Medicine and Law

Beliefs about the moral status of children have changed significantly in recent decades in the Western world. At the same time, knowledge about likely consequences for children of individual, parental, and societal choices has grown, as has the array of choices that (prospective) parents may have at their disposal. The intersection between these beliefs, this new knowledge, and these new choices has created a minefield of expectations from parents and a seemingly ever-expanding responsibility towards their children. Some of these new (...) challenges have resulted from progress in genetics and neuroscience. It is these challenges that we focus on in this introduction and volume. (shrink)

We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...) daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

Throughout the 19th century and early decades of the 20th century, milk was a dangerous food that required state intervention to make it safe. Throughout this period, the germ theory of contagious disease came to prominence, but could not explicitly determine the causal relationships linking germs, milk, and human illness. Using the notion of an ideational regime, I examine how (1) knowledge claims move from uncertainty to certainty and become privileged claims within ideational regimes that (2) result in an unintended, (...) but necessary deployment of a biopolitical strategy for governance. The argument here is that theoretical uncertainty meant managing populations as a uniform undifferentiated reality using pasteurization technologies. I use two historical moments as evidence of these processes. The first is the 1901 British Congress on Tuberculosis when I argue germ theory came to a theoretical standstill and the second is Ontario’s 1938 amendment to the province’s Public Health Act that permanently institutionalised province-wide compulsory pasteurisation laws organised around the notion of nutritional equivalency. This genealogical exploration should provide some insight into how bacteria became the singular cause of illness and into the conditions that led to targeting milk as the main site of intervention instead of treating individual bodies. (shrink)

Summary This volume undertakes to determine the fundamentals and limits of an ethical assessment of the methods of modern medical technology with regard to the concepts of human dignity and human image, which are particularly important for this purpose. It shows that the philosophical-legal foundation of the term human dignity has not yet been clearly clarified; one even has to ask whether the term is (still) suitable for assessing ethical problems in medical technology. The term human image also needs clarification (...) and clarification in order to be taken seriously as a topos in the medical ethical discussion. The volume emerged from the work of an interdisciplinary and international research group at the Center for Interdisciplinary Research (ZiF), Bielefeld. It deals primarily with the theoretical foundation of the terms human dignity and human image and is supplemented by a volume, the contributions of which illustrate the problems of practice using examples from different areas of medical technology. (shrink)

This chapter examines the explicit and implicit roles that the concept of beneficence plays in the guidelines that govern biomedical research involving humans. We suggest that the role beneficence is actually playing in the guidelines is more comprehensive than is commonly assumed. The broader conceptualisation of beneficence proposed here clarifies the relationship of beneficence to respect for autonomy. It does this by showing how respect for autonomy is at the service of beneficence rather than in tension with it.

This book makes an important contribution to ongoing efforts in the fields of medical law and bioethics to answer the challenges posed by the limitations of the principle of respect for autonomy, especially as these pertain to human research ethics. The principle of respect for autonomy seems to have become firmly embedded in human research ethics since its inclusion in the 1947 Nuremberg Code, which was a response to atrocities committed by Nazi doctors. Nonetheless, there is an increasing awareness of (...) the limitations of the principle of respect for autonomy and the underlying conceptualisations of human autonomy. (shrink)

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

This book makes an important contribution to ongoing efforts in the fields of medical law and bioethics to answer the challenges posed by the limitations of the principle of respect for autonomy, especially as these pertain to human research ethics. The principle of respect for autonomy seems to have become firmly embedded in human research ethics since its inclusion in the 1947 Nuremberg Code, which was a response to atrocities committed by Nazi doctors. Nonetheless, there is an increasing awareness of (...) the limitations of the principle of respect for autonomy and the underlying conceptualisations of human autonomy. (shrink)

Since the end of World War II, most guidelines governing human research seem to have relied on the principle of respect for autonomy as a key, though not sole, criterion in assessing the moral validity of research involving human participants.1 One explanation for this apparent reliance on respect for autonomy may be that respect for autonomy, made effective through the practice of obtaining informed consent, functions as a useful proxy when dealing with competent adults for the more complex principle of (...) respect for human dignity that underpins much of the moral discourse in this area. If this explanation holds, then assessment of the moral licitness of research involving human individuals whose autonomy is limited in some way requires a deeper analysis of the ‘thicker’ concepts of human dignity, since we cannot rely on respect for autonomy to do the work of respect for human dignity where autonomy (understood as a capacity to consent based on adequate information) is not present, is limited or is compromised. (shrink)

Respect for autonomy has become a fundamental principle in human research ethics. Nonetheless, this principle and the associated process of obtaining informed consent do have limitations. This can lead to some groups, many of them vulnerable, being left understudied. This book considers these limitations and contributes through legal and philosophical analyses to the search for viable approaches to human research ethics. It explores the limitations of respect for autonomy and informed consent both in law and through the examination of cases (...) where autonomy is lacking (infants), diminished (addicts), and compromised (low socio-economic status). It examines alternative and complementary concepts to overcome the limits of respect for autonomy, including beneficence, dignity, virtue, solidarity, non-exploitation, vulnerability and self-ownership. It takes seriously the importance of human relationality and community in qualifying, tempering and complementing autonomy to achieve the ultimate end of human research - the good of humankind. (shrink)

This essay experiments with Kant’s writings on rational religion distilled through the Strange Case of Dr Jekyll and Mr Hyde as canonical confrontations with primal problems of evil. It suggests boundaries between Stevenson’s characters and their occupations comparable to the those conflicted in the Kantian university, namely, law, medicine, theology, and philosophy (which makes a short anticipatory appearance in his earlier text on rational religion). With various faculties it investigates diffuse comprehensions—respectively, legal crime, biogenetic transmission, and original sin—of key ethical (...) modes: will, inheritance, incorporation, freedom, duty, obligation, love, living, and killing to conclude on the possible logic of evil (or evils of logic) collateral and possibly innate to Kant’s comprehension of radical evil. (shrink)

In responding to an unjust legal situation involving human rights abuses, one approach is to seek a selective ban on some abuses if a more comprehensive ban is not feasible politically. While such an approach to embryo research or abortion, for example, can reasonably be applied, much harder to defend is regulation—that is, giving permission or instructions for others to do or prepare to do what we believe is morally wrong. Regulation necessarily involves us in wrongly intending that others choose (...) wrongly, that is, in formal cooperation with evil. We should choose other means of making a bad situation better: selective banning or discouragement by, for example, withholding funding, and the mandating of acts that are good or potentially good in the context in which they are mandated. (shrink)

The subject matter of ethics is morality, and ethics deals with it in four different though closely related ways: by analysis, by criticism, by norm construction, and by moral pragmatics.

The review of James Marcum's book starts with the explanation of the introductory character of the book in the field of philosophy of medicine. Than, the quality-of-care crisis is presented as the central motivation of the book. The clash between prevalent biomedical model in medicine and desirable humanistic model is explored through the presentation of all three parts of the book. The first part deals with metaphysical boundaries of biomedical and humanistic models. The second part is concerned with the epistemology (...) of medicine. The third part of the book is devoted to the ethical issues in medical science. (shrink)

In this dissertation, I use recent theoretical approaches in the human sciences to reconsider fundamental organizing structures of psychiatric knowledge. Chapter 1 outlines how the tropes of "theory" and "a-theory" are used in the human sciences and in psychiatry, critiques psychiatry's a-theoretical approach, and explores the possibilities for a retheorized psychiatry along the lines of work in the human sciences. Chapter 2 and 3 concentrate respectively on two key aspects of "theory"---language and power---and considers their role in shaping and fixing (...) psychiatric knowledge structures. Chapter 4 organizes the theoretical discussion thus far around a sustained reflection on "modernism" and "postmodernism" as relevant to psychiatry. Three themes of psychiatric modernism are outlined and contrasted with three themes of psychiatric postmodernism. I argue in favor of psychiatry, or some branch of psychiatry, shifting toward more postmodern paradigm. ;Chapter 5 is a bridge chapter, which explores other recent theoretical scholarship similar to mine applied in the new genre I call "medical cultural studies." I make this shift to medicine primarily for the practical reason that there has been more work in cultural studies of medicine than there has in cultural studies of psychiatry. The next two chapters start the process of cultural studies of psychiatry. Chapter 6 is devoted to the dramatic rise of pharmaceuticals in psychiatry, and chapter 7 is devoted to the controversial role of DSM---psychiatry's dominant diagnostic manual. The last chapter imagines a possible feminist successor science for psychiatry. After reviewing the main themes of feminist epistemology, I apply their efforts to a "re-formed" psychiatry. In this chapter, I imagine, based on my research but without regard for politically practicalities, how things might be otherwise in psychiatry. Of course, imagination doesn't make it so, but; imagination can guide our efforts toward change. (shrink)

In light of the central role that medications play in medical progress, the declining rate of new drug development over the past decade is cause for concern . Without important breakthroughs in drug discovery, the future will not be auspicious for the many people suffering from chronic and incurable illnesses. The sluggish pace of pharmaceutical innovation has been particularly characteristic of the largest drug manufacturers, which have generally focused their energies on potential blockbuster medications, those that can generate over $1 (...) billion in annual revenue . Given Pharma’s struggles, the success of the country’s largest drug manufacturer in bringing the .. (shrink)

The first official condemnation of political abuse of psychiatry in the USSR to be made by an international psychiatric organization came on August 30, 1977. On that date, the General Assembly, governing body of the World Psychiatric Association (WPA), adopted a resolution of Britain's Royal College of Psychiatrists against "the systematic abuse of psychiatry for political purposes in the USSR." Subsequently passed by a vote of 122 to 66 was a resolution submitted by the American Psychiatric Association, to set up (...) a committee monitoring "The misuse of psychiatric skills, knowledge and facilities for the suppression of dissent wherever it occurs.". (shrink)

Relationships, jobs, and health behaviors-these are what New Year's resolutions are made of. Every year millions resolve to adopt a better diet, exercise more, become fit, or lose weight but few put into practice the health behaviors they aspire to. For those who successfully begin, the likelihood that they will maintain these habits is low. Healthcare professionals recognize the importance of these, and other, health behaviors but struggle to provide their patients with the tools necessary for successful maintenance of their (...) medical regimens. The thousands of research papers that exist on patient adherence and health behavior change can leave professionals overwhelmed. This book synthesizes the results from more than 50 years of empirical research, resulting in simple, powerful, and practical guidance for health professionals who want to know the most effective strategies for helping their clients to put long-term health-relevant behavior changes into practice. It advocates a straightforward 3-ingredient model: Before a person can change, they must know what change is necessary ; desire the change ; and then have the tools to achieve and maintain the change. This book is designed to be informative and compelling, but its numerous anecdotes and examples render it engaging and entertaining, as well. Written for a practitioners and students of medicine, chiropractic, osteopathy, nursing, health education, physician assistant programs, dentistry, clinical and health psychology, marriage and family counseling, social work, school psychology, and care administrators -- and for lay persons who wish to take an active role in their health, this book brings together major empirically-based findings within the field and provides succinct, evidence-based recommendations and strategies for using these findings to make real changes. (shrink)