This article analyses the different connotations of “normality” and “being natural,” bringing together the theoretical discussion from both human medicine and veterinarymedicine. We show how the interpretations of the concepts in the different areas could be mutually fruitful. It appears that the conceptions of “natural” are more elaborate in veterinarymedicine, and can be of value to human medicine. In particular they can nuance and correct conceptions of nature in human medicine that (...) may be too idealistic. Correspondingly, the wide ranging conceptions of “normal” in human medicine may enrich conceptions in veterinarymedicine, where the discussions seem to be sparse. We do not argue that conceptions from veterinarymedicine should be used in human medicine and vice versa, but only that it could be done and that it may well be fruitful. Moreover, there are overlaps between some notions of normal and natural, and further conceptual analysis on this overlap is needed. (shrink)
The objective of this article is to investigate ethical aspects of technology through the moral term “paternalism”. The field of investigation is medicine. The reason for this is twofold. Firstly, “paternalism” has gained moral relevance through modern medicine, where physicians have been accused of behaving paternalistic and threatening patients’ autonomy. Secondly, medicine is a brilliant area to scrutinise the evaluative aspects of technology. It is argued that paternalism is a morally relevant term for the ethics of (...) technology, but that its traditional conception is not adequate to address the challenges of modern technology. A modification towards a “technological paternalism” is necessary. That is, “technological paternalism” is a fruitful term in the ethics of technology. Moreover, it is suited to point out the deficiencies of the traditional concept of paternalism and to reform and vitalise the conception of paternalism in ethics in order to handle the challenges of technology. (shrink)
Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional ethics, one (...) should notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professional ethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)
Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms (...) on which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)
This paper proposes an ethical reflection on personalized medicine and more precisely on the diagnostic technology underlying it, including nanochips. Our approach is inspired by a combination of two philosophical frames of reference: first, John Dewey’s distinction between intuitive valuation and reflexive evaluation, second, John Rawls’ reflective equilibrium. We aim at what we call a ‘reflexive equilibrium’, a mutual adjustment between on the one hand, the intuitive beliefs scientists have about the ethics of the technologies they work on (...) (‘valuations’ in Dewey’s vocabulary) and, on the other hand, the reflexive ethical assessment of these technologies (‘evaluations’). Our goal, in this paper, is to provide the first step of this process through a philosophical analysis of some valuations on individualized medicine. In order to apprehend the ethical values shaping the development of biochips, we present and analyze qualitative interviews with scientists involved in the conception and the development of biochips involving nanotechnologies. We then propose a critical assessment of the role of ethics in these scientific practices. Last, we suggest two distinct and complementary ways to solve some of the issues brought to light by the interviews, without aiming at any dogmatic or “ready-made” answer. The first of these perspectives gives a central role to the capability individuals could achieve through personalized medicine; the second approach analyses the ethical disruptions entailed by personalized medicine with a special focus on care. (shrink)
Veterinarians have obligations towards both the animals they treat and their clients, the owners of the animals. With both groups, veterinarians have complicated relations; many times the interests of both groups conflict. In this article, using Q-methodology as a method for discourse analysis, the following question is answered: How do Dutch practicing veterinarians conceptualize animals and their owners and their professional responsibility towards both? The main part of the article contains descriptions of four different discourses on animals and their owners (...) and on veterinarian professional responsibilities that prevail among veterinarians. The factual images veterinarians have of animals and their owners are connected to different moral questions and solutions to these questions. (shrink)
Medicine and families, two venerable institutions crucial to human well-being, are in crisis. The medical profession, struggling to control and equitably distribute care, finds itself compromised by its own success; families are shattered by divorce, violence and confusion about their own nature. What has gone unnoticed is the way these two powerful and pervasive spheres contribute to each other's loss of direction. The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each (...) other. The authors explore how medicine, through its new reproductive technologies, is altering the structure of families, how families can participate more fully in medical decision-making, and how to understand the impact on families when medical advances extend life but not vitality . This book takes an unprecedented perspective on both institutions. Innovative and vivid, their stories tell the tales of families interacting with the medical establishment. (shrink)
This essay examines the so-called phenomenon of defensive medicine and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a defensive measure.
The biofuel boom is placing enormous demands on existing cropping systems, with the most crucial consequences in the agri-food sector. The biofuel industry is responding by initiating private governance and certification. The Roundtable on Sustainable Palm Oil (RSPO) and the Cramer Commission, among others, have formulated criteria on “sustainable” biofuel production and processing. This article explores the legitimacy of private governance and certification by the biofuel industry, highlighting opportunities and challenges. It argues that the concept of output based legitimacy is (...) problematic in the case of biofuel as long as no consensus or commonly agreed “best” solution has been established on what sustainable biofuel production is. Furthermore, it shows that the private governance initiatives analyzed fail to adequately include actors from developing countries. Finally, the article argues that we need mechanisms for control and accountability in order to guarantee that the political output of biofuel certification serves the common welfare. (shrink)
The purpose of this research endeavor was to determine the status of dying, death, and bereavement as topics within the curricula of the 28 veterinarymedicine schools in the United States. Data were obtained via a mailed questionnaire . Results revealed that over 96% of the schools have offerings related to end-of-life issues, with 80% of students exposed to these offerings. The average number of hours students devote to end-of-life issues is 14.64, about the same as for U.S. (...) medical and baccalaureate nursing schools. Topics covered most often are “euthanasia” and “communication with owners of dying animals.” Veterinary schools over-whelmingly note that dying, death, and bereavement are important topics. It might be helpful to veterinarymedicine students if their own feelings regarding dying and death were addressed early in the curriculum and throughout class activities and clinical work. Veterinarians would likely relate better to animal guardians and to nonhuman animals themselves if they felt more comfortable with dying and death. (shrink)
While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in (...) a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)
During the 1980s, when a flexibleapproach to research, known asfarmer-back-to-farmer, was developed, theInternational Potato Center (CIP) became famousfor participatory research. Subsequently itappeared to have lost leadership in this field.This article documents participatory researchactivities in CIP over the past thirty years tofind out what happened. Even in the 1980s,implementation of participatory research wasactually limited. Participatory research in thecenter grew unevenly, with little clearencouragement from the CGIAR. Decentralizationof social scientists in the 1990s led to thefragmentation of participatory research and, inthe absence of (...) any clear champion, it seemedthat it might wither away. Recently, increasinginterest in IPM, donor support, and therecruitment of international staff who havebeen exposed to other currents of participatoryresearch and training has led to a revival ofinterest. This needs to be carefully nurturedto ensure that the flexibility for whichparticipatory research in CIP earlier gainedworld renown is retained. (shrink)
Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.