Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)
It is a welcome development when academic philosophy starts to concern itself with practical issues, in such a way as to influence people's lives. Recently this has happened with one moral issue in particular—but infortunately it is the wrong issue, and people's actions have been influenced in the wrong way. The issue is that of the moral status and treatment of animals. A number of philosophers have argued for what they call ‘animal liberation’, comparing it directly with egalitarian causes such (...) as women's liberation and racial equality and suggesting that, if racism and sexism are rationally indefensible, so is ‘speciesism’. If one ought to give equal consideration to the interests of all human beings, then, so they daim, one must on the same grounds and in the same way recognize that ‘all animals are equal’, be they human or non-human. We believe that this assimilation of ‘animal liberation’ to human liberation movements is mistaken. (shrink)
This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)
Organ trafficking and trafficking in persons for the purpose of organ transplantation are recognized as significant international problems. Yet these forms of trafficking are largely left out of international criminal law regimes and to some extent of domestic criminal law regimes as well. Trafficking of organs or persons for their organs does not come within the jurisdiction of the ICC, except in very special cases such as when conducted in a manner that conforms to the definitions of genocide or crimes (...) against humanity. Although the United States Code characterizes trafficking as a transnational crime with national implications, (22 U.S.C. § 7101(b)(24) (2010)), trafficking is rarely prosecuted in domestic courts. It has thus functioned in practice largely as what might be judged a stateless offense, out of the purview of both international and national courts. Yet these forms of organ trafficking remain widespreadâand devastating to those who are its victims. In this article, we begin by describing what is known about the extent of organ trafficking and trafficking in persons for the purpose of removal of organs. We then critically evaluate how and why such trafficking has remained largely unaddressed by both international and domestic criminal law regimes. This state of affairs, we argue, presents a missed chance for developing the legitimacy of international criminal law and an illustration of how far current international legal institutions remain from ideal justice. (shrink)
Syndromic surveillance uses new ways of gathering data to identify possible disease outbreaks. Because syndromic surveillance can be implemented to detect patterns before diseases are even identified, it poses novel problems for informed consent, patient privacy and confidentiality, and risks of stigmatization. This paper analyzes these ethical issues from the viewpoint of the patient as victim and vector. It concludes by pointing out that the new International Health Regulations fail to take full account of the ethical challenges raised by syndromic (...) surveillance. (shrink)
Defenders of patient autonomy have successfully supported the legal adoption of advance directives. More recently, some defenders of patient autonomy have also supported the legalization of voluntary active euthanasia. This paper explores the wisdom of combining both practices. If euthanasia were to become legal, should it be permitted by advance directives? The paper juxtaposes the most significant doubts about advance directives, with the most significant doubts about euthanasia. It argues that the doubts together raise more concern about the combined practices (...) than about either euthanasia or advance directives separately. Not all cases of voluntary euthanasia by advance directive are equally problematic, however. Advance directives can help in the defense of euthanasia for patients who make the request in advance and reaffirm it under circumstances of severe suffering. Keywords: advance directives, durable power of attorney, euthanasia, living will, patient interests CiteULike Connotea Del.icio.us What's this? (shrink)
Many problems in environmental ethics are what have been called “global systemic problems,” problems in which what happens in one part of the world affects preservationist efforts elsewhere. Restoration of the Everglades is one such example. If global warming continues, the Everglades may well be flooded within the next quarter to half century and all restoration efforts will be for naught. Yet, the United States government is both pursuing restorationist efforts and withdrawing from the Kyoto Protocol on emissions of greenhouse (...) gases. One aspect of global systemic problems concerns whether there are interconnections between the preservationist obligations of the locals and the duties of others. There are three main lines of arguments for concluding that there are, indeed, interconnected obligations in such cases. First, the consequentialist case for imposing duties on locals assumes that others do not have inconsistent consequentialist obligations. In addition, a related consequentialist case can be made that when problems are systemic, others have positive supportive duties. Second, a weak principle of reciprocity supports the interconnectedness of obligations. Insistence that someone has an obligation that benefits you implies the duty not to act to undermine the efforts of that person to fulfill that obligation. Third, a weak principle of fairness—that it is only fair to expect one person to bear the burdens of producinga collective good if others have obligations to do their cooperative part—supports interconnected obligations with regard to global systemic problems. Because all three arguments point to the same conclusion, there is a very strong case for interconnected obligations as part of the solution to global systemic problems—problems that are all too prevalent in our world today. (shrink)
The growing use of interoperable electronic health records is likely to have significant effects on the physician-patient relationship. This relationship involves two-way trust: of the physician in patients, and of the patients in their providers. Interoperable records opens up this relationship to further view, with consequences that may both enhance and undermine trust. On the one hand, physicians may learn that information from their patients is — or is not — to be trusted. On the other hand, patients may learn (...) from the increased oversight made possible by electronic records that their trust in their physicians is — or is not — warranted. Release of information through new methods of surveillance may also undermine patient trust. The article concludes that because trust is fragile, attention to transparency and confidentiality in the use of interoperable electronic records is essential. (shrink)
Statutes criminalizing behavior that risks transmission of HIV/AIDS exemplify use of the criminal law against individuals who are victims of infectious disease. These statutes, despite their frequency, are misguided in terms of the goals of the criminal law and the public health aim of reducing overall burdens of disease, for at least three important reasons. First, they identify individual offenders for punishment, a paradigm that is misplaced in the most typical contexts of transmission of infectious disease and even for HIV/AIDS, (...) despite claims of AIDS exceptionalism. Second, although there are examples of individuals who transmit infectious disease in a manner that fits the criminal law paradigm of identification of individual offenders for deterrence or retribution, these examples are limited and can be accommodated by existing criminal laws not devoted specifically to infectious disease. Third, and most importantly, the current criminal laws regarding HIV/AIDS, like many other criminal laws applied to infectious disease transmission, have been misguided in focusing on punishment of the diseased individual as a wrongful transmitter. Instead of individual offenders, activities that enhance the scale of disease transmission—behaviors that might be characterized as ‘transmission facilitation’—are a more appropriate target for the criminal law. Examples are trafficking in human beings (including sex trafficking, organ trafficking, and labor trafficking), suppression of information about the emergence of infection in circumstances in which there is a legally established obligation to disclose, and intentional or reckless activities to discourage disease treatment or prevention. Difficulties remain with justifications for criminalizing even these behaviors, however, most importantly the need for trust in reducing overall burdens of disease, problems in identifying individual responsible offenders, and potential misalignment between static criminal law and the changing nature of infectious disease. (shrink)
Many problems in environmental ethics are what have been called “global systemic problems,” problems in which what happens in one part of the world affects preservationist efforts elsewhere. Restoration of the Everglades is one such example. If global warming continues, the Everglades may well be flooded within the next quarter to half century and all restoration efforts will be for naught. Yet, the United States government is both pursuing restorationist efforts and withdrawing from the Kyoto Protocol on emissions of greenhouse (...) gases. One aspect of global systemic problems concerns whether there are interconnections between the preservationist obligations of the locals and the duties of others. There are three main lines of arguments for concluding that there are, indeed, interconnected obligations in such cases. First, the consequentialist case for imposing duties on locals assumes that others do not have inconsistent consequentialist obligations. In addition, a related consequentialist case can be made that when problems are systemic, others have positive supportive duties. Second, a weak principle of reciprocity supports the interconnectedness of obligations. Insistence that someone has an obligation that benefits you implies the duty not to act to undermine the efforts of that person to fulfill that obligation. Third, a weak principle of fairness—that it is only fair to expect one person to bear the burdens of producinga collective good if others have obligations to do their cooperative part—supports interconnected obligations with regard to global systemic problems. Because all three arguments point to the same conclusion, there is a very strong case for interconnected obligations as part of the solution to global systemic problems—problems that are all too prevalent in our world today. (shrink)
Privacy is one of our most essential values, but popular understanding of it lags far behind the heat the concept generates. It's easy to understand why. The concept itself has shifted in U.S. law from autonomy, to property, to confidentiality. Further, with a host of cultural differences as to how privacy is understood globally and in different religions, and with nonstop technological advancements, its significance is continually evolving. Leslie P. and John G. Francis draw upon their extensive expertise in law, (...) philosophy, political science, regulatory policy, and bioethics to parse privacy's meaning in the modern age. This book will inform, appease, and alert readers to what is at stake when privacy is breached. (shrink)
_The Blackwell Guide to Medical Ethics_ is a guide to the complex literature written on the increasingly dense topic of ethics in relation to the new technologies of medicine. Examines the key ethical issues and debates which have resulted from the rapid advances in biomedical technology Brings together the leading scholars from a wide range of disciplines, including philosophy, medicine, theology and law, to discuss these issues Tackles such topics as ending life, patient choice, selling body parts, resourcing and confidentiality (...) Organized with a coherent structure that differentiates between the decisions of individuals and those of social policy. (shrink)
