The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medicalethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, (...) epistemology, and political philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring - stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy. (shrink)
What is health policy for? In Health and the Good Society, Alan Cribb addresses this question in a way that cuts across disciplinary boundaries. His core argument is that biomedical ethics should draw upon public health values and ethics; specifically, he argues that everybody has some share of responsibility for health, including a responsibility for promoting greater health equality. In the process, Cribb argues for a major rethink of the whole project of health education.
Responsible citizens are expected to combine ethical judgement with judiciously exercised social activism to preserve the moral foundation of democratic society and prevent political injustice. But do they? Utilizing a research model integrating insights from rational choice theory and cognitive developmental psychology this book carefully explores three exemplary cases of morally inspired activism: Jewish rescue in wartime Europe, abortion politics in the United States, and peace and settler activism in Israel. From all three analyses a single conclusion emerges: the (...) most politically competent individuals are, most often, the least morally competent. This is the central paradox of political morality. These findings cast doubt on strong models of political morality characterized by enlightened moral reasoning and concerted political action while affirming alternative weak models that fuse activism with sectarian moral interests. They provide empirical support to further upend the liberal vision of democratic character, education, and society. (shrink)
The work related to medicalethics written by Polish authors are reviewed and some topics concerning teaching and various other activities in this field are presented. The attention is centered on the opinions and attitudes concerning the essence of medical profession and the personal model of the physician, doctor-patient relationship (including duties of the doctor), medical research on humans, abortion and other problems. The role of medico-ethical tradition in Poland is described. Main trends in polish ethical (...) thought in relation to medicine are taken into consideration. General aspects of medicalethics in present-day Poland are tentatively characterized. (shrink)