Online research in philosophy

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)

The purpose of this essay is to argue for the necessity of an ethics of the practice of the specialist-technologist in medicine. In the first part I sketch three stages of medical ethics, each with a particular viewpoint regarding the technology of medicine. I focus on Brody's consideration of the physician's power as a example of contemporary medical ethics which explicitly excludes the specialist-technologist as a locus of development of medical ethics. Next, the philosophy of Heidegger is (...) examined to suggest an approach to the problem, and, finally, some of Levinas' contributions regarding the other are introduced to suggest a preliminary approach to a medical ethics of the specialist-technologist. (shrink)

Medical technology assessment deals with the evaluation of novel or existing health care procedures. This paper addresses the interdependence between factual and normative issues, using the controversies about acceptability and desirability of reduced-size liver transplantations with living donors as example.

A growing literature addresses the ethicalimplications of electronic surveillance atwork, frequently assigning ethical priority tovalues such as the right to privacy. Thispaper suggests that, in practice, the issuesare sociologically more complex than someaccounts suggest. This is because manyworkplace electronic technologies not designedor deployed for surveillance purposesnevertheless embody surveillance capacity. Thiscapacity may not be immediately obvious toparticipants or lend itself to simpledeployment. Moreover, because of their primaryfunctions, such systems embody a range of otherfeatures which are potentially beneficial forthose utilising them. As (...) a result, more complexethical dilemmas emerge as different desired goods compete for priority in thedecision-making of individuals and groups. From a sociological point of view this raisesinteresting questions about the way ethicaldilemmas arise in the context of the ongoingsocial relationships of work. The paperexplores these issues using data from a studyof the development and implementation of acomputerised instructional package in amaternity setting. This medical settingillustrates clearly how seeking to assignethical priority to a particular concern, suchas the right to privacy, cannot butoversimplify the real day to day dilemmasencountered by participants. At the same time,the example of the instructional packagedemonstrates that it is difficult to predict inadvance what ethical issues will be raised bytechnologies that almost always turn out tohave a range of capabilities beyond thoseenvisaged in their original designspecification. (shrink)

Medical technologies and assistive devices such as ventilators and power wheelchairs are designed to sustain life and/or improve functionality but they can also contribute to stigmatization and social exclusion. In this paper, drawing from a study of ten men with Duchenne muscular dystrophy, we explore the complex social processes that mediate the lives of persons who are dependent on multiple medical and assistive technologies. In doing so we consider the embodied and emplaced nature of (...) disability and how life is lived through bodies coupled with technologies and experienced as 'techno-body-subjects in situ'. Normative implications for theory and research, including bioethics research, are discussed. (shrink)

The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dys-morphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different (...) forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future. (shrink)

Some ethicists argue that patient confidentiality is absolute and thus should never be broken. I examine these arguments that when critically scrutinised, become porous. I will explore the concept of patient confidentiality and argue that although, this is a very important medical and bioethical issue, this needs to be wisely delivered to reduce third party harm or even detriment to the patient. The argument for absolute confidentiality is particularly weak when it comes to genetic information and inherited disease.

In this paper we analyse how the risks associated with research on transgenic plants are regulated in Sweden. The paper outlines the way in which pilot projects in the plant sciences are overseen in Sweden, and discusses the international and national background to the current regulatory system. The historical, and hitherto unexplored, reasons for the evolution of current administrative and legislative procedures in plant science are of particular interest. Specifically, we discuss similarities and differences in the regulation of medicine and (...) plant science, and we examine the tendency towards dichotomizing risk — focusing on social/ethical risks in medicine and biological risks in plant science. The context of this article is the Synpraxia research project, an inter-disciplinary program combining expertise in sciences and the humanities. (shrink)

Edited by four leading members of the new generation of medical and healthcare ethicists working in the UK, respected worldwide for their work in medical ethics, Principles of Health Care Ethics, Second Edition_is a standard resource for students, professionals, and academics wishing to understand current and future issues in healthcare ethics. With a distinguished international panel of contributors working at the leading edge of academia, this volume presents a comprehensive guide to the field, with state of the art (...) introductions to the wide range of topics in modern healthcare ethics, from consent to human rights, from utilitarianism to feminism, from the doctor-patient relationship to xenotransplantation. This volume is the Second Edition of the highly successful work edited by Professor Raanan Gillon, Emeritus Professor of Medical Ethics at Imperial College London and former editor of the Journal of Medical Ethics, the leading journal in this field. Developments from the First Edition include:_ The focus on ‘Four Principles Method’ is relaxed to cover more different methods in health care ethics. More material on new medical technologies is included, the coverage of issues on the doctor/patient relationship is expanded, and material on ethics and public health is brought together into a new section. (shrink)

Using ideas gleaned from the philosophy of technology of Martin Heidegger and Hans Jonas and the philosophy of health of Georges Canguilhem, I argue that one of the characteristics of emerging medical technologies is that these technologies lead to new conceptions of health. When technologies enable the body to respond to more and more challenges of disease, we thus establish new norms of health. Given the continued development of successful technologies, we come to expect more and more that our (...) bodies should be able to respond to ever-new challenges of environment and disease by establishing ever-new norms of health. Technologies may aim at the prevention and treatment of disease, but they also bring about modifications of what we consider normal for the human being. Thus, new norms of health arise from technological innovation. (shrink)

The first IVF baby was born in the 1970s. Less than 20 years later, we had cloning and GM food, and information and communication technologies had transformed everyday life. In 2000, the human genome was sequenced. More recently, there has been much discussion of the economic and social benefits of nanotechnology, and synthetic biology has also been generating controversy. This important volume is a timely contribution to increasing calls for regulation - or better regulation - of these and other new (...) technologies. Drawing on an international team of legal scholars, it reviews and develops the role of human rights in the regulation of new technologies. Three controversies at the intersection between human rights and new technology are given particular attention. First, how the expansive application of human rights could contribute to the creation of a brave new world of choice, where human dignity is fundamentally compromised; second, how new technologies, and our regulatory responses to them, could be a threat to human rights; and, third, how human rights could be used to create better regulation of these technologies. (shrink)

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 (...) class='Hi'>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 medical ethics 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)

Heidegger’s thoughts on modern technology have received much attention in many disciplines and fields, but, with a few exceptions, the influence has been sparse in biomedical ethics. The reason for this might be that Heidegger’s position has been misinterpreted as being generally hostile towards modern science and technology, and the fact that Heidegger himself never subjected medical technologies to scrutiny but was concerned rather with industrial technology and information technology. In this paper, Heidegger’s philosophy of modern technology is introduced (...) and then brought to bear on medical technology. Its main relevance for biomedical ethics is found to be that the field needs to focus upon epistemological and ontological questions in the philosophy of medicine related to the structure and goal of medical practice. Heidegger’s philosophy can help us to see how the scientific attitude in medicine must always be balanced by and integrated into a phenomenological way of understanding the life-world concerns of patients. The difference between the scientific and the phenomenological method in medicine is articulated by Heidegger as two different ways of studying the human body: as biological organism and as lived body. Medicine needs to acknowledge the priority of the lived body in addressing health as a way of being-in-the-world and not as the absence of disease only. A critical development of Heidegger’s position can provide us with a criterion for distinguishing the uses of medical technologies that are compatible with such an endeavor from the technological projects that are not. (shrink)

In Matters of Life and Death Elliot Dorff thoroughly addresses this unavoidable confluence of medical technology and Jewish law and ethics.

New genetic technologies and their applications in biomedicine have important implications for social identities in contemporary societies. In medicine, new genetics is increasingly important for the identification of health and disease, the imputation of personal and familial risk, and the moral status of those identified as having genetic susceptibility for inherited conditions. There are also consequent transformations in national and ethnic collective identity, and the body and its investigation is potentially transformed by the possibilities of genetic investigations and modifications (including (...) the highly controversial terrains of reproductive technologies and the use of human embryos in biomedical research). The papers in this volume, drawn from an international array of authors, address these issues from a variety of national, disciplinary and empirical standpoints. An informative read for postgraduates and professionals in the fields of sociology, social anthropology, science and technology studies, and environmental studies, the chapters comprise empirically based and theoretically informed discussions of key sociological, anthropological, political and ethical issues. Using the resources of a wide range of social science disciplines to provide a comparative approach to complex issues, this superb collection explores the local and global consequences of the new genetics, and analyzes the social implications of these advances for identity formation in a period of rapid social change. (shrink)

This collection brings together original essays demonstrating the cutting edge of philosophical research in medical ethics. 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 medical ethics.

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 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 medical ethics, 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. Medical Ethics 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)

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 medical ethics. 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 Medical Ethics Workbook and definitions from the (...) Dictionary of Medical Ethics. (shrink)

Our lives are dominated by technology. We live with and through the achievements of technology. What is true of the rest of life is of course true of medicine. Many of us owe our existence and our continued vigour to some achievement of medical technology. And what is true in a major way of general medicine is to a significant degree true of psychiatry. Prozac has long since arrived, and in its wake an ever-growing armamentarium of new psychotropics; beyond (...) that, neuroscience promises ever more technological advances for the field. -/- However, the effect of technology on the field of psychiatry remains highly ambiguous. On the one hand there are the achievements, both in the science and practice of psychiatry; on the other hand technology's influence on the field threatens its identity as a humanistic practice. In this ambiguity psychiatry is not unique - major thinkers have for a long time been highly ambivalent and concerned about the technological order that now defines modern society. For the future, the danger is that the psychiatrically real becomes that which can be seen, the symptom, and especially that which can be measured. Disorders and treatments might become reduced to what can be defined by diagnostic criteria and what can be mapped out on a scale. -/- This book exams how technology has come to influence and drive psychiatry forward, and considers at just what cost these developments have been made. It includes a range of stimulating and thought-provoking chapters from a range of psychiatrists and philosophers. (shrink)

The Blackwell Guide to Medical Ethics 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)

Book Symposium on Andrew Feenberg’s Between Reason and Experience: Essays in Technology and Modernity Content Type Journal Article Pages 203-226 DOI 10.1007/s13347-011-0017-8 Authors Inmaculada de Melo-Martín, Division of Medical Ethics, Weill Cornell Medical College, New York, NY 10065, USA David B. Ingram, Loyola University Chicago, 6525 North Sheridan Road, Chicago, IL 60626, USA Sally Wyatt, e-Humanities Group, Royal Netherlands Academy of Arts and Sciences (KNAW) & Maastricht University, Cruquiusweg 31, 1019 AT Amsterdam, The Netherlands Yoko Arisaka, Forschungsinstitut für (...) Philosophie Hannover, Gerberstrasse 26, 30169 Hannover, Germany Andrew Feenberg, School of Communication, Simon Fraser University at Harbour Centre, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada Journal Philosophy & Technology Online ISSN 2210-5441 Print ISSN 2210-5433 Journal Volume Volume 24 Journal Issue Volume 24, Number 2. (shrink)

Value-freedom or value-neutrality is a well-known topic in the philosophy of science. But what about the value-neutrality of technology, medical or other? Is it too far-fetched to imagine technology as in some sense value-neutral — in view of its intimate connection with purposeful human action? No; unexpected perhaps, but less far-fetched than expected. If we try to conceive of technology as a cognitive possibility abstracted from each and every specific social context, we shall find (at least) three senses in (...) which it may be regarded as value-neutral: (1) neutral vis-à -vis different possible uses and ends; (2) neutral before action; (3) neutral qua cognitive object, analogous to the cognitive core of science. The further meanings and implications of these three senses of value-neutrality are discussed. (shrink)

It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and (...) not do under such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society in a most fundamental way. Medical futility has both a quantitative and qualitative component. I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word to suffer ) is a person who seeks the healing (meaning to make whole ) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it. Sadly, in the futility debate wherein some critics have failed or refused to define medical futility an important area of medicine has in large part been neglected, not only in treatment decisions at the bedside, but in public discussions—comfort care—the physician’s obligation to alleviate suffering, enhance well being and support the dignity of the patient in the last few days of life. (shrink)

Like nuclear energy, most technologies could have dual use—for health and well being and disaster and terror. Some research publications have brought to the forefront the tragic consequences of the latter potential through their possible use. Monitoring life science research and development (R&D) to prevent possible misuse is a challenging task globally, more so in developing economies like India, which are emerging as major biotech hubs. As a signatory to the Biological and Toxin Weapons Convention, India has put in motion (...) a process of evolving a series of measures to manage dual-use technology. The Indian Council of Medical Research (ICMR) has taken a lead in drafting model codes of conduct, ethics and practice for use by other S&T agencies to tailor them as per their requirements. Taking cue from the discussions held by the editors of the various medical and science journals in the developed world, the Indian Journal of Medical Research, the official publication of the ICMR, is working on policy and uniform practice of publication of dual-use research results. The Government of India too has promulgated legal provisions to minimize the risks of misuse of technology, like the Weapons of Mass Destruction Act. Clearly, no single agency would be able to manage the dual-use of technology effectively. Multiple agencies have to come together to work in tandem for effective implementation of various measure and also like Janus, ensure that they are neither too restrictive nor intrusive to discourage the development of science. (shrink)

Goodman’s paradox gives rise to a cluster of problems, problems that are in need of different answers. I will discuss some variants of the grue hypothesis applied to the technological context. One conclusion in this paper is that there is room for rational decisions, and that solutions to the paradoxes in technology can be found in the practical choice situation. *Received April 2008. †To contact the author, please write to: Department of Medical and Health Sciences, Linköping University, SE‐581 83 (...) Linköping, Sweden; e‐mail: ingemar.nordin@liu.se. (shrink)

Richard J. Arneson From Choice to Chance: Genes and the Just Society1 intelligently addresses difficult issues at the intersection of medical ethics and the theory of justice. The authors, Dan Brock, Allen Buchanan, Norman Daniels, and Daniel Wikler, repeatedly emphasize their opinion that advances in genetic technology force upon us entirely new ethical questions which previous moral theories lack the resources to resolve.2 The claims that new scientific discoveries render previous moral theories obsolete should be regarded with suspicion. The (...) reader’s suspicion should be further aroused when she notes another feature of the authors’ theorizing that neatly fits the claim that we stand at the dawn of a new world of ethical theorizing. The authors’ discussion from start to finish stays at a middle level. By this I mean that the authors in each chapter begin with a few moral principles taken to be plausible or possibly plausible and examine their implications for issues raised by new genetic technology.3 This is not an exercise in applied ethics, because the principles initially invoked are subjected to criticism and scrutiny. But in almost every significant case the results are inconclusive. The moral puzzles that are raised are left unsolved, with moral reasons pointing toward opposed conclusions and the.. (shrink)

Advances in genetic technology will enable us to intervene in human biological development to prevent and cure diseases, to restore individuals' functions and capacities back to a normal level after injury and even to enhance them beyond what has hitherto been considered as normal functioning for our species. Such a power to reshape and modify the human condition raises fundamental questions that touch upon the central core of morality. One of these questions is distributive justice. Will all people have equal (...) access to the beneficial effects of genetic technology in general and medical genetics in particular? Most of the new therapeutic and enhancement techniques will probably be quite expensive. That means that, probably during a long period of time after the new genetic technology enters medical practice, its use will be practically monopolized by the rich, to the detriment of all those who are not in a position to afford genetic treatments. In this paper, I argue that the health care inequality that inevitably will follow from the adoption of genetic technology, while posing a challenge to provide as long as possible for genetic interventions for all, is hardly a reason to reject the new technology. In that case, we would have to reject any new medicine or medical technique that cannot be made available to all people at once. Finally, I also argue that the ?enhanced new world? that would follow the introduction of genetic technology, even with the kind of inequality that might then arise, poses no serious threat either to elite sports or to society and should therefore be welcome. (shrink)

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.

Since the introduction of ultrasound technology in the 1960s as a tool to visibly articulate the interiors of the pregnant body, feminist scholars across disciplines have provided extensive critique regarding the visual culture of fetal imagery. Central to this discourse is the position that fetal images occupy- as products of a visualizing technology that at once penetrates and severs pregnant and fetal bodies. This visual excision, feminist scholars describe, has led not only to an erasure of the female body from (...) fetal images but also to an erasure of the pregnant body in social, political, and biomedical discourses. Vital to feminist scholarship is, thereby, an engagement with fetal images in ways that reinscribe the pregnant body onto fetal images and into political discourses pertaining to reproductive rights. In this paper, similar to the feminist aim, I am interested in engaging with fetal images as way to gain agency for pregnant women and their bodies. The critical question that I ask is: Can we conceive of medical technology in an embodied way -one that interacts organically, dynamically, and through multisensory dimensions with pregnant bodies? In attempting to answer this question, I turn to Bruno Latour and Gilles Deleuze’s articulations of how bodies and machines interact to produce visual fact. (shrink)

Technology has been developed in order to protect and safeguard human dignity; however, technology may also threaten it. The principle of human dignity plays an important role in assessing medical technology and medical practices. Keywords: autonomy, medical ethics, dignity, technology assessment, Poland, bioethics CiteULike Connotea Del.icio.us What's this?

Certain restrictions on public funding for assisted reproductive technology (ART) are articulated and defended by recourse to a distinction between medical infertility and social infertility. We propose that underlying the prioritization of medical infertility is a vision of medicine whose proper role is to restore but not to improve upon nature. We go on to mark moral responses that speak of investments many continue to make in nature as properly an object of reverence and gratitude and therein (sometimes) (...) a source of moral guidance. We draw on the work of Ludwig Wittgenstein in arguing for the plausibility of an appeal to nature in opposition to the charge that it must contain a logical fallacy. We also invite consideration of the moral plausibility of some appeal to nature. Finally, we examine what follows in the case of ART. Should medicine respect as natural limits that should not be overcome: the need for a man and a woman in reproduction; menopause; and even declining fertility with age? We must first ask ourselves to what degree we should defer to nature in the conduct of medicine, at least in the particular if not the general case. This will involve also asking ourselves what we think is natural and in what instances and spirit might we defy nature. Divergent opinions and policies concerning who should receive ART treatment and public funding are more easily understood in view of the centrality, complexity and fundamental nature of these questions. (shrink)

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical (...) thinking. In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems. (shrink)

Scientists and engineers lack the equivalent of an ethics committee to which their colleagues in the medical profession may turn when ethical dilemmas arise. In the US workers in aerospace industry have campaigned for a Technology Bill of Rights. In the UK there has been a vigorous movement around the concept of socially useful and environmentally desirable technology. The organisation Scientists for Social Responsibility has set up a panel of scientists who can advise younger colleagues on issues of ethical (...) responsibility. (shrink)

The convergence of biomedical and information technology holds the potential to alter the discourses of identity, or as is argued here, to turn us inside out. The advent of digital networks makes it possible to ‘see inside’ people in ways not anticipated and thus create new performance arenas for the expression of identity. Drawing on the ideas of Butler and Foucault and theories of performativity, this paper examines a new context for human-computer interaction and articulates potentially disturbing issues with monitoring (...) health rather than wellbeing. It argues that by adopting explicitly social framings we can see beyond the idea of medical interventions for health to recognize the political implications of the new categorizations and their implementation in code. In the process, it critiques traditional ways of understanding machine-body relations within the field of technology design. (shrink)

This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally cause the (...) death of their patients and that vital organs can be obtained only from dead donors. The aim of this book is to undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. This involves exposing the misconception that stopping life support merely allows patients to die from their medical conditions, that there is an ethical bright line separating withdrawal of life support from active euthanasia, and that determination of death of hospitalized patients prior to vital organ donation is consistent with the established biological conception of death. A novel ethical justification is required for procuring vital organs from still-living donors. It is contended that in the context of plans to withdraw life support, donors of vital organs are not harmed or wronged by organ procurement prior to death, provided that valid consent is obtained for stopping treatment and organ donation. In view of serious practical difficulties in facing the truth regarding organ donation, an alternative pragmatic account is developed for justifying current practices that relies on the concept of transparent legal fictions. In sum, it is the thesis of this book that to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics. (shrink)

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals.So as (...) to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites.We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit. (shrink)

What is medical progress? The answer to this question is often associated with advances in diagnostic technology, with greater understanding of disease or pathological mechanisms particularly at the molecular level, or with the discovery of drugs and the developmental of surgical procedures to treat diseases. However, this facile answer can be problematic. In a New York Times Magazine article, for example, Lisa Sanders (2003) recounts a lecture delivered to her first-year class, at a "white-coat" ceremony, by the medical (...) school dean. Half of what we—the faculty—teach you—the students—is nonsense, she was told, but we don't know which half. She illustrates what the dean said, with the following change in advice for .. (shrink)

Current United States guidelines for neonatal resuscitation note that there is no mandate to resuscitate infants in all situations. For example, the fetus that at the time of delivery is determined to be so premature as to be non-viable need not be aggressively resuscitated. The hypothetical case of an extremely premature infant was presented to neonatologists from the United States and four other European countries at a September 2006 international meeting sponsored by the World Health Organization Collaborating Center in Reproductive (...) Health of Atlanta (currently, the Global Collaborating Center in Reproductive Health). Responses to the case varied by country, due to differences in legal, ethical and related practice parameters, rather than differences in medical technology, as similar medical technology was available within each country. Variations in approach seemed to stem from physicians’ perceptions of their ability to remove the neonate from life support if this appeared non-beneficial. There appears to be a desire for greater convergence in practice options and more open discussion regarding the practical problems underlying the variability. Specifically, the conference attendees identified four areas that need to be addressed: (1) lack of international consensus guidelines in viability and therapeutic options, (2) lack of bodies capable of generating these guidelines, (3) variation in laws between countries, and (4) the frequent failure of physicians and families to confront death at the beginning of life. (shrink)

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 (...) class='Hi'>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)

Medical imaging has provided insight into the living body that were not possible beforehand. With these methods a revolution in medical diagnosis and biomedical research has begun. Problematic aspects on the other hand are arising from the highly constructive properties of image production, which use complicated physical and physiological effects. Images are established via highly complicated combinations of technology and contingently chosen mathematical and algorithmic solutions. In addition, image construction follows properties of the human visual and cognitive system (...) to allow for the discrimination of the desired categories. It is no wonder that the visualizations referring to the body also show effects which have no physiological correlation within the body. Still such images are often used as if they were one-to-one correlates of the body. This has impacts, e.g. for their use as standardizing instances, resulting in new definitions of the normed healthy body, sickness or pathologies, maleness and femaleness and in determinisms as opposed to the brain's plasticity and variability, both in time and space, inter- as well as intra-individually. (shrink)

This article deals with the question how technologycontributed to the performing of objective assessmentsof health risks and to the public trust in theinsurance institution. Many authors have pointed tothe relevance of medical or statistical technologywith regard to the constitution of objectivity,because these technologies should be capable ofdiminishing the influence of social interactions – the``human element'' – on the process of producingknowledge about health risks. However, in this articleit is shown that the constitution of objective riskassessments and public trust cannot (...) be seen as theproduct of one particular type of technology, but thatit is the product of a socio-technical network, inwhich several heterogeneous elements becomeinterrelated and interdependant. The historicalreconstruction of this network also sheds a new lighton the role of `the human element' in the constitutionof objectivity and trust. It shows that elements inthe network which regulate the social interactionbetween the subjects involved are of no lessimportance to generate trust than technologies whichtend to abstract from this interaction. In otherwords, objective and subjective elements areintertwined much more than is often recognized, andpublic trust is to a fairly large degree depends onconventions in social interaction. (shrink)

There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, (...) we argue that the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. (shrink)

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to (...) what they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. (shrink)

Issues in medical ethics are rarely out of the media and it is an area of ethics that has particular interest for the general public as well as the medical practitioner. This short and accessible introduction provides an invaluable tool with which to think about the ethical values that lie at the heart of medicine. Tony Hope deals with the thorny moral questions such as euthanasia and the morality of killing, and also explores political questions such as: how (...) should health care resources be distributed fairly? Each chapter in this book considers a different issue: genetics, modern reproductive technologies, resource allocation, mental health, medical research, and discusses controversial questions such as: -/- · Who should have access to reproductive technology? Who should pay? · Is it right to fund expensive drug treatment for individuals? · Should active euthanasia be legalized? · Should treatment for mental illness be imposed on patients without their consent? · Who should have access to information from genetic testing? · Should we require consent for the use of dead bodies or organs in medical research? (shrink)

In order to cope with the changing health needs in the community, an holistic approach on AIDS prevention and control with particular reference to essential quality was introduced at an educational seminar at Hebei Medical University in China, 1996. We have identified three major points in the present study through learning and research process: 1. The importance of ‘cultural norm’ for the unification of science and technology is identified for the community approach; 2. ‘community care’ emphasising human quality provides (...) unity in diversity for educational program; and 3. ‘community control’ emphasising quality assurance demonstrates the effectiveness for program analysis from the viewpoint of human centred systems. (shrink)

Background: Audio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural palliative care is, however, largely lacking.This paper aims at describing elements of both the physical workplace and the cultural-social context of the palliative care practice, which are imperative for the use of teleconsultation technologies. Methods: A semi-structured expert meeting and qualitative, open interviews were deployed to explore (...) professionals’ assumptions and wishes, which are considered to contain latent presumptions about the practice’s physical workplace and latent elements of the cultural-social context, regarding (1) the mediating potential of audio-visual teleconsultation, (2) how the audio-visual teleconsultations will affect medical practice, and (3) the design and usage of the teleconsultation technology. We used a qualitative analysis to investigate how palliative care professionals interpret the teleconsultation package in preparation. The analysis entailed open and axial coding techniques developed in a grounded theory approach. Results: Respondents assume: 1. teleconsultation will hinder physical proximity, thereby compromising anamnesis and diagnosis of new or acutely ill patients as well as “real contact” with the person behind the patient; 2. teleconsultation will help patients becoming more of a pivotal figure in their own care trajectory; 3. they can use teleconsultation to keep a finger on the pulse; 4. teleconsultations have a healing effect of their own due to offered time and digital attention; 5. teleconsultation to open up an additional “gray” network outside the hierarchical structures of the established chain of transmural palliative care. This network could cause bypassing of caregivers and uncertainty about responsibilities; 6. teleconsultations lead to an extended flow of information which helps palliative care professionals to check the stories of patients and medical specialists. Conclusions: Professionals assume teleconsultation co-defines a new patient–professional relationship by extending hospital-based caregivers’ perceptions of as well as attention for their patients. At the cost, however, of clinical and personal connectedness. Secondly, a hermeneutics is needed to carefully interpret teleconsultation images. Thirdly, teleconsultations transform caregiving cultures as formerly separated care domains collide, demanding a redefinition of roles and responsibilities. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated new technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the (...) distribution of health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

For elite athletes seeking a winning advantage, manipulation of their own genetic code has become a realistic possibility. In Genetic Technology and Sport, experts from sports science, genetics, philosophy, ethics, and international sports administration describe the potential applications of the new technology and debate the questions surrounding its use.

In this eye-opening look at the doctor-patient decision-making process, physician and law professor Jay Katz examines the time-honored belief in the virtue of silent care and patient compliance. Historically, the doctor-patient relationship has been based on a one-way trust -- despite recent judicial attempts to give patients a greater voice through the doctrine of informed consent. Katz criticizes doctors for encouraging patients to relinquish their autonomy, and demonstrates the detrimental effect their silence has on good patient care. Seeing a growing (...) need in this age of medical science and sophisticated technology for more honest and complete communication between physician and patients, he advocates a new, informed dialogue that respects the rights and needs of both sides. In a new foreword to this edition of The Silent World of Doctor and Patient , Alexander Morgan Capron outlines the changes in medical ethics practice that have occurred since the book was first published in 1984, paying particular attention to the hotly debated issues of physician-assisted suicide and informed consent in managed care. (shrink)

I Conceptual Foundations Ethical problems emerging from modern medical technology have been evaluated on an issue-by-issue basis. ...

Machine generated contents note: Introduction. -- Acknowledgments. -- The Author. -- 1 Ethical Theories and Bioethics in a Global Perspective. -- Theories of Ethics. -- Are Theories of Ethics Global? -- Can Theories of Ethics Encourage People to Do the Right Thing? -- 2 Autonomy and Informed Consent in Global Perspective. -- Ethical Principles and Practical Issues of Informed Consent. -- Does Informed Consent Really Matter to Patients? -- Is Informed Consent a Universal Principle or a Cultural Value? -- 3 (...) Withholding or Withdrawing Treatment and Physician-Assisted Suicide. -- Withholding or Withdrawing Treatment at the End of Life. -- Assisting Patients in Committing Suicide. -- 4 Ethical Issues in Reproductive Health. -- Ethics of Abortion in Different Times, Places, and Cultures. -- Current Ethical Issues in Abortion. -- Assisted Reproductive Technology and Stem Cell Research. -- Emergency Contraception. -- Ethics of Imposing Conditions on Funding. -- 5 Ethical Issues of Female Genital Mutilation. -- The Facts About FGM. -- FGM as a Challenge to Ethical Relativism. -- Ethics of FGM for Adult Women. -- 6 Ethical Issues of Research with Human Subjects. -- Background Information and the Belmont Report. -- Autonomy and Voluntary Informed Consent. -- Beneficence and Cost-Benefit Analysis. -- Issues of Justice and Fairness for Human Subjects. -- 7 The Right to Health Care, and Ethical Obligations to Provide Care. -- Is There an Ethical Right to Health Care? -- Ethical Obligations of Health Care Professionals. -- Ethical Obligations of for-Profit Health Care Providers. -- 8 Ethical Issues in Rationing and Allocation of Limited Resources. -- Levels of Allocating Resources. -- Methods of Rationing Health Resources. -- Comparative Effectiveness Research and Cost-Effectiveness Analysis. -- 9 Ethical Issues of Health Insurance and Health System Reform. -- Ethical Issues in Financing Health Services and Designing Insurance Systems. -- Fundamental Values of Health Systems. -- 10 Ethical Issues in the Movement of Patients Across National Borders. -- Ethical Duties to Provide Health Care to Undocumented Aliens. -- Ethical Issues in Medical Tourism. -- 11 Ethical Issues in the Movement of Health Care Professionals Across National Borders. -- Ethical Issues in the Migration of Health Professionals. -- Proposed Solutions and Their Ethical Implications. -- Fair Treatment of Health Care Workers from Other Countries. -- 12 Corruption and Informal Payments in Health Systems. -- Payment of Informal Fees by Patients and Their Families. -- Is Corruption Bad for Your (and Other People's) Health? -- References. -- Index. (shrink)

Health Care Ethics examines the way ethical dilemmas are played out in everyday clinical practice and argues for an approach to ethical decision-making which focuses more on patient needs than competing professional interests. While advances in medical science and technology have improved the ability to save and prolong lives, they have also given rise to fundamental questions about what constitutes life and personhood, especially in the context of what are termed 'persistent vegetative state' and 'brain death'. Drawing on the (...) example of intensive care where such questions feature strongly in everyday practice, Kath M Melia examines how decisions are taken within the context of multiprofessional teamworking, including · whether to admit a patient and commence treatment · what the aim of treatment should be (i.e. palliation, care or cure) · when to limit, withhold or withdraw treatment · when to donate organs. As an area in which different professional groups work closely together, the author argues that there are lessons to be learnt from intensive care which can be applied to ethical decision making in all areas of health care for the greater good of patients. The book makes a significant contribution to the literature on ethics in health care and to the development of ethical decision making which prioritises the needs of patients. It is essential reading for ethicists, sociologists and health care professionals. (shrink)

What are the final limits of medicine? What should we not try to cure medically, even if we had the necessary financial resources and technology? This book philosophically addresses these questions by examining two mirror-image debates in tandem. Members of certain groups, who are deemed by traditional standards to have a medical condition, such as deafness, obesity, or anorexia, argue that they have created their own cultures and ways of life. Curing their conditions would be a form of genocide. (...) Members of other groups are seeking to provide medical treatment to what would conventionally be deemed 'cultural conditions'. Mild neurotics who take anti-depressants to elevate their mood, runners who use steroids, or men and women seeking cosmetic surgery are asking for medical treatment for problems that might be solved culturally, by changing norms, pressures, or expectations in the broader culture. Each of these two debates endeavors to locate medicine's final frontier and to articulate what it is that we should not treat medically even if we could. This volume analyzes what these two contemporary debates have to say to each other and thus offers a new way of determining medicine's final limits. (shrink)

Laing contends that the practice of eugenics has not disappeared. Conceptually related to the utilitarian and Social Darwinist worldview and historically evolving out of the practice of slavery, it led to some of the most spectacular human rights abuses in human history. The compulsory sterilization of and experimentation on those deemed “undesirable” and “unfit” in many technologically developed states like the US, Scandinavia, and Japan, led inexorably and most systematically to Nazi Germany with the elimination of countless millions of people (...) for their race, class, political views, sexuality, religion or disability. She Biometric databases exposing one’s medical data, DNA defects, IQ, political views, while in some ways appearing socially useful, demonstrates how vulnerable humans are, not just at the hands of political malfeasors and tyrants but insurance companies, government snoopers, false friends and determined social engineers. (shrink)

Traditional medicines -- Modern medicine -- Disease -- Diagnosis -- Drug -- Trial -- Treatment -- Prevention -- Iatroethics -- Science or technology, craft or service?

Nature and sources of medical ethics -- Sources of medical law -- Consent to treatment -- Confidentiality -- Clinical negligence -- Mental health -- Adults with Incapacity (Scotland) Act 2000 -- The law in relation to abortion -- The ethics of abortion -- Reproductive technology and surrogacy -- The law in relation to end of life issues -- The ethics of end of life issues -- Research -- Maintaining standards and regulation -- Presenting evidence and reports -- The (...) coroner's court -- The General Medical Council -- Employment and other rights of doctors. (shrink)

When first published twenty years ago, The Logic of Medicine presented a new way of thinking about clinical medicine as a scholarly discipline as well as a profession. Since then, advances in research and technology have revolutionized both the practice and theory of medicine. In this new, extensively rewritten edition, Dr. Murphy includes changes to show how these different areas of scholarship may affect details of "the logic of medicine" without compromising its fundamental coherence. New to this edition are discussions (...) of the challenge of the flood of new empirical data, new ideas in genetics, molecular biology, homeostasis, pathogenesis, cancer, aging, and Alzheimer's disease. Murphy also comments on such new theoretical topics as dynamic systems, chaos, and fractals and their impact on the burgeoning fields of philosophy and practice of medicine. Written with medical students in mind, the book includes a glossary, many new examples, and problems for solutions with comments on each. An entirely new chapter deals with modeling. Clinicians and researchers will also find the principles thought-provoking and illuminating. (shrink)

Introduction The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. Objective The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. Methods Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a retrospective historical (...) and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. Results Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1 – ethics in research (26); 2 – ethical procedures and advanced technology (46); 3 – ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. Conclusion The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education. (shrink)

These essays bring medical discoveries from ancient times to landmarks in modern medicine, and take the reader to twenty-first century biogenetics and molecular biology. This unique volume focuses on medical science as an art of healing, where modern medicine is not just restricted to science and technology.

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting (...) that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options. (shrink)

Technological developments often bring about new risks. Informed consent has been proposed as a means to legitimize the imposition of technological risks. This principle was first introduced in medical practice to assure the autonomy of the patient.The introduction of IC in the field of technological practice raises questions about the comparability of the type of informed consent. To what extent are thepossibilities to include laypeople in making decisions regarding risks similar in the technological field to giving informed consent in (...) the medical field and whatdoes this imply for the design and implementation of IC in the technological field? Medical and the technological practice are clearly alike in that both fieldsare characterized by highly specialized, technical knowledge which can be quite inaccessible to the average layperson. However, a fundamental difference ariseswith regard to the aim, knowledge of risks and exclusiveness of the practices in each field. The differences in aim imply that the necessity for each practice isperceived differently by laypeople, thus leading them to assess the respective risks differently. The differences in knowledge of risks arise from the variabilityin the ways that can be used to describe a given risk. Definition of risk in medical practice is more homogenous in this respect than the risk definition intechnological fields. Futhermore, medical practice tends to be more exclusive, leading laypeople immersed in that practice to necessarily embrace most of thefundamental underlying that practice. These differences result in divergent recommendations for the implementation of informed consent in the technological field, basically: there is a need for more extensive procedure and for less decisive authority for the individual. (shrink)

I begin with a discussion of the value of privacy and what we lose without it. I then turn to the difficulties of preserving privacy for genetic information and other medical records in the face of advanced information technology. I suggest three alternative public policy approaches to the problem of protecting individual privacy and also preserving databases for genetic research:(1) governmental guidelines and centralized databases, (2) corporate self-regulation, and (3) my hybrid approach. None of these are unproblematic; I discuss (...) strengths and drawbacks of each, emphasizing the importance of protecting the privacy of sensitive medical and genetic information as well as letting information technology flourish to aid patient care, public health and scientific research. (shrink)

Translator's summary and notes: Karl Jaspers (1883–1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today.Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every (...) class='Hi'>medical person, the researcher contests with the physician and the technician with the humanist. (shrink)

In informal terms, abductive reasoning involves inferring the best or most plausible explanation from a given set of facts or data. It is a common occurrence in everyday life and crops up in such diverse places as medical diagnosis, scientific theory formation, accident investigation, language understanding, and jury deliberation. In recent years, it has become a popular and fruitful topic in artificial intelligence research. This volume breaks new ground in the scientific, philosophical, and technological study of abduction. It presents (...) new ideas about inferential and information-processing foundations for knowledge and certainty. The authors argue that knowledge arises from experience by processes of abductive inference, in contrast to the view that it arises non-inferentially, or that deduction and inductive generalization are enough to account for knowledge. Much AI research is hypothetical, so the importance of this book is that it reports key discoveries about abduction that have been made as a result of designing, building, testing, and analyzing actual working knowledge-based systems for medical diagnosis and other abductive tasks. The book tells the story of six generations of increasingly sophisticated generic abduction machines, RED-1, RED-2, PEIRCE, MDX2, TIPS, QUAWDS, and the discovery of reasoning strategies that make it computationally feasible to form well-justified composite explanatory hypotheses, despite the threat of combinatorial explosion. The final chapter argues that perception is logically abductive and presents a layered-abduction computational model of perceptual information processing. This book will be of great interest to researchers in AI, cognitive science, and philosophy of science. (shrink)

Misunderstanding Science? offers a challenging new perspective on the public understanding of science. In so doing, it also challenges existing ideas of the nature of science and its relationships with society. Its analysis and case presentation are highly relevant to current concerns over the uptake, authority, and effectiveness of science as expressed, for example, in areas such as education, medical/health practice, risk and the environment, technological innovation. Based on several in-depth case-studies, and informed theoretically by the sociology of scientific (...) knowledge, the book shows how the public understanding of science questions raises issues of the epistemic commitments and institutional structures which constitute modern science. It suggests that many of the inadequacies in the social integration and uptake of science might be overcome if modern scientific institutions were more reflexive and open about the implicit normative commitments embedded in scientific cultures. (shrink)

In this paper I will discuss three areas in which advances in human reproductive technology could occur, their uses and abuses, and their effects on society. First is the potential to drastically increase the success rate and availability of in vitro fertilization and embryo freezing. Second is the ability to perform biopsies on embryos prior to the onset of pregnancy. Finally, I will consider the adding or altering of genes in embryos, commonly referred to as genetic engineering.As new reproductive technologies (...) pass from experimental models into the potential for medical utilization, I believe that it will be important for lawmakers everywhere to avoid the impulse to outlaw procedures that a society believes to be unnatural at a first glance. Rather, I would hope that they can respond thoughtfully with legislation that serves two purposes — to protect the rights of couples to overcome infertility or to reduce the risk of genetic disease in their children-to-be, and more importantly, to protect children-to-be from the abuses that could result from some of the practices that I will discuss. (shrink)

This paper begins with a discussion of the value of privacy,especially for medical records in an age of advancing technology.I then examine three alternative approaches to protection ofmedical records: reliance on governmental guidelines, the useof corporate self-regulation, and my own third hybrid view onhow to maintain a presumption in favor of privacy with respectto medical information, safeguarding privacy as vigorously andcomprehensively as possible, without sacrificing the benefitsof new information technology in medicine. None of the threemodels I examine are (...) unproblematic, yet it is crucial to weighthe strengths and weaknesses of these alternative approaches. (shrink)

This article introduces cultural studies of medicine to medical humanities readers. Rather than offer extended definitions of cultural studies of medicine or provide a detailed history of the domain, I have organized this introduction around a close reading and review of three recently published texts in the field. These three texts, dealing respectively with cyborg technology, AIDS, and the medical management of sexual identity problems, represent excellent examples of the opportunities and possibilities of applying cultural studies approaches to (...) medical topics. After working through these texts (and the semiotic theories which animate them), I devote my conclusion to a broader consideration of the role of cultural studies of medicine for both medical practice and medical humanities scholarship. (shrink)

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of (...) technological services by age. (shrink)

In the past, the study of the allocation of scarce medical resources centered around high-technology forms of health care such as the artificial heart, haemodialysis, et cetera. A major controversy considered in this study concerns the use of non-biomedical criteria (i.e., whether the social worth or financial status of a particular patient should dictate preferential medical treatment over another patient in times of shortage) in the allocation decision-making process. This article suggests that the study of allocation need not (...) only focus on the dramatic realm of the high-tech, but should also concern itself with less dramatic everyday situations. Decisions concerning treatment based upon social worth and financial status are made almost daily by most practitioners; a thorough awareness of this phenomenon is prerequisite to the proper practice of medicine. Interviews with physicians disclose that most of these everyday allocation decisions are made tacitly, with non-biomedical criteria playing a role even in decisions that appear to have been prompted only by benign (even-guided) intentions. (shrink)

There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD).

In addition to good medical services, all aspects of an economy must work together to ensure a high level of public health. However, the abundant economies of the North are contributing heavily to global environmental disaster, with increasing concomitant damage to human health. Environmental health problems result from toxicity (i.e., pollution), scarcity (i.e., poverty), and energy degradation (i.e., entropy). Common to these three factors in environmental demise are the limits of the Earth. Production has evolved to a point where (...) the Earth is no longer safe from radical depletion. Therefore, simple living is a necessary feature of global public health. Rarely do readers of this journal see these limits first hand, but they are real. Our limited perceptions and efforts hinder our ability to understand how to reduce the impact of production on natural ecosystems. Contrary to standard media portrayals, growth and technology cannot solve our public health problems, because they are unequally distributed across the world and neither can they solve the problem of limits. The need for modest consumption in developed nations is an essential and almost completely ignored element of the answer to environmental and associated health problems. A radical and rapid change to public health is needed in order to avoid abysmal global health consequences during the next century. These changes involve a restructuring of our economy, including the health care industry. In the short run, this is an ethical demand. In the long run, this is an inevitability. The actual and appropriate role of bioethicists in championing these changes is unclear. (Abstract by Bruce R. Smith). (shrink)

HTA and TA institutions at national parliaments (PTA) both share the same origin and of course have objectives and some of their methods in common. Nevertheless both TA branches developed in some distance during the 1970s and 1980s. Drawing on the case of biomedicine this paper outlines the differences between HTA and PTA, highlighting the “clinical perspective” of HTA and the “societal perspective” of PTA. It is shown that biomedicine which has developed rapidly during the last decade has hardly been (...) dealt with by HTA, whereas it ranked quite prominent on the agendas of PTA institutions. Biomedical technologies became a subject of policy making beyond the boundaries of health care politics since biomedicine is perceived as an ethical challenge to society and not only as a medical innovation that has to be assessed by clinical experts. It is argued that there may however be good reasons to integrate the HTA and the PTA perspective in future TA on biomedical technologies. (shrink)

Are sociologists always critical about genetics? Are philosophers always more supportive? This is the impression of many sociologists in the United Kingdom who argue that contemporary British philosophers criticise genetic technologies and applications in ways that scientists and medical doctors can deal with. They emphasise matters like informed consent, but pay less or no attention to the wider social consequences of technologies, practices and policies. Philosophers in their turn may see sociologists as irrationally hostile to science and medical (...) practice. Some of them refuse to criticise genetics, arguing that there is nothing to criticise. Others feel that their criticisms are in fact more accurate than the concerns raised by sociologists. And yet others point out that the impression of uncritical support can only be true of a certain specific group. Philosophers have so many internal disagreements among themselves that the generalisation can hardly be justified. In this paper an attempt is made by a sociologist (ML) and a philosopher (MH) to understand how sociological and philosophical perspectives on bioethics may differ in discussions about genetics. The paper, which proceeds in dialogue form, is based on our email correspondence on the advantages and disadvantages of genetic technologies and their applications, and on the idea of social consequences as understood by scholars from two different disciplines. (shrink)

In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assisted suicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal economic (...) loss. Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)

This book offers a comprehensive roadmap for determining when and how to regulate risky reproductive technologies on behalf of future children. First, it provides three benchmarks for determining whether a reproductive practice is harmful to the children it produces. This framework synthesizes and extends past efforts to make sense of our intuitive, but paradoxical, belief that reproductive choices can be both life-giving and harmful. Next, it recommends a process for reconciling the interests of future children with the reproductive liberty of (...) prospective parents. The author rejects a blanket preference for either parental autonomy or child welfare and proposes instead a case-by-case inquiry that takes into account the nature and magnitude of the proposed restrictions on procreative liberty, the risk of harm to future children, and the context in which the issue arises. Finally, he applies this framework to four past and future medical treatments with above average risk, including cloning and genetic engineering. Drawing lessons from these case studies, Peters criticizes the current lack of regulatory oversight and recommends both more extensive pre-market testing and closer post-market monitoring of new reproductive technologies. His moderate pragmatic approach will be widely appreciated. (shrink)

Due to the rapid advances in medical technology, medical students are now being faced with increasingly complex and unparalleled ethical and practical dilemmas during their training. The new and future challenges of high-tech medicine demand improvements in current medical education, not only by meeting the needs of students through humanized training programs, but also by involving them in finding solutions to the ethical and legal quandaries they encounter. Today’s students of medical universities must acquire knowledge and (...) understanding of the ethical and legal issues relevant to the practice of medicine, and we have to do everything possible to introduce these students to the current discussions on more or less controversial ethical and legal topics. Although final answers may not be found, the very discussion, argumentation, and awakening of students’ interest should become an essential part of the core curriculum of every doctor. (shrink)