Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such as home (...) birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. (shrink)

Futility disputes are increasing and courts are slowly abandoning their historical reluctance to engage these contentious issues, particularly when confronted with inappropriate surrogate demands for aggressive treatment. Use of the judicial system to resolve futility disputes inevitably brings media attention and requires clinicians, hospitals, and families to debate these deep moral conflicts in the public eye. A recent case in Minnesota, In re Emergency Guardianship of Albert Barnes, explores this emerging trend and the complex responsibilities of clinicians and hospital administrators (...) seeking to replace an unfaithful surrogate demanding aggressive therapy. Use of the courts requires the coordinated commitment of significant institutional resources, management of intense media scrutiny and individual and organizational courage to enter the unpredictable world of litigation. Given the dearth of legislative guidance on medical futility, individual clinicians and institutions will continue to bear the difficult responsibility for resolution of individual futility disputes. The Barnes case illustrates how one institution successfully used the judicial system to replace an unfaithful surrogate, cease the provision of inappropriate aggressive care, and stimulate a community dialogue about appropriate care at the end of life. (shrink)

This paper gives an overview of the placebo effect in popular culture, especially as it pertains to the work of authors Patrick O’Brian and Sinclair Lewis. The beloved physician as placebo, and the clinician scientist as villain are themes that respectively inform the novels, The Hundred Days and Arrowsmith. Excerpts from the novels, and from film show how the placebo effect, and the randomized clinical trial, have emerged into popular culture, and evolved over time.

John C. Fletcher, a pioneer in the field of bioethics and friend and mentor to many generations of bioethicists, died tragically on May 27th at the age of 72. The son of an Episcopal priest from Bryan, TX, Fletcher graduated in 1953 with a degree in English Literature from the University of the South in Sewanee, TN. After completing a Masters in Divinity degree from the Virginia Theological Seminary and a stint as a Fulbright scholar at the University of Heidelberg (...) in 1956, he was ordained in the Episcopal Church and received a doctorate in Christian ethics from the Union Theological Seminary in New York. After ordination, Fletcher worked in various Episcopal churches and founded the Interfaith Metropolitan Theological Seminary in Washington, D.C. However, despite his religious faith, he was also a skeptic, and renounced his ordination in the mid-1990s due to his need for ?intellectual honesty.? Fletcher began his bioethics contributions in the early 1970's, when he became a founding Fellow of the Hastings Center and eventually the first Chief of the Bioethics Program at the Clinical Center of the National Institutes of Health. At the University of Virginia in Charlottesville, he was the Founding Director of the Center for Bioethics and a professor of biomedical ethics at the medical school, and became the Kornfeld Professor of Biomedical Ethics until his retirement in 1999. Fletcher was a prominent authority and voice in the national and international bioethical dialogue through his talks, his testimonies before scientific and congressional panels, his many articles, and his bioethical and religiously-orientated books, including: An Introduction to Clinical Ethics (1997), Coping with Genetic Disorders: a Guide for Clergy and Parents (1982), Ethics and Human Genetics: A Cross-Cultural Perspective (1989), which he wrote with sociologist Dorothy C. Wertz. Dr. Fletcher received the Lifetime Achievement Award from the American Society of Bioethics and Humanities in 2000. With the passing of Dr. John C. Fletcher, bioethics has lost one of its great voices, a dedicated teacher and mentor, and a friend and colleague to scholars in bioethics and a host of other fields. Below is a touching tribute from one of his former students. (shrink)

Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such as home (...) birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. (shrink)

Women are routinely subjected to penetrating surveillance during pregnancy. On the surface, this may appear to flow from a cultural commitment to protect babies – a cultural practice of “better safe than sorry” that is particularly vigilant given the vulnerability of fetuses and babies. In reality, pregnancy occasions incursions against human rights and well-being that would be anathema in other contexts. Our cultural practices concerning risk in pregnancy are infused with oppressive norms about women’s responsibility for pregnancy outcomes and the (...) demands of extreme self-sacrifice from women to protect their fetuses. Of particular concern is our culture’s willingness to enforce norms concerning risk during pregnancy using coercive measures including forced cesarean sections and criminal penalties for exposing fetuses to risk. This chapter will consider assaults on self-determination, bodily integrity and privacy inherent in such interventions, as well as the structural violence and “mangled pieties” that buttress such practices in our unjust society. (shrink)