This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paper—and really the lead in idea—stresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) is killing (...) another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended. (shrink)

Objective: To evaluate existing ethical guidelines for the treatment of hunger strikers in light of findings on psychological changes that accompany the cessation of food intake.Design: Electronic databases were searched for editorials and ethical proclamations on hunger strikers and their treatment; studies of voluntary and involuntary starvation, and legal cases pertaining to hunger striking. Additional studies were gathered in a snowball fashion from the published material cited in these databases. Material was included if it provided ethical or legal guidelines; (...) shed light on psychological changes accompanying starvation, or illustrated the practice of hunger striking. Authors’ observations, opinions, and conclusions were noted.Conclusions: Although the heterogeneous nature of the sources precluded statistical analysis, starvation appears to be accompanied by marked psychological changes. Some changes clearly impair competence, in which case physicians are advised to follow advance directives obtained early in the hunger strike. More problematic are increases in impulsivity and aggressivity, changes which, while not impairing competence, enhance the likelihood that patients will starve themselves to death. (shrink)

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the (...) application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. (shrink)

This book presents essays by eminent scholars from across the history of medicine, early science and European history, including those expert on the history of the book. The volume honors Professor Nancy Siraisi and reflects the impact that Siraisi's scholarship has had on a range of fields. Contributions address several topics ranging from the medical provenance of biblical commentary to the early modern emergence of pathological medicine. Along the way, readers may learn of the purchasing habits of physician-book collectors, (...) the writing of history and the development of natural history. Modeling the interdisciplinary approaches championed by Siraisi, this volume attests to the enduring value of her scholarship while also highlighting critical areas of future research. Those with an interest in the history of science, the history of medicine and all related fields will find this work a stimulating and rewarding read. (shrink)

Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson’s disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette’s syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore (...) disrupted communication between and among groups of neurons in interacting regions of the brain. This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders.But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient’s condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient’s quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians’ exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure. (shrink)

Should people be assisted to die or be given euthanasia when they are suffering from terminal medical conditions? Should they be assisted to die when they are suffering but do not have a ‘diagnosable medical illness?’ What about assisted dying for psychiatric conditions? And is there a difference morally between assisted suicide, voluntary active euthanasia and voluntary passive euthanasia?These are deep questions directly addressed or in the background of the productive discussion between Varelius and Young.1 ,2 Their focus is whether (...) doctors should assist people to die who are ‘tired of life’ and experiencing ‘existential suffering’. An example was Edward Brongersma, an 86-year-old man, who was tired of life but with no serious medical condition, who was assisted by Dr Philip Sutorius to commit suicide in 1998. In the Netherlands, where euthanasia is legal, the Dutch Supreme Court ruled in 2002 that this was wrong because "edical expertise, by its nature, does not extend to questions and complaints that do not have a sick- ness or ailment—mental or physical—as their source.3"Sutorius was convicted, but not punished.Robert Young, considering this case, concurs, concluding, "a physician may justifiably consider that an individual who is ‘tired of life’ should consult a non-medical, professional counsellor, and if that produces no change in outlook, choose suicide. Outside Switzerland, an individual who makes that choice has to then be determined enough to do so unassisted .2"I will argue that there is, within current medical ethics and human rights, a method of assisted suicide which could fall within the limits of the law. But first I will review some recent cases involving requests for dying. I will then discuss an alternative which some may argue addresses these cases, and those of …. (shrink)

The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both (...) for-profit and not-for-profit sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients.This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the traditional autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas. (shrink)

Recent advances in biomedical technology and therapeutic procedures hace generatad a moral crisis in modern medicine. The cast strides made in medical science and technology have creatred options which only a few decades earlier would have been relegated to the realm of science fiction. Man, to a significant degree, now has the ability to exercise control not only over the stages of disease but even over the very processes of life and death, With the unfolding of new discoveries and techniques, (...) the sceintific an dintellectual communities have developed a keen awareness of the ethical issues which arise out of man's enhanced ability to control his destiny. In response to the concern over questions of this nature, there has emerged the rapidly developing field of bioethics. Jews, to whomall such questions are quests not only for applicable humanitarian principles but for Divine guidance, must, of necessity, seek answers in the teachings of the Torah . "The Torah of God is Perfect" ( Psalms 19:8), and in its teachings the discernign student will find eternally-valid answers to even newly-formulated queries. As Physicians and patients turn to Rabbinic authorities for answers, Jewish scholars seen to elucidate and expound the teachings of the torah in these vital areas of concern. The present essay hgihlights some of the ethical issues faced by the Jewish physician who faithfully observes his tradition in all matters including his daily practise of medicin. Although more questions are raised than answered, the aim of this essay will have been achieved if the reader is stimulates to pursue these issues in the extensive writings on the subject now available in English CiteULike Connotea Del.icio.us What's this? (shrink)

This contribution intends to explore patients’ lived experience, with a focus on the temporal dimension. On the basis of a qualitative study that led me to interview persons with Parkinson’s disease, caregivers, and medical professionals, I develop an empirical and philosophical investigation of the temporalities surrounding the implementation of deep brain stimulation in Greece. I raise the issue of access to DBS medical care, and show how distinct temporalities are implied when the patients face such a matter: that of linear (...) time, linked with the medical discourse, the bureaucratic time linked to administrative and financial hurdles in the implementation and maintenance of DBS, and the technological time of the body/technology fusion. I consider initially the impact of technology and health care settings on the lived experience of patients and the enactment of multiple bodies which are interrelated with the social world. I then expand my analysis in order to show that this experience cannot be a solipsistic one, or specific to one physician/patient relationship. It is fully socially shaped. (shrink)

BackgroundBreaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child’s disability. Egyptian mothers’ preferences for how to be told the bad news about their child’s disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers’ preferences for how to be told the bad news about their child’s disability.MethodsMothers of 100 infants (...) recently diagnosed with Down syndrome were interviewed regarding their preferences for how to be told bad news. Mothers were recruited through outpatient clinics of the Pediatric Genetics Department at Fayoum University Hospital (located 90 km southwest of Cairo, Egypt) from January to June 2011.Results and discussionQuestionnaire analyses revealed nine themes of parental preferences for how to be told information difficult to hear. Mothers affirmed previously reported recommendations for conveying bad medical news to parents, including being told early, being told of others with a similar condition, and being informed of the prognosis.ConclusionsMothers affirmed communication themes previously discussed in the literature, such as being told early, and being informed of the prognosis. Although more research is needed in this important area, we hope that our findings will stimulate future search and help health care providers in different societies establish guidelines for effectively communicating bad news. (shrink)

BackgroundBreaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child’s disability. Egyptian mothers’ preferences for how to be told the bad news about their child’s disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers’ preferences for how to be told the bad news about their child’s disability.MethodsMothers of 100 infants (...) recently diagnosed with Down syndrome were interviewed regarding their preferences for how to be told bad news. Mothers were recruited through outpatient clinics of the Pediatric Genetics Department at Fayoum University Hospital (located 90 km southwest of Cairo, Egypt) from January to June 2011.Results and discussionQuestionnaire analyses revealed nine themes of parental preferences for how to be told information difficult to hear. Mothers affirmed previously reported recommendations for conveying bad medical news to parents, including being told early, being told of others with a similar condition, and being informed of the prognosis.ConclusionsMothers affirmed communication themes previously discussed in the literature, such as being told early, and being informed of the prognosis. Although more research is needed in this important area, we hope that our findings will stimulate future search and help health care providers in different societies establish guidelines for effectively communicating bad news. (shrink)

While there may be a place in some contexts for high handed, “blanket” legislative prohibitions on dissenting views of what constitutes death, the paper under consideration does not describe such a contextThis stimulating and provocative paper by Professor Appel, Defining death: when physicians and families differ, asks us to consider “whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards”. This is a striking question in many ways. It reminds (...) us that, as a simple description of fact, there are indeed different standards for human death in so far as different groups or communities have accepted and continue to accept varying notions of what constitutes human death. The question’s reference to “opting out” suggests, perhaps reasonably, that it seems prima facie odd to think of adopting a definition of death as being a matter of individual choice. The reference to “permission” invites us to suppose limitations, primarily legal, upon the extent to which such a choice could be tolerated. Also, the question ascribes to certain “definitions of death” the authority of being widely accepted. The definitions thus favoured are, we learn, the various formulations of death referring to the state of the brain, chief among them “whole brain death” although the author is troublingly vague over whether all such formulations are morally, legally, or conceptually equivalent; and the relevant communities of acceptance turn out to consist of many—but, as the author admits, not all—physicians labouring under varying and inconsistent jurisdictions in the United States.My preface to the criticisms that follow is a …. (shrink)

Nourbakhsh et al. found that amantadine, modafinil, and methylphenidate were no better than placebo at reducing fatigue after six weeks. Consequently, physicians have raised ethical concerns about prescribing these medicines as “placebos.” Such concerns are premature and overshadowed by ethical concerns surrounding the habit-forming potential of modafinil and methylphenidate.

Now I know why so many stories have been written with the theme: “everything changed in one moment.” More than 1,000 days have come and gone, and I still remember one Sunday morning and still follow and feel the effects of one decision.

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because patients in PDOC can (...) survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory–practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices in medicine. The (...) Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: providing effective education to change attitude and behavior; considering motivational and emotional factors; reconstructing regulations and processes to facilitate ethical practice; conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation. (shrink)

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory–practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices in medicine. The (...) Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: providing effective education to change attitude and behavior; considering motivational and emotional factors; reconstructing regulations and processes to facilitate ethical practice; conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation. (shrink)

Are physicians sometimes morally required to ease caregiver burden? In our paper we defend an affirmative answer to this question. First, we examine the well-established principle that medical care should be centered on the patient. We argue that although this principle seems to give physicians some leeway to lessen caregivers' suffering, it is very restrictive when spelled out precisely. Based on a critical analysis of existing cases for transcending patient-centeredness we then go on to argue that the medical ethos should (...) indeed contain a rule requiring physicians to alleviate caregiver burden under certain circumstances. Finally, we apply our findings to deep brain stimulation (DBS) for Parkinson's disease. We present empirical data from a recent study of DBS indicating that spousal caregivers of Parkinson patients treated with DBS are sometimes deeply troubled by the effects of the therapy and discuss what moral obligations the treating physicians may have in such cases. (shrink)

In an article recently published in the Journal of Medical Ethics, I assessed the position that voluntary euthanasia and physician-assisted suicide can be appropriate only in cases of persons who are suffering unbearably because they are ill or injured, not in cases of unbearably distressed persons whose suffering is caused by their conviction that their life will never again be worth living. More precisely, I considered one possible way of defending that position, the argument that the latter kind of (...) distress—to which I referred to as existential suffering—does not qualify as grounds for VE and PAS because doctors are not experts on questions pertaining to the meaning, value and purpose of life: existential questions, as I called them. I maintained that cases of VE and PAS related to illness and injury involve existential questions relevantly similar to those faced in connection with existential suffering. Therefore, I concluded, if VE and PAS based on suffering arising from illness or injury falls within the domain of medical expertise, it is consistent that VE and PAS cannot be denied in cases of purely existential suffering by maintaining that the professional expertise of doctors does not extend to existential questions.1The article inspired some interesting discussion. Robert Young offered two reasons for thinking that its argument is of limited practical significance.2 Julian Savulescu maintained that, within current medical ethics and human rights, there already is a method of assisted suicide: voluntary palliated starvation , which allows that existential distress can sometimes provide grounds for assisted dying and which could fall within the limits of the law.3 The discussion by Young and Savulescu suggest that my argument, or rather the nature of the project of which it is purported to be a part, could benefit from some clarification. That …. (shrink)

Can a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment and (...) consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications – access to MAiD. (shrink)

BackgroundPast research shows that physicians experience high ill-being but also high well-being.ObjectiveTo shed light on how medical faculty’s experiences of their job demands and job resources might differentially affect their ill-being and their well-being with special attention to the role that the work-life interface plays in these processes.MethodsQualitative thematic analysis was used to analyze interviews from 30 medical faculty at a top research hospital in Canada.FindingsMedical faculty’s experiences of work-life conflict were severe. Faculty’s job demands had coalescing effects on their (...) stress, work-life conflict, and exhaustion. Although supportive job resources helped to mitigate the negative effects of job demands, stimulating job resources contributed to greater work-life conflict, stress, and exhaustion. Thus, for these medical faculty job resources play a dual-role for work-life conflict. Moreover, although faculty experienced high emotional exhaustion, they did not experience the other components of burnout. Some faculty engaged in cognitive reappraisal strategies to mitigate their experiences of work-life conflict and its harmful consequences.ConclusionThis study suggests that the precise nature and effects of job demands and job resources may be more complex than current research suggests. Hospital leadership should work to lessen unnecessary job demands, increase supportive job resources, recognize all aspects of job performance, and, given faculty’s high levels of work engagement, encourage a climate that fosters work-life balance. (shrink)

The most serious threat currently facing people all over the world is that of a global nuclear war, in which hundreds of millions of people would be killed by the immediate effects of nuclear explosions, and over a billion others would later die of cold and starvation in the ensuing nuclear winter. Physicians and other health professionals have an ethical responsibility to educate themselves, their patients, and the public to the need for major political changes to achieve multilateral disarmament (...) and thus prevent nuclear war. Scientists ought to oppose all research and government expenditures preparing for war, and should participate only in work designed to improve health and living standards for all the world's inhabitants. (shrink)

An idea is a public good. The use of an idea by one person does not hinder others to benefit from the same idea. However in order to generate new life-saving ideas, e.g. inventions in the life sciences, a huge amount of human and material resources are needed. Powerful, but highly criticized tools to speed up the rate of innovation are exclusive rights, most prominently the use of patents and plant breeders’ rights. Exclusive rights leave by nature a number of (...) people empty-handed, with starvation, stuntedness, prevalence of disease and death as preventable and quotidian consequences. To stimulate a human rights compatible use of exclusive rights a wide range of moral frameworks have been developed to condemn current praxes. Most prominent in the debate are theories building on (1) utilitarian calculations of weighing benefits with Peter Singer as a prominent advocate, (2) Pogge’s vindication of compensatory duties for institutional harms, (3) a comprehensive analysis on how the current innovation incentive system fails to secure human rights and human capabilities and lastly (4) showing how the status quo nurtures misrecognition. With help of those theories modest targets as well as a thorough restructure of the innovation incentive system can be justified. Those theories have the mammoth task of restraining well-established ideas supporting the permissibility of a reckless use of property rights that are deeply anchored in the property law discourse. Life sciences raise a range of special problems when justifying pro-poor innovation. Healthy people living in a society with a good sanitary infrastructure need far less resources to tackle health problems than people in places with a poor infrastructure. Patents that involve gene sequences (or part thereof) make inventing around impossible, making the seeking of licenses mandatory for investigators wanting to make follow-up research with the molecule. Speedy sharing of data concerning public health hazards or threats to food security are vital to maintain living standards. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 267-278 [Access article in PDF] Book Review Healing Deconstruction: Postmodern Thought in Buddhism and Christianity Healing Deconstruction: Postmodern Thought in Buddhism and Christianity. Edited by David Loy. Atlanta: Scholars Press, 1996. 120 pp. The philosophers have only interpreted the world, in various ways; the point, however, is to change it.--Karl Marx, Eleventh Thesis on Feuerbach Healing Deconstruction, edited by David Loy, is a collection of (...) essays which are situated by and elaborate the intersection of radical Christian, Buddhist, and deconstructionist discourses. With the exception of "Mindfulness of the Selves" by Morny Joy, all of these essays were first presented at the Fourth International Buddhist-Christian [End Page 267] Dialogue conference in Boston in 1992. While each author addresses different aspects of problems associated with suffering, the self, language, and healing, they share certain poststructuralist sensibilities in common and, with the exception of Robert Magliola, share a commitment to developing "a more holistic praxis" (p. 2). The title of this volume is, says Loy, "intentionally ambiguous. On the one side, it emphasizes the healing possibilities of deconstruction in a field where the deconstructive turn has too often been understood reductively" and on the other, it "refers to the potential healing power of this dialogue for deconstruction itself, whose critique of logocentrism had led to a rupture within contemporary thought" (ibid.). 1 The authors both affirm "the liberating and healing potential of de-essentialized concepts and images, language, bodies and symbols" and maintain "that actually realizing this healing potential requires a move from theorizing to practice, for only that can truly deconstruct the self" (p. 10).Chief among the problems they identify as presenting barriers to developing a new way of relating to the world and a new self are dualistic thinking and the notion of the autonomous self. Each of the authors contributes to comprehending the philosophical factors that foster the creation of these barriers and what may be done philosophically to dismantle them. Moreover, Philippa Berry, Joy, and Magliola not only deploy Christian, Buddhist, deconstructionist, and feminist tactics to dismantle these barriers, they also articulate alternative modes of relating to the world.Creating new ways of relating to the world and new senses of self are clearly in order. Profit-driven global development, enforced by U.S. directed, taxpayer financed military power, is not only fostering the growth of illiteracy, homelessness, poverty, slave labor, and starvation for hundreds of millions of persons worldwide it is also threatening the biological basis of life. To make matters worse, revolutions in communication, transportation, and weapons systems have accelerated the rate at which these processes are developing around the world. The left used to say: either socialism or barbarism. Today we might say, either a way of life or death. In light of the fact that, as Joy indicates, "[r]acism, sexism, and classism still pervade our social structures in ways that damage the lives of billions of people"; it is clear that we need "a new way of relating to the world: a different sense of self" (pp. 71, 97). It is no exaggeration to claim that we must build an alternative mode of being and becoming to that which presently exists in order to ensure that all human beings are able to enjoy the rich abundance of life. The authors in Healing Deconstruction make diverse contributions to this end and provocatively stimulate our thinking about how we might best create an alternative mode of human existence.Their contributions suffer, however, from problems which are, among other things, symptomatic of the state of critical theory and politics as we begin the twenty-first century. With the triumph of global capitalism and the retrenchment of the political right, critical theory and politics, particularly in their academic manifestations, have in large measure retreated from the radical agendas that characterized political movements in the 1960s. Whereas anticolonial, civil rights, antiracist, feminist, indigenous, environmental, and working class organizations and movements sought to transform existing institutions in order to insure universal access to social, [End Page 268] political, and economic resources, most liberals and many... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Stepping Off the Edge of the Earth:A bariatric patient’s journey out of obesityNikki MassieI have been overweight my entire life. When I was born—three weeks early—I weighed 9 lbs., 3 oz. I proceeded to trend on the high end of the weight percentile for my age. By the time I was 14 years old I’d surpassed 200 lbs. By the time I graduated high school I’d hit 250 lbs.Even (...) today, after losing a considerable amount of weight from having Roux–en–Y gastric bypass surgery, I am still considered overweight according to the body mass index.All this is to say that the way I think about my health, my body and my life is very much from the perspective of someone who has never experienced the so–called condition of being “normal.”Enough is EnoughI’ve been asked many times how I decided to have bariatric surgery. The answer isn’t simple. Because I’d been overweight all my life, the notion of being anything but overweight seemed a bit absurd to me. Not absurd as in, “I would not be happy if I were smaller” but more like, “I don’t know if this could ever happen for me and, if it did, who would I be?”Truth be told, I wasn’t entirely unhappy as an overweight woman. By the account of my primary care physician I also was not necessarily unhealthy for an overweight person. I didn’t have high blood pressure or diabetes (I wasn’t even pre–diabetic). My heart seemed to work fine. I was just very, very large.However, I’d been large (or larger than others) my entire life. In many ways my very identity was inextractable from that fact. While I can’t speak for my entire culture, my experience as an African–American woman is one where women of size were not reviled, but celebrated. Being too thin was always presented to me as a negative cultural value, I believe because it was associated with drug use.That means that growing up I didn’t have some of the experiences other obese people had. There were a few people who teased me but they were the exception, not the norm. I don’t recall being lonely because of my size. I dated avidly throughout my adolescence. I was asked to, and went to, both my proms.I proceeded into young adulthood with a few bumps along the way. I suffered a bout of depression in my sophomore year of college and just after my 21st birthday I found the first signs of what would be massive hair loss from alopecia areata (although did not know that’s what it was at the [End Page 107] time). Otherwise, I was fairly healthy and no more or less happy than any other 21 year–old I knew.At age 22, I had my first child, a daughter. This was the beginning of an upward weight climb that took me from being very overweight into very obese. At age 21, I weighed about 240 lbs. (I am 5 ft. 8 inches tall). By the time I was 26 (and after I had a second daughter), I weighed in at 340 lbs.At this point I began to want to lose weight. I no longer liked the way I looked in pictures. My increased clothing size and cost depressed me even further. My attempts at dieting, however, failed miserably. I did seek help from my primary care physicians (I went through several throughout my young adulthood). Each time I’d be given a copy of the food pyramid and a pamphlet explaining the health benefits of losing weight.But how? How exactly does one lose weight? In my mind it was some strange combination of sadistic exercise and starvation. That’s what I saw in magazines. Women who ate the equivalent of one meal per day who exercised many hours a day. I had no desire to do either and so I continued on my trend upward.During that time my mother (now deceased) worried about my weight a lot. I’d... (shrink)

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists (...) function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway. (shrink)

This book is a discussion of the most timely and contentious issues in the two branches of neuroethics: the neuroscience of ethics; and the ethics of neuroscience. Drawing upon recent work in psychiatry, neurology, and neurosurgery, it develops a phenomenologically inspired theory of neuroscience to explain the brain-mind relation. The idea that the mind is shaped not just by the brain but also by the body and how the human subject interacts with the environment has significant implications for free will, (...) moral responsibility, and moral justification of actions. It also provides a better understanding of how different interventions in the brain can benefit or harm us. In addition, the book discusses brain imaging techniques to diagnose altered states of consciousness, deep-brain stimulation to treat neuropsychiatric disorders, and restorative neurosurgery for neurodegenerative diseases. It examines the medical and ethical trade-offs of these interventions in the brain when they produce both positive and negative physical and psychological effects, and how these trade-offs shape decisions by physicians and patients about whether to provide and undergo them. (shrink)

Background: This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient’s decision-making capacity. The study aims to answer: 1) does concern about a patient’s treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and (...) 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient’s treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers (...) are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers (...) are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians (...) about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children’s hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are ethics committee meetings, Nursing Ethics Forum, ethics Brown Bag workshops, PICU ethics rounds, Grand Rounds, NICU Comprehensive Care Rounds, Palliative Care Team case conferences, multidisciplinary consults in Fetal Health Center, and ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of “core competencies” than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple “moral spaces” in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today. (shrink)

Spurred by a severe shortage of cadaveric organs, there has been a marked growth in living organ donation over the past several years. This has stimulated renewed interest in the ethics of this practice. The major concern has always been the possibility that a physician may seriously harm one person while trying to improve the well-being of another. As Carl Elliott points out, this puts the donor's physician in a difficult predicament: when evaluating a person who volunteers (...) to donate an organ, “a doctor is in the position of deciding not simply whether a subject's choice is reasonable … but whether he [the doctor] is morally justified in helping the subject accomplish it.”1 This question has become even more difficult since the introduction of living donor operations that are more risky than living kidney donation and the suggestion that volunteers at added risk may sometimes be acceptable.2 So, how can we decide when the risk is too much? (shrink)

The widespread adoption of radioisotopes as tools in biomedical research and therapy became one of the major consequences of the "physicists' war" for postwar life science. Scientists in the Manhattan Project, as part of their efforts to advocate for civilian uses of atomic energy after the war, proposed using infrastructure from the wartime bomb project to develop a government-run radioisotope distribution program. After the Atomic Energy Bill was passed and before the Atomic Energy Commission was formally established, the Manhattan Project (...) began shipping isotopes from Oak Ridge. Scientists and physicians put these reactor-produced isotopes to many of the same uses that had been pioneered with cyclotron-generated radioisotopes in the 1930s and early 1940s. The majority of early AEC shipments were radioiodine and radiophosphorus, employed to evaluate thyroid function, diagnose medical disorders, and irradiate tumors. Both researchers and politicians lauded radioisotopes publicly for their potential in curing diseases, particularly cancer. However, isotopes proved less successful than anticipated in treating cancer and more successful in medical diagnostics. On the research side, reactor-generated radioisotopes equipped biologists with new tools to trace molecular transformations from metabolic pathways to ecosystems. The U.S. government's production and promotion of isotopes stimulated their consumption by scientists and physicians, such that in the postwar period isotopes became routine elements of laboratory and clinical use. In the early postwar years, radioisotopes signified the government's commitment to harness the atom for peace, particularly through contributions to biology, medicine, and agriculture. (shrink)

Although science supplies medicine's “gold standard,” knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in the retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints are always (...) situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principles remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, families, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice. (shrink)

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered (...) simultaneously at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

Mary was angry. Youre going to take my pain medications away, aren't you? These were the first words she spoke as I walked into the examining room. Mary had a complex medical history, beginning with a back injury in 1988 that led to several surgical procedures, multiple injections of local anesthetic and corticosteroids, and placement of a dorsal column stimulator, none of which provided significant relief of her pain. Crippled by severe and sharp pain in her lower back and left (...) leg, she had sought help from several physicians, and had most recently been referred to me specifically, as she put it, to take away the pain medications.Not that the pain medications had afforded Mary a normal life by any stretch of imagination. She was taking eight to ten moderate strength opioid tablets per day in an effort to decrease her pain. She was not active, choosing to spend most of her time at home. She had quit her job shortly after the work-related accident. In fact, the workman's compensation board is still disputing her claim, and this dispute took a toll on Mary. (shrink)

Mary was angry. Youre going to take my pain medications away, aren't you? These were the first words she spoke as I walked into the examining room. Mary had a complex medical history, beginning with a back injury in 1988 that led to several surgical procedures, multiple injections of local anesthetic and corticosteroids, and placement of a dorsal column stimulator, none of which provided significant relief of her pain. Crippled by severe and sharp pain in her lower back and left (...) leg, she had sought help from several physicians, and had most recently been referred to me specifically, as she put it, to take away the pain medications.Not that the pain medications had afforded Mary a normal life by any stretch of imagination. She was taking eight to ten moderate strength opioid tablets per day in an effort to decrease her pain. She was not active, choosing to spend most of her time at home. She had quit her job shortly after the work-related accident. In fact, the workman's compensation board is still disputing her claim, and this dispute took a toll on Mary. (shrink)

The Thai concern for bioethics has been stimulated by the departure of Thai medicine from its long tradition through the introduction of Western medical models. Bioethics is now being taught to Thai medical students emphasizing moral insights and principles found within Thai culture. These are to a large extent Buddhist themes. Veracity is always a duty for people in general and medical personnel in particular. Falsehoods and deception cannot be morally justified simply on the grounds that we think it (...) is good for another. Buddhism also prohibits killing. The doctrine of kamma holds that joys and sorrows are the result of one's own past actions. Kamma must run its course or will be manifest in a future life. Mercy-killing also violates the Buddhist psychology. A physician who kills subconsciously transfers his aversion to suffering to the one who embodies the suffering. Buddhist justice is understood in terms of impartiality and equal treatment. Compassion goes beyond justice to self-giving and self-denial. It is central to the path to the attainment of highest human fulfillment. Keywords: Buddhism, Thailand, veracity, euthanasia, justice, compassion, teaching CiteULike Connotea Del.icio.us What's this? (shrink)

Indigenous understandings of consciousness represent an important inspiration for scientific discussions about the nature of consciousness. Despite the fact that Indigenous concepts are not outputs of a research driven by rigorous, scientific methods, they are of high significance, because they have been formed by hundreds of years of specific routes of cultural evolution. The evolution of Indigenous cultures proceeded in their native habitat. The meanings that emerged in this process represent adaptive solutions that were optimal in the given environmental and (...) social milieu. We argue that it would not be appropriate to handle these meanings as something that science considers to be wrong, or outdated relics of the human past. In contrast, Indigenous concepts and their meanings may be considered to be an important heritage of native human populations, but moreover, they are also an interesting material for analyses and inspiration for recent scientific debates. Furthermore, it is also necessary to mention another reason why the exploration of Indigenous concepts has been so topical recently. Thus far, much psychological theoretical development has been published in English as a result of research conducted in Western countries. The dominance of English and the superiority of research conducted by researchers from Western countries may be considered as a kind of barrier toward other ways of knowing. We argue that the traditional cultural knowledge coming from Indigenous societies may offer an interesting source of new thought for science. The weakening of the strong dependence of science on well-established academic circles dominated by Western theoretical perspectives may be beneficial for stimulating its further development (Sidik, 2022). Therefore, this special symposium of the Journal of Consciousness Studies aims to open the doors for other ways of knowing, For the knowing that emerged in native Indigenous cultures. We argue that the rich cultural heritage of these societies may stimulate the emergence of new analytical perspectives for scientific theorising about the nature of consciousness. For all these reasons, the Indigenous concepts of consciousness captured our interest, and we decided to start investigating them. In 2020 and 2021, we retrieved and analysed pieces of information from past ethnographical field evidence gathered in various Indigenous cultures. After removal of data about the cultures showing a high acceptance of influences from external religious traditions (e.g. Christianity, Islam or Buddhism), a comparative analysis of data from 55 Indigenous groups was conducted and published in the Journal of Consciousness Studies (Trnka and Lorencova, 2022). This primary project revealed many interesting results, but more importantly, it also showed many unexplored avenues that called for further exploration. This special symposium of the Journal of Consciousness Studies is a continuation and new development of research on the Indigenous understanding of consciousness. Past ethnographical evidence involved some valuable pieces of knowledge about Indigenous concepts of consciousness, but the relevant information was often fragmentary or even totally missing in some cases. Moreover, many authors of past ethnographic records applied a strong etic approach that clouded the understanding of native Indigenous thoughts. Therefore, the main goal of the recent symposium was to broaden the overall information basis for the analysis of Indigenous concepts of consciousness or closely related phenomena. In other words, the symposium aimed to bring more detailed knowledge of Indigenous concepts of consciousness, mind and body and their relations in various groups of Indigenous people. In 2022, we contacted potential contributors and were pleased by their positive reactions, which reflected the topicality of this research focus. The authors were asked to draft their papers with a special focus on (a) a cultural Indigenous understanding of the concept of consciousness, (b) a cultural Indigenous understanding of the mind-body differentiation (or consciousness-body differentiation) and (c) cultural metaphors and cultural beliefs related to consciousness, mind and body. Many of contributors were native members of Indigenous cultures that made the descriptions of Indigenous concepts more accurate and reliable. This enabled many truly emic, in-depth insights into the Indigenous concepts of consciousness and related phenomena to be gained. As a result, this issue of the Journal of Consciousness Studies introduces eight papers, each focused on a different geographical region/Indigenous groups: Nahua and Maya (Mexico), Guna (Panama), Mapuche (Chile), Maori (New Zealand), Telingit (Altai), Mongolian groups, Igbo (Nigeria) and Asabano (New Guinea). These papers are followed by one more general paper discussing magical consciousness on the case of an Aboriginal wise man (Australia). The symposium closes with our concluding editorial essay, which generalises the findings and introduces three theoretical models of understandings of consciousness inspired by the analysis of Indigenous concepts of consciousness. Aside from the importance for basic research, the exploration of Indigenous concepts of consciousness is also very important for informing practitioners from many applied spheres. Many current methods for treating addictions, traumatic life events, professional burnout and other mental health problems use features of Indigenous healing practices. A proper understanding of meanings related to mind, body and consciousness are quite important for Western psychotherapists to adapt the Indigenous practices to particular Western cultural milieus. Furthermore, a proper understanding of meanings related to mind, body, and consciousness is also important for treating ethnic, linguistic and culturally diverse populations (APA, 1990). For therapists, psychologists and physicians, understanding the meanings of these concepts may promote their own better care of their clients from various Indigenous ethnic groups. Last but not least, Indigenous concepts, meanings and languages are closely related to the continuation of the heritage of Indigenous people (United Nations, 2016). The world’s Indigenous languages have recently been under threat of disappearing; many Indigenous languages are endangered globally, and the rate of loss is high (United Nations, 2016). Importantly, recent research has also shown that the retention of Indigenous languages may be protective for the psychological and physical health of their speakers. All these areas represent fields for potential use of the findings presented in this symposium of the Journal of Consciousness Studies. As a concluding note, the editors of this symposium hope that this collection of papers will inspire academic scholars while also providing important information for practitioners from various spheres. (shrink)

Here we identify approximately 40,000 healthy human volunteers who were intentionally exposed to infectious pathogens in clinical research studies dating from late World War II to the early 2000s. Microbial challenge experiments continue today under contemporary human subject research requirements. In fact, we estimated 4,000 additional volunteers who were experimentally infected between 2010 and the present day. We examine the risks and benefits of these experiments and present areas for improvement in protections of participants with respect to safety. These are (...) the absence of maximum limits to risk and the potential for institutional review boards to include questionable benefits to subjects and society when weighing the risks and benefits of research protocols. The lack of a duty of medical care by physician–investigators to research subjects is likewise of concern. The transparency of microbial challenge experiments and the safety concerns raised in this work may stimulate further dialogue on the risks to participants of human experimentation. (shrink)

First published in 1930 this book was written under the leadership and inspiration of Alfred Adler. He and a group of physicians and educators organized 28 child guidance clinics in Vienna, Berlin and Munich in the years prior to publication. Conducted according to the tenets of Individual Psychology, these clinics revealed many new and stimulating problems that they felt were as applicable to conditions in America and England at the time as in the experimental countries. The book was designed as (...) an organized and connected account of the problems, accomplishments and failures encountered in the daily work, reported from actual experience by the experts in charge. Adler edited the volume and assigned each subject to the specialist in that field. The result was designed to be of value to the welfare worker, the physician, and the forward-looking parent of the time. Today it can be read and enjoyed in its historical context. (shrink)

First published in 1930 this book was written under the leadership and inspiration of Alfred Adler. He and a group of physicians and educators organized 28 child guidance clinics in Vienna, Berlin and Munich in the years prior to publication. Conducted according to the tenets of Individual Psychology, these clinics revealed many new and stimulating problems that they felt were as applicable to conditions in America and England at the time as in the experimental countries. The book was designed as (...) an organized and connected account of the problems, accomplishments and failures encountered in the daily work, reported from actual experience by the experts in charge. Adler edited the volume and assigned each subject to the specialist in that field. The result was designed to be of value to the welfare worker, the physician, and the forward-looking parent of the time. Today it can be read and enjoyed in its historical context. (shrink)

Oocyte donation raises conflicts of interest and commitment for physicians but little attention has been paid to how to reduce these conflicts in practice. Yet the growing popularity of assisted reproduction has increased the stakes of maintaining an adequate oocyte supply and minimizing conflicts. A growing body of professional guidelines, legal challenges to professional self-regulation, and empirical research on the practice of oocyte donation all call for renewed attention to the issue. As empirical findings better inform existing conflicts and their (...) potential harms, we can better attempt to reduce these conflicts. To that end, the article first describes the nature of conflicts in oocyte donation and relevant regulations and professional guidelines. We then describe studies on conflicts at four phases of oocyte donation: recruitment, screening, stimulation, and post-stimulation monitoring. Next we consider three models for conflict reduction in medicine generally: improved professional self-regulation, outright restriction like Stark anti-referral laws, or the use of conflict mediators, like in living organ donation. We ultimately conclude that improved professional self-regulation is a reasonable starting place for oocyte donation. (shrink)