This article analyses the different connotations of “normality” and “being natural,” bringing together the theoretical discussion from both human medicine and veterinarymedicine. We show how the interpretations of the concepts in the different areas could be mutually fruitful. It appears that the conceptions of “natural” are more elaborate in veterinarymedicine, and can be of value to human medicine. In particular they can nuance and correct conceptions of nature in human medicine that (...) may be too idealistic. Correspondingly, the wide ranging conceptions of “normal” in human medicine may enrich conceptions in veterinarymedicine, where the discussions seem to be sparse. We do not argue that conceptions from veterinarymedicine should be used in human medicine and vice versa, but only that it could be done and that it may well be fruitful. Moreover, there are overlaps between some notions of normal and natural, and further conceptual analysis on this overlap is needed. (shrink)
Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional ethics, one (...) should notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professional ethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)
This paper proposes an ethical reflection on personalized medicine and more precisely on the diagnostic technology underlying it, including nanochips. Our approach is inspired by a combination of two philosophical frames of reference: first, John Dewey’s distinction between intuitive valuation and reflexive evaluation, second, John Rawls’ reflective equilibrium. We aim at what we call a ‘reflexive equilibrium’, a mutual adjustment between on the one hand, the intuitive beliefs scientists have about the ethics of the technologies they work on (...) (‘valuations’ in Dewey’s vocabulary) and, on the other hand, the reflexive ethical assessment of these technologies (‘evaluations’). Our goal, in this paper, is to provide the first step of this process through a philosophical analysis of some valuations on individualized medicine. In order to apprehend the ethical values shaping the development of biochips, we present and analyze qualitative interviews with scientists involved in the conception and the development of biochips involving nanotechnologies. We then propose a critical assessment of the role of ethics in these scientific practices. Last, we suggest two distinct and complementary ways to solve some of the issues brought to light by the interviews, without aiming at any dogmatic or “ready-made” answer. The first of these perspectives gives a central role to the capability individuals could achieve through personalized medicine; the second approach analyses the ethical disruptions entailed by personalized medicine with a special focus on care. (shrink)
This essay examines the so-called phenomenon of defensive medicine and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a defensive measure.
Medicine and families, two venerable institutions crucial to human well-being, are in crisis. The medical profession, struggling to control and equitably distribute care, finds itself compromised by its own success; families are shattered by divorce, violence and confusion about their own nature. What has gone unnoticed is the way these two powerful and pervasive spheres contribute to each other's loss of direction. The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each (...) other. The authors explore how medicine, through its new reproductive technologies, is altering the structure of families, how families can participate more fully in medical decision-making, and how to understand the impact on families when medical advances extend life but not vitality . This book takes an unprecedented perspective on both institutions. Innovative and vivid, their stories tell the tales of families interacting with the medical establishment. (shrink)
While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in (...) a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)
Veterinarians have obligations towards both the animals they treat and their clients, the owners of the animals. With both groups, veterinarians have complicated relations; many times the interests of both groups conflict. In this article, using Q-methodology as a method for discourse analysis, the following question is answered: How do Dutch practicing veterinarians conceptualize animals and their owners and their professional responsibility towards both? The main part of the article contains descriptions of four different discourses on animals and their owners (...) and on veterinarian professional responsibilities that prevail among veterinarians. The factual images veterinarians have of animals and their owners are connected to different moral questions and solutions to these questions. (shrink)
Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These (...) have piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters. (shrink)
Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.
With the prevalence of complementary and alternative medicine (CAM) increasing in western societies, questions of the ethical justification of these alternative health care approaches and practices have to be addressed. In order to evaluate philosophical reasoning on this subject, it is of paramount importance to identify and analyse possible arguments for the ethical justification of CAM considering contemporary biomedical ethics as well as more fundamental philosophical aspects. Moreover, it is vital to provide adequate analytical instruments for this task, (...) such as separating ‘CAM as belief system’, and ‘CAM as practice’, Findings show that beneficence and non-maleficence are central issues for an ethical justification of CAM as practice, while freedom of thought and religion are central to CAM as belief system. Many justification strategies have limitations and qualifications that have to be taken into account. Singularly descriptive premises in an argument often prove to be more problematic than universal ethical principles. Thus, non-ethical issues related to a general philosophical underpinning - e.g. epistemology, semantics, and ontology - are highly relevant for determining a justification strategy, especially when strong metaphysical assumptions are involved. Even if some values are shared with traditional biomedicine, axiological differences have to be considered as well. Further research should be done about specific CAM positions. These could be combined with applied qualitative social research methods. (shrink)
This paper provides a brief overview and critique of the dominant objectivist understanding and use of illness narrative in Enlightenment (scientific) medicine and ethics, as well as several revisionist accounts, which reflect the evolution of this approach. In light of certain limitations and difficulties endemic in the objectivist understanding of illness narrative, an alternative phronesis approach to medical ethics influenced by Charles Taylor’s account of the interpretive nature of human agency and language is examined. To this end, (...) the account of interpretive medical responsibility previously described by Schultz and Carnevale as "clinical phronesis" (based upon Taylor’s notion of "strong" or "radical evaluation") is reviewed and expanded. The thesis of this paper is that illness narrative has the ability to benefit patients as well as the potential to cause harm or iatrogenic effects. This benefit or harm is contingent upon how the story is told and understood. Consequently, these tales are not simply "nice stories," cathartic gestures, or mere supplements to scientific procedures and decision making, as suggested by the objectivist approach. Rather, they open the agent to meanings that provide a context for explanation and evaluation of illness episodes and therapeutic activities. This understanding provides indicators (guides) for right action. Hence, medical responsibility as clinical phronesis involves, first, the patient and provider’s coformulation and cointerpretation of what is going on in the patient’s illness narrative, and second, the patient and provider’s response to interpretation of the facts of illness and what they signify–not simply a response to the brute facts of illness, alone. The appeal to medical responsibility as clinical phronesis thus underscores the importance of getting the patient’s story of illness right. It is anticipated that further elaboration concerning the idea of clinical phronesis as interpretive illness narrative will provide a new foundation for medical ethics and decision making. (shrink)
This commentary, while sympathetic to Thomasma and Pellegrino , raises three sets of questions concerning the adequacy of their view of medicine as a foundation for medical ethical decision-making. The first set of questions concerns the account of the nature of medicine presented by Thomasma and Pellegrino. It is argued that the account is not clearly univocal and that even the most important description offered requires further clarification. Questioned, secondly, is the reasoning used by Thomasma and Pellegrino to (...) propel their movement from establishing an evaluative component in medicine to asserting an ethical dimension to medical judgment. It is argued that the authors equivocate in their presentation between the medical and moral uses of value terms. Finally, the role of the living body as a foundation for medical ethics is questioned, both in terms of the normative force such a ground can generate, and in terms of the range of duties to which this foundation must commit the profession. (shrink)
Background The broad topic of research ethics is one which has been relatively well-investigated and discussed. Unique ethical issues have been identified for such populations as pediatrics, where the issues of consent and assent have received much attention, and obstetrics, with concerns such as the potential for research to cause harm to the fetus. However, little has been written about ethical concerns which are relatively unique to the population of patients seen by the practitioner of rehabilitation medicine. Discussion (...) This paper reviews unique ethical concerns in conducting research in this population, including decision-making capacity, communication, the potential for subject overuse, the timing of recruitment, hope for a cure and therapeutic misconception and the nature of the health care provider-research subject relationship. Summary Researchers in the area of rehabilitation medicine should be aware of some of the unique ethical challenges posed by this patient population and should take steps to address any potential concerns in order to optimize subject safety and ensure that studies meet current ethical guidelines and standards. (shrink)
Foot-and-mouth disease was the event which led to the increased and improved training of veterinarians able to produce through their research new veterinary knowledge for practical application.It led to the transformation of the Mexican veterinary profession. It changed the kind of knowledge veterinarians received at university, and it also changed the work they did as professionals. Veterinarians gradually began to perform a much wider range of tasks: they did research, taught, worked as civil servants, or assumed positions as (...) academic administrators and as high governmental officials with a large amount of influence on governmental agricultural activities. They also engaged directly in animal husbandry and in food production.In parallel with these changes, the National University, and within it the Faculty of VeterinaryMedicine and Animal Husbandry, underwent a concomitant series of changes which ran hand-in-hand with the growth of the Mexican state. The university provided training for specialised research workers by offering scholarships and programmes of graduate study. This consolidated the activities of an academic community working on applied veterinarymedicine. The beneficiaries of these efforts take part in and influence, to varying degrees, the planning and programming of agricultural policies in a way that would not formerly have been possible. (shrink)
This short work examines what the Hippocratic Oath said to Greek physicians 2400 years ago and reflects on its relevance to medical ethics today. Drawing on the writings of ancient physicians, Greek playwrights, and modern scholars, each chapter explores one passage of the Oath and concludes with a modern case discussion. This book is for anyone who loves medicine and is concerned about the ethics and history of the profession.
While ethicists have directed much attention to controversial biomedical issues--including euthanasia, abortion, and genetic engineering--they have largely ignored the less obvious, but more pervasive, everyday ethical problems faced by family physicians. Ethical Issues in Family Medicine addresses these problems, offering an ethics that reflects the distinctive features of family practice, and helping family physicians to appreciate the extent to which ethical issues influence their practice.
The concept of reproductive health promises to play a crucial role in improving women's health and rights around the world. It was internationally endorsed by a United Nations conference in 1994, but remains controversial because of the challenge it presents to conservative agencies: it challenges policies of suppressing public discussion on human sexuality and regulating its private expressions. Reproductive Health and Human Rights is designed to equip healthcare providers and administrators to integrate ethical, legal, and human rights principles in protection (...) and promotion of reproductive health, and to inform lawyers and women's health advocates about aspects of medicine and healthcare systems that affect reproduction. Rebecca Cook, Bernard Dickens, and Mahmoud Fathalla, leading international authorities on reproductive medicine, human rights, medical law, and bioethics, integrate their disciplines to provide an accessible but comprehensive introduction to reproductive and sexual health. They analyse fifteen case-studies of recurrent problems, focusing particularly on resource-poor settings. Approaches to resolution are considered at clinical and health system levels. They also consider kinds of social change that would relieve the underlying conditions of reproductive health dilemmas. Supporting the explanatory chapters and case-studies are extensive resources of epidemiological data, human rights documents, and research materials and websites on reproductive and sexual health. In explaining ethics, law, and human rights to healthcare providers and administrators, and reproductive health to lawyers and women's health advocates, the authors explore and illustrate limitations and dysfunctions of prevailing health systems and their legal regulation, but also propose opportunities for reform. They draw on the values and principles of ethics and human rights recognized in national and international legal systems, to guide healthcare providers and administrators, lawyers, governments, and national and international agencies and legal tribunals. Reproductive Health and Human Rights will be an invaluable resource for all those working to improve services and legal protection for women around the world. -/- Updates to this book, and information on translations to French, Spanish, Portuguese, Chinese and Arabic are now available at www.law.utoronto.ca/faculty/cook/ReproductiveHealth.html. (shrink)
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)
The article explores the communist ideology that has guided the formation of professional ethics of medicine in China. It first explores the constitutions of the People’s Republic of China and the Chinese Communist Party and codes of practice for medicine enforced since 1949, showing that the core of the ideology in relation to health provision and doctor–patient relationship has always been ‘serving the people wholeheartedly’. The ideological undertaking, however, has never been successfully exercised. In the pre-reform era, (...) the bureaucratisation of health professionals led to the emergence of ‘bureaucratic medicine’ featuring negligence of patients’ interests. In the reform era, the prevailing commercialisation of health care is in fundamental conflict with the ideological commitment to serving the people. As a result, the socialist professional ethics of medicine has not been satisfactorily practiced in reality. (shrink)
Religion and medicine -- Theology and medical ethics -- The profession and its integrity -- Life and its sanctity -- Health and healing -- Death and its (in)dignity -- Nature and its mastery -- Care of patients and their suffering -- Respect for persons and their agency -- Contraception -- Technological reproduction -- Genetic control -- Abortion -- Choosing death and letting die -- Care of neonates -- The physician-patient relationship: advise and consent -- Psychiatric care: professional commitments (...) and social responsibilities -- Research and experimentation -- Allocation and distribution.; This collection includes a wide range of contemporary theological essays dealing with medicineethics, as well as some material from Scripture and from classical theologians. It contains the work of Catholics and Protestants, "liberals" and "evangelicals," as well as some contemporary essays not written by Christian theologians but of great importance for theological reflection. Together the essays provide a rich introduction to theological reflection on medical ethics and a convincing demonstration of the contribution theology can make to the consideration of issues in medical ethics. (shrink)
Recruiting minorities into research studies requires special attention, particularly when studies involve “extra-vulnerable” participants with multiple vulnerabilities, e.g., pregnant women, the fetuses/neonates of ethnic minorities, children in refugee camps, or cross-border migrants. This study retrospectively analyzed submissions to the Ethics Committee of the Faculty of Tropical Medicine (FTM-EC) in Thailand. Issues related to the process and outcomes of proposal review, and the main issues for which clarification/revision were requested on studies, are discussed extensively.
Medicine in a Neurocentric World: About the Explanatory Power of Neuroscientific Models in Medical Research and Practice Content Type Journal Article Category Editorial Notes Pages 307-313 DOI 10.1007/s12376-009-0036-2 Authors Lara Huber, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 55131 Mainz Germany Lara K. Kutschenko, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine (...) Am Pulverturm 13 55131 Mainz Germany Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4. (shrink)
The moral authority for professional ethics in medicine customarily rests in some source external to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, internal morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians (...) qua physicians. Similarly, an ethic specific to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship. (shrink)
The article offers an approach to inquiry about, the foundation of medical ethics by addressing three areas of conceptual presupposition basic to medical ethical theory. First, medical ethics must presuppose a view about the nature of medicine. it is argued that the view required by a cogent medical morality entails that medicine be seen both as a healing relationship and as a practical art. Three ways in which medicine inherently involves values and valuation are presented (...) as important, i.e., in being aimed at the good of health, in being a cognitive art evaluating towards that good, and as a manifestation of a virtuous disposition concerning that good. Finally, a value ontology drawn from these considerations is seen as necessarily underlying medical ethics. A set of three such basic values are promoted as crucial: the value of health; the value of the individual patient; and the value of altruism that mediates the class of potential patients. (shrink)
This essay discusses the ethics of traditional Chinese medicine. After a brief remark on the history of traditional Chinese medical ethics, the author outlines the Confucian ethics which formed the cultural context in which traditional Chinese medicine was evolving and constituted the core of its ethics. Then he argued that how Chinese physicians applied the principles of Confucian ethics in medicine and prescribed the attitude a physician should take to himself, to patients (...) and to his colleagues. In the last part of the essay he discusses the characteristics of traditional Chinese medical ethics. Keywords: Confucian, China, humaneness, compassion, virtues CiteULike Connotea Del.icio.us What's this? (shrink)
The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, (...) epistemology, and political philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring - stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy. (shrink)
The search for an ontological basis of medical practice is questioned from the viewpoint that ontologies are always related to the interpreting person in his situation, and that the definition of medicine includes a certain choice. This choice-character comes into greater play when ethical proposals are made. A foundation of medical ethics on an ontology of the healthy body or the factual medical practice is a naturalistic fallacy. Prior to an ontological basis, the ethical event of responsibility for (...) the suffering and transcendent other (Levinas) is constitutive for medicine. This event with its dimension of infinity of the other can only be ontologized by a totalitarian act. A philosophy of medicine should start with the heteronomy of the other. (shrink)
The objective of this article is to investigate ethical aspects of technology through the moral term “paternalism”. The field of investigation is medicine. The reason for this is twofold. Firstly, “paternalism” has gained moral relevance through modern medicine, where physicians have been accused of behaving paternalistic and threatening patients’ autonomy. Secondly, medicine is a brilliant area to scrutinise the evaluative aspects of technology. It is argued that paternalism is a morally relevant term for the ethics of (...) technology, but that its traditional conception is not adequate to address the challenges of modern technology. A modification towards a “technological paternalism” is necessary. That is, “technological paternalism” is a fruitful term in the ethics of technology. Moreover, it is suited to point out the deficiencies of the traditional concept of paternalism and to reform and vitalise the conception of paternalism in ethics in order to handle the challenges of technology. (shrink)
Some problems that arise in the account given by Thomasma and Pellegrino  of the foundations of medical ethics in a philosophy of medicine are addressed, in particular questions of a conceptual character about treating therelatum of medicine as health. Which concept of health is appropriate and which will bear the burden of the position thomasma and Pellegrino advance? It is argued that the proper relationship of medicine is one between a healer and developing embodied minds. (...) As a consequence, the project of providing a univocal account of the nature of medicine fails. Instead, pluralism infects philosophy and medicine, resulting in different philosophies of medicine. From these philosophies of medicine will follow not a single medical ethics but a variety. (shrink)
The social ethics of medicine is the study and ethical analysis of social structures which impact on the provision of health care by physicians. There are many such social structures. Not all these structures are responsive to the influence of physicians as health professionals. But some social structures which impact on health care are prompted by or supported by important preconceptions of medical practice. In this article, three such elements of the philosophy of medicine are examined in (...) terms of the negative impact on health care of the social structures to which they contribute. The responsibilities of the medical profession and of individual physicians to work to change these social structures are then examined in the light of a theory of profession. (shrink)
From an ethical standpoint, the goal of clinical research is to benefit patients. While individual investigations may not yield results that directly improve patients’ evaluation or treatment, the corpus of the research should lead in that direction. Without the goal of ultimate benefit to patients, such research fails as a moral enterprise. While this may seem obvious, the need to protect and benefit patients can get lost in the milieu of clinical research. Many advances in emergency medicine have been (...) based upon the results of research studies conducted both within the specialty and by others outside of the field. But has this research benefited patients? Has it followed the Hippocratic commitment “to do good or at least do no harm”? The answer is: yes, and no. This paper attempts to demonstrate this: first by citing advances from applied research that have benefited emergency department patients over the past three decades, and follows with some aspects of emergency medicine research that makes one question both its safety and its efficacy. While enormous gains have been made in patient care as a result of emergency medical research, ethical considerations complicate this rosy picture, and point to future areas of concern for researchers. (shrink)
In an era of rapidly rising health care costs, physicians and policymakers are searching for new and effective ways to contain health care spending without sacrificing the quality of services provided. These proposals are increasingly articulated in terms of an ethical duty of stewardship. The duty of stewardship in medicine, however, is not at present well understood, and it is frequently conflated with other duties. This article presents a critical analysis of the notion of stewardship, which shows that it (...) has an important and distinctive place in medical ethics. It claims that stewardship in medicine concerns the responsible use of a society’s medical resources and it discusses the extent to which medical professionals are the proper stewards of these resources. The article argues that the duty of stewardship is best understood as a duty that applies in a space between the obligations of health care providers to provide beneficent care to their patients on the one hand and the obligations of citizens to bring about and support a just health care system on the other. Seen with clear eyes, stewardship in medicine is neither a consequence of beneficent medical care nor a substitute for justice. (shrink)
Next SectionEvidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, (...) other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. (shrink)
Foucault's genealogies and archeologies provide occasions in which one may come to know the powers, accidents, and influences that have structured a particular knowledge or discipline. The Birth of the Clinic shows the development of modern medicine in a process by which rational inference and emphasis on the history of a disease are replaced by pathological anatomy. In modern anatomy, the corpse, not reason, became the “space” of modern medical knowledge. In this “space” developed a confederation of dead body, (...) knowledge, trained and noninferential gaze, organic unity, and the increased importance of bodily space instead of physical time. The discussion shows how Foucault's genealogy of modern medicine is influenced by and overcomes the knowledge that it describes. In this context, his genealogy is also shown to be self-overcoming and to raise important questions for medical ethics when ethical thought is conceived within the structures of knowledge that have been exposed by the genealogy. (shrink)
On the 50th anniversary of the Willowbrook experiment's inception, in which Dr. Saul Krugman intentionally infected cognitively disabled children with hepatitis, it is worth reflecting on how our attitude toward research ethics of the past informs our current practices. In examining ethical violations in postwar medicine, we frequently turn to examples that shock and appall, thereby offering concomitant comfort as we measure their safe distance from our own medical context. And yet, which modern medical student has not heard (...) a variation of the phrase "This study would never have passed an ethics committee today" in reference to a classic experiment or a professor's very own work? Even with Nuremburg fresh in the .. (shrink)
Although it is now generally acknowledged that new biomedical technologies often produce new definitions and sometimes even new concepts of disease, this observation is rarely used in research that anticipates potential ethical issues in emerging technologies. This article argues that it is useful to start with an analysis of implied concepts of disease when anticipating ethical issues of biomedical technologies. It shows, moreover, that it is possible to do so at an early stage, i.e. when a technology is only just (...) emerging. The specific case analysed here is that of ‘molecular medicine’. This group of emerging technologies combines a ‘cascade model’ of disease processes with a ‘personal pattern’ model of bodily functioning. Whereas the ethical implications of the first are partly familiar from earlier—albeit controversial—forms of preventive and predictive medicine, those of the second are quite novel and potentially far-reaching. (shrink)
Human and veterinarymedicine have many commonalities. The split into distinct disciplines occurred at different times in different places. In Europe, the establishment of the first veterinary universities towards the end of the 18th century was triggered by ravaging rinderpest epidemics and the increasing importance of livestock for draft, food supply, and war fare. Given this background, would it make sense to combine human, animal, traditional and modern medicine in healthcare provision, especially in less developed countries? (...) Such a “one-medicine” approach could enhance biomedical progress, improve the outreach of medical and veterinary services especially in remote areas, offer greater choices to patients, and make healthcare more culturally appropriate. On the other hand, it would require generalists rather than specialists and rare diseases may go unrecognized. The commonalities of human and veterinarymedicine and the financial constraints many governments are presently facing are arguments in favor of a “one-medicine” approach, while status thinking, education systems, administrative structures, and legislations hinder its implementation. There are no instant recommendations for the application of one medicine but governments and development professionals need to generate fine-tuned, location-specific healthcare solutions. Advocacy, changes in education and training, the creation of institutional linkages, and the removal of legal barriers could help overcome obstacles. (shrink)
This article comments on the treatment of critical-care ethics in four preceding articles about critical-care medicine and its ethical challenges in mainland China, Hong Kong, Japan, and the Philippines. These articles show how cultural values can be in both synchrony and conflict in generating these ethical challenges and in the constraints that they place on the response of critical-care ethics to them. To prevent ethical conflict in critical care the author proposes a two-step approach to the ethical (...) jus tification of critical-care management: (1) the decision to resuscitate and initiate critical-care management, which is based on the obligation to prevent imminent mortality without permanent loss of consciousness; and (2) the decision to continue critical-care management, which is based on the obligation both to prevent imminent death without permanent loss of consciousness and to avoid unnecessary, significant iatrogenic costs to the patient and psychosocial costs to the family when the reduction of morta lity risk is marginal. Physicians and hospitals should restore the critical-care physician's authority and power - against prevailing cultural values, if necessary - to control when critical-care intervention is offered, when it is recommended to continue, and when it is recommended to be discontinued and the patient allowed to die. (shrink)
The internet is becoming increasingly important in health care practice. The number of health-related web sites is rising exponentially as people seek health-related information and services to supplement traditional sources, such as their local doctor, friends, or family. The development of e-medicine poses important ethical challenges, both for health professionals and for those who provide clinical ethics support for them. This paper describes some of these challenges and explores some of the ways in which those who provide clinical (...)ethics support might respond creatively to them. By offering ways of responding to such challenges, both electronically and face-to-face, the providers of clinical ethics support can show themselves to be an indispensable part of good quality health care provision. (shrink)