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)
A number of recent publications by the philosopher David Seedhouse are discussed. Although medicine is an eminently ethical enterprise, the technical and ethical aspects of health care practices can be distinguished, therefore justifying the existence of medicalethics and its teaching as a specific part of every medical curriculum. The goal of teaching medicalethics is to make health care practitioners aware of the essential ethical aspects of their work. Furthermore, the contention that (...) rational bioethics is a fruitless enterprise because it analyses non-rational social events seems neither theoretically tenable nor to be borne out by actual practice. Medicalethics in particular and bioethics in general, constitute a field of expertise that must make itself understandable and convincing to relevant audiences in health care. (shrink)
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)
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.
The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medicalethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)
The authors consider four aspects of contemporary medicalethics in France: abortion and contraception; artificial insemination; suicide and euthanasia, and drug trials on healthy human volunteers, and then outline the various ethical codes which apply to French doctors. Many in France who accept technological progress are unwilling or unable to acknowledge the impact upon medicalethics of this progress. The conflict is epitomised by the new role being demanded from the doctor. Where formerly he was (...) regarded as the guardian of traditional values today he is urged to adapt, to change, to take account of the technological innovations in medicine. `In such a situation,' the authors ask, `how is it possible to avoid a feeling of uneasiness?'. (shrink)
This paper argues that two characteristics of social life impinge importantly upon medical attempts to maintain high ethical standards. The first is the tension between the role of ethics in protecting the patient and maintaining the solidarity of the profession. The second derives from the observation that the foundations of contemporary medicalethics were laid at a time of one-to-one doctor-patient relations while nowadays most doctors work in or are associated with large-scale organisations. Records cease (...) to be the property of individual doctors, become available not only to other doctors but also to educational and social work personnel. Making records openly available to patients is suggested as the only antidote to this irreversible loss of individual practitioner control. The importance for doctors of understanding the nature of professional and bureaucratic organisations in order to deal with the hazards involved is stressed as is the responsibility of the General Medical Council to regulate medical competence as well as personal behaviour. (shrink)
New and Emerging Science and Technology (NEST) based innovations, e.g. in the field of Life Sciences or Nanotechnology, frequently raise societal and political concerns. To address these concerns NEST researchers are expected to deploy socially responsible R&D practices. This requires researchers to integrate social and ethical aspects (SEAs) in their daily work. Many methods can facilitate such integration. Still, why and how researchers should and could use SEAs remains largely unclear. In this paper we aim to relate motivations (...) for NEST researchers to include SEAs in their work, and the requirements to establish such integration from their perspectives, to existing approaches that can be used to establish integration of SEAs in the daily work of these NEST researchers. Based on our analyses, we argue that for the successful integration of SEAs in R&D practice, collaborative approaches between researchers and scholars from the social sciences and humanities seem the most successful. The only way to explore whether that is in fact the case, is by embarking on collaborative research endeavours. (shrink)
I argue that work in medicalethics which attempts to humanize medicine without examining hidden assumptions (about medicine's ontology, explanations, goals, relationships) has the dehumanizing effect of legitimating practices which treat persons as abstractions. After illustrating the need to reexamine the field of medicalethics and the doctor-patient relationship in particular, I use Foucault's work to provide a social, historical framework for discussion. This background begins to demonstrate that doctor-patient relationships cannot be made satisfactory by (...) new hospital policies or interpersonal skills, but have deep-rooted problems due to medicine's place in social history. Real progress requires social or structural change. (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.
It is often assumed that the chief responsibility medical professionals bear is patient care and advocacy. The meeting of other duties, such as ensuring a more just distribution of medical resources and promoting the public good, is not considered a legitimate basis for curtailing or slackening beneficial patient services. It is argued that this assumption is often made without sufficient attention to foundational principles of professional ethics; that once core principles are laid bare this assumption is revealed (...) as largely unwarranted; and, finally, that these observations at the level of moral theory should be reflected, in various ways, in medical practice. Specifically, this essay clarifies a tension that exists between different kinds of moral principles and explores the possibility of dissipating that tension by shoring up foundational principles. The paper begins by setting out three alternative models of how best to balance patient advocacy responsibilities with broader social responsibilities. It then turns to critically assess these models and argue that one has several advantages over the others. (shrink)
The author of this comment suggests that some of the important points made by Dr Adrian Rogers are vitiated by a tendency to contrast the worst of modern medical practice with an over-idealised view of the past. The state of medicalethics today, the author suggests, is more hopeful than Dr Rogers allows.
This volume explores the focus of interest in community and the emerging theoretical opposition between communitarianism and liberalism, including the practical, theoretical and ethical issues that relate to community in the healthcare professions.
When anthropologists and other social scientists study health services in medical institutions, tensions sometimes arise as a result of the social scientists and health care professionals having different ideas about the ethics of research. In order to resolve this type of conflict and to facilitate mutual learning, we describe two general categories of research ethics framing: those of anthropology and those of medicine. The latter focuses on protection of the individual through the preservation of autonomy (...) expressed through the requirement of informed consent whereas the former focuses on broader political implications. After providing an example of a conflict, we outline four issues that characterize the occasional clashes between social scientists and medical staff: (1) a discrepancy in the way anthropologists perceive patients and medical staff; (2) ambiguity concerning the role of medical staff in anthropological research; (3) impediments to informed consent in qualitative research projects; and (4) property rights in data. Enhanced dialogue could serve to invigorate the ethical debate in both traditions. (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)
Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features (...) were: all professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (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)
In social work there is seldom an uncontroversial `right way' of doing things. So how will you deal with the value questions and ethical dilemmas that you will be faced with as a professional social worker? This lively and readable introductory text is designed to equip students with a sound understanding of the principles of values and ethics which no social worker should be without. Bridging the gap between theory and practice, this book successfully explores the (...) complexities of ethical issues, while recognising the real-world context in which social workers operate. Key features of the text include: - Full of hands-on advice and tips for professional practice. - Engaging and student-friendly. Each chapter is packed with case studies, reader exercises, key definitions and useful summaries. - Comprehensive content. The book explores core issues such as moral philosophy; professionalism; religion; power; oppression; difference and diversity; and ethical codes of practice. - Satisfies all the curriculum and training requirements for the new social work degree. Mapping directly on to first year courses, this text is essential reading for all social work undergraduates. It is an ideal refresher text for upper-level undergraduates, postgraduate and post-qualifying students, and for professionals. `This introductory text succeeds in providing an accessible introduction to the subject area. The book is consistently structured, well planned and uniformly written in a conversational and immediate style…. The discussion manages to combine a sense of engagement with a balanced treatment of the issues. Readers who apply themselves will be well sensitised to the matters under discussion and should be able to take their understanding into the practical arena' - Chris Clark, University of Edinburgh. (shrink)
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)
BackgroundThe methodology of medicalethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts.DiscussionA considered reference to normative research questions can be expected from good quality empirical research (...) in medicalethics. However, a significant proportion of empirical studies currently published in medicalethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medicalethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medicalethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medicalethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medicalethics.SummaryHigh quality empirical research in medicalethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medicalethics with regard to the link between empirical research and normative analysis. (shrink)
Medicalethics could be better understood if some basic theoretical aspects of practices in health care are analysed. By discussing the underlying ethical principles that govern medical practice, the student should also become familiar with the notion that medicalethics is much more than the external application of socially accepted moral standards. Professions in general and medicine in particular have internal values that command their moral virtuosity at the same time as their technical excellence. (...) Three examples where clinical practice can be clearly shown to require an ethical analysis are given: medical praxiology illustrates the motives, means and aims of physicians and patients; clinical decision-making as a practical syllogism that reaches prescriptive conclusions based on medical knowledge and the patient's wishes/intentions. Finally, diagnostics as an ethical bayesian approach is discussed, where the patient informedly decides the benefits and risks of further testing. (shrink)
Fundamental principles : the nature of the dispute -- Types of euthanasia -- Psychiatric assisted suicide -- Neonates -- Incompetent adults -- Human life is sacred -- The slippery slope -- Medical views -- Four methods of easing death and their effect on doctors -- Looking further ahead.
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)
Conducting empirical research on gender in medicalethics is a challenge from a theoretical as well as a practical point of view. It still has to be clarified how gender aspects can be integrated without sustaining gender stereotypes. The developmental psychologist Carol Gilligan was among the first to question ethics from a gendered point of view. The notion of care introduced by her challenged conventional developmental psychology as well as moral philosophy. Gilligan was criticised, however, because (...) her concept of âtwo different voicesâ may reinforce gender stereotypes. Moreover, although Gilligan stressed relatedness, this is not reflected in her own empirical approach, which still focuses on individual moral reflection. Concepts from social psychology can help overcome both problems. Social categories like gender shape moral identity and moral decisions. If morality is understood as being lived through actions of persons in social relationships, gender becomes a helpful category of moral analysis. Our findings will provide a conceptual basis for the question how empirical research in medicalethics can successfully embrace a gendered perspective. (shrink)
This book explores the far-reaching ethical implications of recent changes in the organization and practice of the social professions, including social work, community and youth work. Drawing on moral philosophy, professional ethics and new empirical research, the author explores such questions as: * Can any occupation justifiably claim a special set of ethics? * What is the impact of the new 'ethics of distrust' on the autonomy discretion and creativity of practitioners? * How does inter-professional (...) working challenge conceptions of professional identities and roles? * Do 'professional ethics' act as an obstruction to constructive developments? Combing interviews with practitioners with developments in ethical theory, Ethics, Accountability and the Social Professions shows the complexity and range of issues at stake. (shrink)
The third edition of this popular book has been updated to take account of the latest developments in policy and social work practice. It includes new sections on radical/emancipatory and postmodern approaches to ethics, analysis of the latest codes of ethics from over 30 different countries, additional case studies of ethical problems and dilemmas, practical exercises, and annotated further reading lists at the end of each chapter.
Linda Morrison brings the voices and issues of a little-known, complex social movement to the attention of sociologists, mental health professionals, and the general public. The members of this social movement work to gain voice for their own experience, to raise consciousness of injustice and inequality, to expose the darker side of psychiatry, and to promote alternatives for people in emotional distress. Talking Back to Psychiatry explores the movement's history, its complex membership, its strategies and goals, and the (...) varied response it has received from psychiatry, policy makers, and the public at large. (shrink)
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.
BackgroundPromoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense (...) debate within academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide.MethodsWe reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services.ResultsAccess to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries.ConclusionAlthough in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. (shrink)
In this new book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: What is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? The theory has implications for national and global health policy: Can we meet health needs fairly in aging societies? Or protect health in the workplace while respecting individual liberty? (...) Or meet professional obligations and obligations of justice without conflict? (shrink)
The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values and value (...) judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)