Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the (...) body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

Recruiting patients into clinical research is essential for the advancement of medical knowledge. However, when the physician undertaking the care of the patient is also responsible for recruitment into clinical research, a situation arises of an inter-role breach of confidentiality which is distinguishable from other conflicts of interest. Such discord arises as the physician utilizes confidential information obtained within the therapeutic relationship beyond its primary objective, and safeguards ought to be observed in order to avert this important, and generally overlooked, (...) problem. The moral worth of the pledge of confidentiality is based not on its innate value but on its being a promise on which subsequent interactions and disclosures are founded. Within the patient-doctor interaction, confidentiality is an important facet of the promised fidelity and, as such, a loose interpretation of the notion threatens the essence of the relationship, and any violation thereof requires compelling moral justification. To avoid conflict, patients' confidential information ought not be used for the purpose of recruitment, which needs to be undertaken through general education and non-directed appeals, and a preliminary consent to be approached for research should be obtained from the patient prior to her being identified as a suitable research subject. Securing this prior consent would avoid one source of potential, albeit unintended, coercion. (shrink)

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death (...) of many women diagnosed with carcinoma in situ. (shrink)

Many bioethics questions are resistant to journalistic exploration on account of their inherently philosophical dimensions. Such dimensions are ill-suited to what we may term the internal goods (in MacIntyre's sense) of the newspapers and mass media generally, which constrain newspaper coverage to an abbreviated form of narrative that, whilst not in itself objectionable, is nonetheless inimical to the conduct of philosophical reflection. The internal goods of academic bioethics, by contrast, include attention to philosophical questions inherent in bioethical issues and value-enquiry. (...) The danger for bioethics is that its agenda for reflective enquiry will, if dictated by this abbreviated narrative, be distorted in terms of both range and priorities, to the inevitable neglect of questions having a philosophical dimension to them. This danger can be avoided by a constructive partnership between the media and academic bioethics. The success of this partnership relies on four suggested provisos, for the meeting of which both journalists and academics bear responsibility. (shrink)

In a research proposal recently submitted to one of the research ethics committees in Wales, children suffering from otitis media, or ‘glue ear’ as it is more familiarly known, were to be tested for allergic reactions to a number of substances using skin-prick tests. Small lancets would be used to pierce the skin of the forearm, allowing the penetration of traces of the allergenic reagent. The size of the subsequent inflamed area of skin would be measured. To demonstrate the expected (...) correlation between glue ear and an allergic reaction, it would be necessary to see whether other children who did not suffer from glue ear also had the same reactions. If they did not, of course, then some causal association between the reaction and the disease condition could be inferred and investigated, with the hope of improving the treatment of the disease itself. (shrink)