MedWorm: Medical Ethics

Subcription.

The Journal of Medicine and Philosophy — Fri, 20 Nov 2009 07:32:09 +0100

Authors: PMID: 19920167 [PubMed - as supplied by publisher] (Source: The Journal of Medicine and Philosophy)

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Editorial Board.

The Journal of Medicine and Philosophy — Fri, 20 Nov 2009 07:32:07 +0100

Authors: PMID: 19920168 [PubMed - as supplied by publisher] (Source: The Journal of Medicine and Philosophy)

Cover.

The Journal of Medicine and Philosophy — Fri, 20 Nov 2009 07:32:04 +0100

Authors: PMID: 19920169 [PubMed - as supplied by publisher] (Source: The Journal of Medicine and Philosophy)

Why I Wrote ... Holding On? Vacant Possession, Paternity, Double Trouble, Right to Die - novels addressing key medical ethical dilemmas

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

(Source: Clinical Ethics)

Splitting hairs over the definition of murder: Thomas Aquinas and the doctrine of double effect

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

A recent article in the March 2009 edition of Clinical Ethics stated that, ‘In the Summa Theologica, Thomas Aquinas discusses how murder may be justified in self defence’, provided that killing is not intended. This statement is open to challenge on historical and semantic grounds, with respect to the writings of the 13th Century Roman Catholic philosopher Thomas Aquinas (1225–1274). A better appreciation of Aquinas' writings on this topic could inform the debate relating to medical end-of-life decisions. The normatively loaded word ‘murder’ is not applicable to Aquinas' conclusion on unintended homicide, nor is it applicable to unintended homicide in current law, which is by definition not murder. (Source: Clinical Ethics)

Substituted misjudgement

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem et...

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Confidentiality and consent in living kidney transplantation: is it essential for a donor to know that their recipient has HIV disease?

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

It is now possible for someone with HIV disease to receive a kidney transplant from a living donor, although there is evidence only about the short-term outcomes of such a procedure. A person with HIV disease may not wish to disclose their diagnosis to a potential kidney donor. This paper argues that disclosure of the diagnosis of HIV to the donor is not necessary for informed consent. Concerns about the relationship of trust between the clinical team and the donor hold weight in deciding whether disclosure is essential, though openness about the limited nature of informed consent may facilitate a trusting relationship in the absence of disclosure. In general, the recipient's medical information should be treated as confidential, thereby avoiding any need to distinguish between HIV and oth...

Experiencing bad treatment: qualitative study of patient complaints concerning their treatment by public health-care practitioners in the County of Stockholm

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

In conclusion, what patients react most strongly against is when health-care personnel treat them disrespectfully by not abiding by established social norms. The results indicate that the combination of failure in medical treatment and not receiving an apology often leads patients to complain to the Patients' Advisory Committee. (Source: Clinical Ethics)

Subject positions in research ethics committee letters: a discursive analysis

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

Ethical review of applications to conduct research projects continues to be a focus of scrutiny and controversy. We argue that attention to the actual practices of ethical review has the potential to inform debate. We explore how research ethics committees (RECs) establish their position and authority through the texts they use in their correspondence with applicants. Using a discursive analysis applied to 260 letters, we identify four positions of particular interest: RECs positioned as disinterested and responsible; as representing the interests of potential participants; as facilitating ethically sound, high-quality research; and as engaged in dialogue. These positions are used strategically to deflect criticism or complaint. This analysis has implications for reducing contestation betw...

Cutting through red tape: non-therapeutic circumcision and unethical guidelines

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

Current General Medical Council (GMC) guidelines state that any doctor who does not wish to carry out a non-therapeutic circumcision (NTC) on a boy must invoke conscientious objection. This paper argues that this is illogical, as it is clear that an ethical doctor will object to conducting a clinically unnecessary operation on a child who cannot consent simply because of the parents’ religious beliefs. Comparison of the GMC guidelines with the more sensible British Medical Association guidance reveals that both are biased in favour of NTC and subvert standard consent procedures. It is further argued that any doctor who does participate in NTC of a minor may be guilty of negligence and in breach of the Human Rights Act. In fact, the GMC guidance implies that doctors must claim conscie...

Competent minors and health-care research: autonomy does not rule, okay?

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

This article explores the tensions between law and ethics in relation to clinical research involving minors and concludes that greater respect should be given to the autonomy of those minors who are competent to decide for themselves. (Source: Clinical Ethics)

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Truth-telling in health care

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

(Source: Clinical Ethics)

Clinical Ethics Committee Case 8: Should we carry out a predictive genetic test in our young patient?

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

(Source: Clinical Ethics)

Ethics in collaborative global health research networks

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

(Source: Clinical Ethics)

Focusing clinicians on ethics

Clinical Ethics — Tue, 17 Nov 2009 01:45:09 +0100

(Source: Clinical Ethics)

Editorial

Journal of Bioethical Inquiry — Fri, 13 Nov 2009 18:17:23 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9201-2Authors Kate Cregan, Monash University Centre for Ethics in Medicine and Society Melbourne Australia 3800 Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

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Fairness and equity in the provision of anti-retroviral therapy: some refelctions from lesotho

Developing World Bioethics — Fri, 13 Nov 2009 00:00:00 +0100

This article reports the results of a case study on patient selection at a rural ART clinic in Lesotho. The purpose of the study was to examine whether or not such concepts had relevance or operative value for a treatment team providing ART in rural Lesotho. The study found that while concepts of fairness and equity were relevant to the work of the treatment team, patient selection practices did not necessarily reflect what these concepts entail. The idea of fairness as a structured, formalized selection process did not figure in the approach to ART provision at the site. A less formal, 'first-come-first-served' approach was adopted. While there was knowledge among some team members that social, economic or geographic conditions inhibit individuals and groups from gaining access to ART and...

Training needs assessment in research ethics evaluation among research ethics committee members in three african countries: cameroon, mali and tanzania

Developing World Bioethics — Thu, 12 Nov 2009 00:00:00 +0100

Conclusion: Although the majority of REC members in the targeted African countries had received training in ethics, they expressed a need for additional training. The results of this survey have been used to design a training program in research ethics evaluation that meets this need. (Source: Developing World Bioethics)

How old are you? Newborn gestational age discriminates neonatal resuscitation practices in the Italian debate.

BMC Medical Ethics — Thu, 12 Nov 2009 00:00:00 +0100

DiscussionThe Italian scenario reflects the current animated debate, illustrating the difficulty intrinsic in rigid guidelines on the subject, especially when gestational age is taken as a reference parameter for the medical decision.SummaryConcerning the decision to interrupt or not to initiate resuscitation procedures on low gestational age newborns or on newborns affected by severe and highly invalidating diseases, physicians do not need rigid rules based or inflexible gestational age and birth weight guidelines. Guidance in addressing the difficult and trying issues associated with infants born at the margins of viability with a realistic assessment of the infant's clinical condition must be based on the infant's best interests, with clinicians and parents entering into what has been d...

Ecoethics: Now Central to All Ethics

Journal of Bioethical Inquiry — Mon, 09 Nov 2009 19:02:22 +0100

Abstract A few years ago, I wrote on the need for expansion of the environmental areas of bioethics, and covered some of the topics touched on here. Sadly, although it is possible to find some notable exceptions, bioethics does not provide much of an ethical base for considering human-nature relationships. Here I’m not going to deal with these philosophical issues or others about the nature of ethical decision-making. The rapid worsening of the human predicament means that applied ethical issues with a significant environmental connection (what I call “ecoethics”), must be dealt with without waiting for the more interesting theoretical issues to be resolved. I define ecoethics very broadly to deal with dilemmas over a vast range of scales, and believe they now should...

David Rieff. 2008. Swimming in a Sea of Death

Journal of Bioethical Inquiry — Mon, 09 Nov 2009 19:02:21 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9191-0Authors Allison Neyhart Rubin, California Pacific Medical Centre Program in Medicine and Human Values 2395 Sacramento St, 3rd Floor San Francisco CA 94115 USA Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

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The Ethical Basis for Sustainable Human Security: A Place for Anthropocentrism?

Journal of Bioethical Inquiry — Mon, 09 Nov 2009 19:02:21 +0100

Abstract The deep and lasting changes to human behaviour that are required to address the global environmental crisis necessitate profound shifts in moral foundations. They amount to a change in what individuals and societies conceive of as progress. This imperative raises important questions about the justification, ends, and means of large-scale changes in people’s ethics. In this essay I will focus on the ends—the direction of moral change as prescribed by the goal of sustainable human flourishing. I shall present a meta-ethical critique of anthropocentrism and propose that only an ecocentric ethic can support the sustainable flourishing of humanity. This proposition does not necessarily contradict itself. My claim will be that the values subsumed under the broad co...

Values: the beating heart of health reform.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Murray TH PMID: 19891263 [PubMed - in process] (Source: The Hastings Center Report)

A letter from New Jersey Governor Jon S. Corzine.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Corzine JS PMID: 19891264 [PubMed - in process] (Source: The Hastings Center Report)

Liberty: free and equal.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Jennings B PMID: 19891265 [PubMed - in process] (Source: The Hastings Center Report)

Justice and fairness: mandating universal participation.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Menzel PT PMID: 19891266 [PubMed - in process] (Source: The Hastings Center Report)

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Responsibility: Shane and Joe.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Sabin J PMID: 19891267 [PubMed - in process] (Source: The Hastings Center Report)

Solidarity: unfashionable, but still American.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Sage WM PMID: 19891268 [PubMed - in process] (Source: The Hastings Center Report)

Medical progress: unintended consequences.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Callahan D PMID: 19891269 [PubMed - in process] (Source: The Hastings Center Report)

Privacy: Rethinking health information technology and informed consent.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Gostin LO PMID: 19891270 [PubMed - in process] (Source: The Hastings Center Report)

Physician integrity: why it is inviolable.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Pellegrino ED PMID: 19891271 [PubMed - in process] (Source: The Hastings Center Report)

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Quality: where it came from and why it matters.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Davidoff F PMID: 19891272 [PubMed - in process] (Source: The Hastings Center Report)

Efficiency: Getting clear on our goals.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Roberts MJ PMID: 19891273 [PubMed - in process] (Source: The Hastings Center Report)

Health: the value at stake.

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Blacksher E PMID: 19891274 [PubMed - in process] (Source: The Hastings Center Report)

Stewardship: what kind of society do we want?

The Hastings Center Report — Mon, 09 Nov 2009 05:36:04 +0100

Authors: Nichols LM PMID: 19891275 [PubMed - in process] (Source: The Hastings Center Report)

Biomedical and Environmental Ethics Alliance: Common Causes and Grounds

Journal of Bioethical Inquiry — Thu, 05 Nov 2009 18:42:36 +0100

Abstract In the late 1960s Van Rensselaer Potter, a biochemist and cancer researcher, thought that our survival was threatened by the domination of military policy makers and producers of material goods ignorant of biology. He called for a new field of Bioethics—“a science of survival.” Bioethics did develop, but with a narrower focus on medical ethics. Recently there have been attempts to broaden that focus to bring biomedical ethics together with environmental ethics. Though the two have many differences—in habits of thought, scope of concern, and value commitments—in this paper we argue that they often share common cause and we identify common ground through an examination of two case studies, one addressing drug development, the other food production. Conte...

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Illuminating Environmental Bioethics

Journal of Bioethical Inquiry — Thu, 05 Nov 2009 18:42:34 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9199-5Authors Rob Irvine, University of Sydney Centre for Values, Ethics and the Law in Medicine Sydney Australia Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

Short literature notices

Medicine, Health Care and Philosophy — Wed, 04 Nov 2009 07:13:00 +0100

Content Type Journal ArticleCategory Short Literature NoticesDOI 10.1007/s11019-009-9228-5Authors Roberto Andorno, University of Zurich Institute of Biomedical Ethics Zollikerstrasse 115 8008 Zurich Switzerland Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Books received

Medicine, Health Care and Philosophy — Mon, 02 Nov 2009 18:38:24 +0100

Content Type Journal ArticleCategory Books ReceivedDOI 10.1007/s11019-009-9229-4Authors Roberto Andorno, University of Zurich Institute of Biomedical Ethics Zollikerstrasse 115 8008 Zurich Switzerland Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Graduate Socialization in the Responsible Conduct of Research: A National Survey on the Research Ethics Training Experiences of Psychology Doctoral Students

Ethics & Behavior — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Ethics & Behavior)

To Act or Not to Act: Nonconsequentialism in Environmental Decision-Making

Ethics & Behavior — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Ethics & Behavior)

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Community-Based Participatory Research for Improved Mental Health

Ethics & Behavior — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Ethics & Behavior)

Breaking Confidentiality to Report Adolescent Risk-Taking Behavior by School Psychologists

Ethics & Behavior — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Ethics & Behavior)

Centenarians as stem cell donors.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Lewis R, Zhdanov RI PMID: 19882441 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Jewish and Catholic ethics of reproduction: converging or standing apart?

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Zivotofsky AZ, Jotkowitz A PMID: 19882442 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

A modest proposal.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Burris S, Davis C PMID: 19882443 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

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"Listen to the people": public deliberation about social distancing measures in a pandemic.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Baum NM, Jacobson PD, Goold SD Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness (e.g., recognition of an extant duty not to infec...

Public engagement on social distancing in a pandemic: a Canadian perspective.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: , Upshur R PMID: 19882445 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Listen! The value of public engagement in pandemic ethics.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Garrett JE, Vawter DE, Prehn AW, DeBruin DA, Gervais KG PMID: 19882446 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

The value of public deliberation in public health preparedness.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Gostin LO PMID: 19882447 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

"Dunkirk spirit:" differences between United Kingdom and United States responses to pandemic influenza.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Sorell T, Draper H, Damery S, Ives J PMID: 19882448 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

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Promoting justice, trust, compliance, and health: the case for compensation.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Selgelid MJ PMID: 19882449 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Opportunities and challenges in the use of public deliberation to inform public health policies.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Abelson J PMID: 19882450 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

A Jewish response to the Vatican's new bioethical guidelines.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Zivotofsky AZ, Jotkowitz A The Vatican recently published directives (Dignitas Personae) regarding "beginning of life" issues that explain the Catholic Church's position regarding new technologies in this area. We think that it is important to develop a response that presents the traditional Orthodox Jewish position on these same issues in order to present an alternative, parallel system. There are many points of commonality between the Vatican document and traditional Jewish thought as well as several important issues where there is a divergence of opinion. The latter include the status of the zygote as produced during in vitro fertilization (IVF), the acceptable of procreation in a method other than through the conjugal act, and the permissibility of deriving benefit from th...

The complex nature of Jewish and Catholic bioethics.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Eberl JT PMID: 19882452 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

The Catholic position on germ line genetic engineering.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Delaney JJ PMID: 19882453 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

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Judaism, human dignity and the most vulnerable women on Earth.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Barilan YM PMID: 19882454 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

A Jewish response to the Vatican?

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Henning A, Raucher M, Zoloth L PMID: 19882455 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

How should a non-Catholic respond to Catholic moral teaching?

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Ifland CJ, Brown JA PMID: 19882456 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Religious traditions and embryo science.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Jones DG, Whitaker MI PMID: 19882457 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

A sibling rivalry on personhood, procreation, and evil.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Toth-Fejel T, Dodsworth C PMID: 19882458 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

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Jewish views on the beginnings of human life and the use of medical intervention to produce children.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Loike JD, Fischbach RL, Tendler MD PMID: 19882459 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Assessing social risks prior to commencement of a clinical trial: due diligence or ethical inflation?

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Burris S, Davis C Assessing social risks has proven difficult for IRBs. We undertook a novel effort to empirically investigate social risks before an HIV prevention trial among drug users in Thailand and China. The assessment investigated whether law, policies and enforcement strategies would place research subjects at significantly elevated risk of arrest, incarceration, physical harm, breach of confidentiality, or loss of access to health care relative to drug users not participating in the research. The study validated the investigator's concern that drug users were subject to serious social risks in the site localities, but also suggested that participation in research posed little or no marginal increase in risk and might even have a protective effect. Our experience show...

Evaluating empirical assessments of social risk.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Schonfeld T, Brown JS PMID: 19882461 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

The need to explicate the ethical evaluation tools to avoid ethical inflation.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Bernabe RD, van Thiel GJ, Raaijmakers JA, van Delden JJ PMID: 19882462 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Deflating rhetoric about "ethical inflation".

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Rennie S, Rosenfeld LB PMID: 19882463 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

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The need for evidence-based research ethics.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Anderson EE, Sieber JE PMID: 19882464 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Adding insult to injury: reluctance to engage in clinical research with at-risk groups further disenfranchises these populations.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Lynch HF, Dawson L PMID: 19882465 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

What to do when the risk environment is rapidly shifting and heterogeneous? Anticipatory governance and real-time assessment of social risks in multiply marginalized populations can prevent IRB mission creep, ethical inflation or underestimation of risks.

The American Journal of Bioethics : AJOB — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Ozdemir V PMID: 19882466 [PubMed - in process] (Source: The American Journal of Bioethics : AJOB)

Making sense of risk. Donor risk communication in families considering living liverdonation to a child

Medicine, Health Care and Philosophy — Sat, 31 Oct 2009 11:03:16 +0100

In conclusion, we suggest further research questions on how professional responsibility and role-taking in risk communication should be morally understood. Content Type Journal ArticleCategory Scientific ContributionDOI 10.1007/s11019-009-9226-7Authors Mare Knibbe, University Medical Center Groningen, University of Groningen Department of Health Sciences Expert Center Ethics of Care, 9700 RB Groningen The NetherlandsMarian Verkerk, University Medical Center Groningen, University of Groningen Department of Health Sciences Expert Center Ethics of Care, 9700 RB Groningen The Netherlands Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Student projects in medicine: a lesson in science and ethics.

Accountability in Research — Fri, 30 Oct 2009 22:44:10 +0100

Authors: Edwards SJ Regulation of biomedical research is the subject of considerable debate in the bioethics and health policy worlds. The ethics and governance of medical student projects is becoming an increasingly important topic in its own right, especially in the U.K., where there are periodic calls to change it. My main claim is that there seems to be no good reason for treating student projects differently from projects led by qualified and more experienced scientists and hence no good grounds for changing the current system of ethics review. I first suggest that the educational objectives cannot be met without laying down standards of good science, whatever they may be. Weak science is unnecessary for educational purposes, and it is, in any case, unlikely to produce good resear...

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Dealing with misconduct in biomedical research: a review of the problems and the proposed methods for improvement.

Accountability in Research — Fri, 30 Oct 2009 22:44:07 +0100

Authors: Kumar MN The increasing complexity of scientific research has been followed by increasing varieties of research misconduct. Dealing with misconduct involves the processes of detection, reporting, and investigation of misconduct. Each of these steps is associated with numerous problems which need to be addressed. Misconduct investigation should not stop with inquiries and disciplinary actions in specific episodes of misconduct. It is necessary to decrease the personal price paid by those who expose misconduct and to protect the personal and professional interests of honest researchers accused of misconduct unfairly or mistakenly. There is no dearth of suggestions to improve the objectivity and fairness of investigations. What is needed is the willingness to test the various opt...

Editors' malpractice: forward submitted letters (to the concerned authors), then reject them.

Accountability in Research — Fri, 30 Oct 2009 22:44:04 +0100

Authors: Rivera H It seems that editors still enjoy an almost absolute power in deciding "what gets published" and are barely accountable. The rejection of two "Letters to the Editor" submitted by myself to different journals leads me to expose here the editors' confidentiality breach inherent to improperly sharing unpublished manuscripts with the challenged authors. Although the scientific relevance of the issues raised here is virtually null, these experiences are consistent with the view that full peer review starts only after publication, highlight certain editorial malpractices, and stress that we all should promote scientific integrity. PMID: 19866381 [PubMed - in process] (Source: Accountability in Research)

Ethics briefings

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

(Source: Journal of Medical Ethics)

On the ethics of oestrogen treatment for tall girls: an update

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

New empirical evidence on the long-term effects of oestrogen treatment for tall adolescent girls has shown that the intended psychosocial benefit of the treatment may not have been realised. This paper describes recent trends in the prevalence of the treatment and the results of a large Australian cohort study evaluating girls assessed between 1959 and 1993 for excessive growth. The paper concludes that oestrogen treatment to prevent extreme tallness should belong to the past, not to the future. (Source: Journal of Medical Ethics)

Who should consent for research in adult intensive care? Preferences of patients and their relatives: a pilot study

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

Conclusion: Patients are willing to decide on their own participation in a study. If they lose their capacity to decide for themselves, in the great majority of cases, they would agree to delegate the decision to a relative. (Source: Journal of Medical Ethics)

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The acceptability among French lay persons of ending the lives of damaged newborns

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

Background: Lay persons’ judgements of the acceptability of the not uncommon practice of ending the life of a damaged neonate have not been studied. Methods: A convenience sample of 1635 lay people in France rated how acceptable it would be for a physician to end a neonate’s life—by withholding care, withdrawing care, or active euthanasia—in 54 scenarios in which the neonate was diagnosed either with perinatal asphyxia or a genetic abnormality. The scenarios were all combinations of four factors: three levels of maturity or immaturity, three levels of severity of the health problem, three levels of parents’ preference concerning prolonging care and two levels of decision-making (with or without consulting the other caregivers). Analyses: Analyses of variance...

Harmonisation of ethics committees' practice in 10 European countries

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

Conclusions: Despite the efforts for harmonisation of the European Clinical Trial Directive, from an ethical point of view, there remains a plurality of ethics committees' systems in Europe. It is important to comprehend the individual national systems to understand the problems they are facing. (Source: Journal of Medical Ethics)

Solo doctors and ethical isolation

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

This paper uses the case of solo doctors to explore whether working in relative isolation from one’s peers may be detrimental to ethical decision-making. Drawing upon the relevance of communication and interaction for ethical decision-making in the ethical theories of Habermas, Mead and Gadamer, it is argued that doctors benefit from ethical discussion with their peers and that solo practice may make this more difficult. The paper identifies a paucity of empirical research related to solo practice and ethics but draws upon more general medical ethics research and a study that identified ethical isolation among community pharmacists to support the theoretical claims made. The paper concludes by using the literary analogy of Soderberg’s Doctor Glas to illustrate the issues raised...

Telecare and self-management: opportunity to change the paradigm?

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

Telecare, the provision of care through remote interaction enabled by information and communication technology, is quickly developing. Integration with other technological developments is to be expected and will create systems that enable more intense, continuous and unobtrusive monitoring of health, and more personalised feedback and instructions. One of the goals of telecare is enhancing the independence and self-management of patients. In this article three degrees of self-management are described and a distinction is made between compliant and concordant forms of self-management. It is argued that telecare merely promotes forms of self-management in which compliance to medical instructions is central. Technological developments and normative policy considerations may enforce this trend...

Fallacies in the arguments for new technology: the case of proton therapy

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

In a seminal article in the Journal of Medical Ethics, Søren Holm and Tuja Takala analysed two protechnology arguments in bioethics: the hopeful principle and the automatic escalator. They showed how these arguments relate to problematic arguments such as the precautionary principle and the empirical slippery slope argument, and argued that they should be used with great caution. The present article investigates the recent debate on proton beam therapy, where the hopeful principle and the automatic escalator are identified. However, the debate reveals a series of other arguments that deserve similar caution. An analysis of these arguments indicates that the roots of their fallacies are to be found in the ignorance of the uncertainties about risks and benefits and an overly optimisti...

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Should we enhance animals?

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

Much bioethical discussion has been devoted to the subject of human enhancement through various technological means such as genetic modification. Although many of the same technologies could be, indeed in many cases already have been, applied to non-human animals, there has been very little consideration of the concept of "animal enhancement", at least not in those specific terms. This paper addresses the notion of animal enhancement and the ethical issues surrounding it. A definition of animal enhancement is proposed that provides a framework within which to consider these issues; and it is argued that if human enhancement can be considered to be a moral obligation, so too can animal enhancement. (Source: Journal of Medical Ethics)

Autonomy at the end of life: life-prolonging treatment in nursing homes--relatives' role in the decision-making process

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

Conclusion: The study reveals failing procedures and thus a great potential for improvement. Both ethical and legal aspects must be addressed when considering patient autonomy. (Source: Journal of Medical Ethics)

NICE guidelines, clinical practice and antisocial personality disorder: the ethical implications of ontological uncertainty

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

The British National Institute for Health and Clinical Excellence (NICE) has recently (28 January 2009) released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder (ASPD). Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals "at risk" of raising antisoci...

Process and consensus: ethical decision-making in the infertility clinic--a qualitative study

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

In conclusion, suggestions as to how ethical decision-making processes can be supported and improved in infertility practice will be made. (Source: Journal of Medical Ethics)

Agency, duties and the "Ashley treatment"

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:41 +0100

In 2006, a paper in the journal Archives of Pediatric and Adolescent Medicine described a novel case of growth attenuation therapy and other treatments carried out on Ashley, a severely cognitively, neurologically and physically disabled 6-year-old girl. Some of the moral arguments that have sprung up in respect of the so-called "Ashley treatment" are considered, and it is suggested that they all miss something—that the proper treatment of Ashley may have as much to do with doctors’ duties to themselves as with their duties to her. It is suggested that the Ashley treatment may have been in violation of doctors’ self-regarding duties and that this possibility is worthy of further investigation. (Source: Journal of Medical Ethics)

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Re-consenting human subjects: ethical, legal and practical issues

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:40 +0100

(Source: Journal of Medical Ethics)

Eyewitness in Erewhon Academic Hospital

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:40 +0100

(Source: Journal of Medical Ethics)

The concise argument

Journal of Medical Ethics — Fri, 30 Oct 2009 17:01:40 +0100

(Source: Journal of Medical Ethics)

Informed decision making about predictive DNA tests: arguments for more public visibility of personal deliberations about the good life

Medicine, Health Care and Philosophy — Fri, 30 Oct 2009 07:37:36 +0100

Abstract Since its advent, predictive DNA testing has been perceived as a technology that may have considerable impact on the quality of people’s life. The decision whether or not to use this technology is up to the individual client. However, to enable well considered decision making both the negative as well as the positive freedom of the individual should be supported. In this paper, we argue that current professional and public discourse on predictive DNA-testing is lacking when it comes to supporting positive freedom, because it is usually framed in terms of risk and risk management. We show how this ‘risk discourse’ steers thinking on the good life in a particular way. We go on to argue that empirical research into the actual deliberation and decision making pr...

A Litmus Test for Exploitation: James Stacey Taylor's Stakes and Kidneys.

The Journal of Medicine and Philosophy — Fri, 30 Oct 2009 00:00:00 +0100

Authors: Kuntz JR James Stacy Taylor advances a thorough argument for the legalization of markets in current (live) human kidneys. The market is seemly the most abhorrent type of market, a market where the least well-off sell part of their body to the most well off. Though rigorously defended overall, his arguments concerning exploitation are thin. I examine a number of prominent bioethicists' account of exploitation: most importantly, Ruth Sample's exploitation as degradation. I do so in the context of Taylor's argument, with the aim of buttressing Taylor's position that a regulated kidney market is morally allowable. I argue that Sample fails to provide normative grounds consistent with her claim that exploitation is wrong. I then reformulate her account for consistency and plausibil...

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Organ Markets and the Ends of Medicine.

The Journal of Medicine and Philosophy — Fri, 30 Oct 2009 00:00:00 +0100

Authors: Davis FD, Crowe SJ As the gap between the need for and supply of human organs continues to widen, the aim of securing additional sources of these "gifts of the body" has become a seemingly overriding moral imperative, one that could-and some argue, should-override the widespread ban on organ markets. As a medical practice, organ transplantation entails the inherent risk that one human being, a donor, will become little more than a means to the end of healing for another human being and that he or she will come to have a purely instrumental value. With the establishment of organ markets, not only will the harms of instrumentalization be a reality-the ends of medicine will be further compromised and confused. PMID: 19880547 [PubMed - as supplied by publisher] (Source: The Jo...

Autonomy and Organ Sales, Revisited.

The Journal of Medicine and Philosophy — Fri, 30 Oct 2009 00:00:00 +0100

Authors: Taylor JS In this paper I develop and defend my arguments in favor of the moral permissibility of a legal market for human body parts in response to the criticisms that have been leveled at them by Paul M. Hughes and Samuel J. Kerstein. PMID: 19880548 [PubMed - as supplied by publisher] (Source: The Journal of Medicine and Philosophy)

Constraint, Consent, and Well-Being in Human Kidney Sales.

The Journal of Medicine and Philosophy — Fri, 30 Oct 2009 00:00:00 +0100

Authors: Hughes PM This paper canvasses recent arguments in favor of commercial markets in human transplant kidneys, raising objections to those arguments on grounds of the role of injustice, exploitation, and coercion in compromising the autonomy of those most likely to sell a kidney, namely, the least well off members of society. PMID: 19880549 [PubMed - as supplied by publisher] (Source: The Journal of Medicine and Philosophy)

Exemplary and surrogate models: two modes of representation in biology.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:Biologists use models in two distinct ways that have not been clearly articulated. A model may be used either as an exemplar of a larger group, or as a surrogate for a specific target. Zebrafish serve as an exemplary model of vertebrates in developmental biology; rodents are both exemplary vertebrates and specific surrogates for humans in biomedical research. The distinction between exemplary and surrogate models is important, because the criteria for and implications of model choice diverge in significant ways, depending on which role the model is to serve. So, too, do the kinds of conclusions we can legitimately draw from model-based research. The divergence derives in part from the use of the two sorts of models to answer different kinds of questions: exemplary mo...

Why is modern medicine stuck in a rut?

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:There is a growing perception that modern medicine is approaching a state of crisis characterized by creative inertia, non-innovation, and non-productivity. Compared to the remarkable progress during the first 30 years after World War II, the last 30 years have been characterized by a self-congratulatory illusion of progress, the fruits of which have failed to reach our patients. The problem may lie with the fact that the (often lone) clinical innovator of the past who made all the difference to the spectacular progress of medicine during the golden age has been marginalized to the extent that he is now an endangered species. The two definable forces that have led to his alienation are the hegemony of molecular science and the primacy accorded to the randomized clini...

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The placebo effect: illness and interpersonal healing.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:The placebo effect has been a source of fascination, irritation, and confusion within biomedicine over the past 60 years. Although scientific investigation has accelerated in the past decade, with particular attention to neurobiological mechanisms, there has been a dearth of attention to developing a general theory of the placebo effect. In this article, we attempt to address this gap. To set the stage, we review evidence relating to the reality and clinical significance of the placebo effect. Next we investigate the scope and limits of the placebo effect by examining the hypothesis that the placebo effect operates predominantly by modifying the experience and perceptions of illness symptoms, such as pain, anxiety, and fatigue, rather than by modifying the pathophysi...

Variational causal claims in epidemiology.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

This article examines definitions of cause in the epidemiological literature. Those definitions describe causes as factors that make a difference to the distribution of disease or to individual health status. In philosophical terms, they are "difference-makers." I argue that those definitions are underpinned by an epistemology and a methodology that hinge upon the notion of variation, contra the dominant Humean paradigm according to which we infer causality from regularity. Furthermore, despite the fact that causes are defined in terms of difference-making, this doesn't fix the causal metaphysics but rather reflects the "variational" epistemology and methodology of epidemiology. I suggest that causality in epidemiology ought to be interpreted according to Williamson's epistemic theory. In ...

The painless brain: lobotomy, psychiatry, and the treatment of chronic pain and terminal illness.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

This article examines the use of lobotomy as a treatment for chronic intractable pain and reconstructs then-common perceptions of pain and of the patients who suffered from it. It delineates the social expectations and judgments implicit in physicians' descriptions of the patients, analyzing what was expected from such patients and how the medical establishment responded to non-normative expressions of suffering. I argue that the medicalized response to an expectation for normativity demonstrates the convergence between psychiatric and palliative interventions. Based on a historically informed perspective of psychiatric interventions in the field of pain medicine, I examine the use of psychiatric medications for pain syndromes today and evaluate the interface between depression, chronic pa...

Richard bradley: a unified, living agent theory of the cause of infectious diseases of plants, animals, and humans in the first decades of the 18th century.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:During the years 1714 to 1721, Richard Bradley, who was later to become the first Professor of Botany at Cambridge University, proposed a unified, unique, living agent theory of the cause of infectious diseases of plants and animals and the plague of humans. Bradley's agents included microscopic organisms, revealed by the studies of Robert Hooke and Antony van Leeuwenhoek. His theory derived from his experimental studies of plants and their diseases and from microscopic observation of animalcules in different naturally occurring and artificial environments. He concluded that there was a microscopic world of "insects" that lived and reproduced under the appropriate conditions, and that infectious diseases of plants were caused by such "insects." Since there are struct...

Creativity in biological research.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:During the past century, several biologists have studied the mental processes involved in creativity. In recent years psychologists have approached the subject experimentally. In one such study (), creativity has been shown to originate in the subconscious mind and to be transmitted to the conscious mind as a result of a decrease in latent inhibition, an ordinarily strong cognitive barrier between the conscious mind and the subconscious. In my scientific work I have found evidence for creativity in the design of experiments, in which the addition of apparently superfluous controls has led to important discoveries. PMID: 19855126 [PubMed - in process] (Source: Perspectives in Biology and Medicine)

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Compassionate solidarity: suffering, poetry, and medicine.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:Suffering is the experience of distress or disharmony caused by the loss, or threatened loss, of what we most cherish. Such losses may strip away the beliefs by which we construct a meaningful narrative of human life in general and our own in particular. The vocation of physicians and other health professionals is to relieve suffering caused by illness, trauma, and bodily degeneration. However, since suffering is an existential state that does not necessarily parallel physical or emotional states, physicians cannot rely solely on knowledge and skills that address physiological dysfunction. Rather, they must learn to engage the patient at an existential level. Unfortunately, however, medical pedagogy encourages "detached concern," which devalues subjectivity, emotion,...

An old doctor grows older.

Perspectives in Biology and Medicine — Thu, 29 Oct 2009 02:36:02 +0100

Authors: Abstract:An old man, I am convinced that aging is no disease, but a normal part of living, just like childhood. Society should provide for our inevitable decline rather than support research to postpone our dying. Retirement, now so arbitrary, defines when men and women are old, and so discards contributions from the elderly who want to work. As a physician, I am sure that many of us over 65 could help to assist the caregivers who have so little time. Ageism is part of the problem: medical students learn ageism in their early training, and that ageism is reinforced by later contact with the frail sick elderly who come to them for care. Aging-and death-have grown invisible to the young. But now that we elderly are so many and, thanks to good luck or the Creator's grace, so hea...

COUNTERFACTUAL REASONING IN SURROGATE DECISION MAKING – ANOTHER LOOK

Bioethics — Thu, 29 Oct 2009 00:00:00 +0100

Incompetent patients need to have someone else make decisions on their behalf. According to the Substituted Judgment Standard the surrogate decision maker ought to make the decision that the patient would have made, had he or she been competent. Objections have been raised against this traditional construal of the standard on the grounds that it involves flawed counterfactual reasoning, and amendments have been suggested within the framework of possible worlds semantics. The paper shows that while this approach may circumvent the alleged problem, the way it has so far been elaborated reflects insufficient understanding of the moral underpinnings of the idea of substituted judgment. Proper recognition of these moral underpinnings has potentially far-reaching implications for our normative a...

Pastoral Power and the Confessing Subject in Patient-Centred Communication

Journal of Bioethical Inquiry — Tue, 27 Oct 2009 18:25:09 +0100

Abstract This paper examines the power relations in “patient-centred communication”. Drawing on the work of Michel Foucault I argue that while patient-centred communication frees the patient from particular aspects of medical power, it also introduces the patient to new power relations. The paper uses a Foucauldian analysis of power to argue that patient-centred communication introduces a new dynamic of power relations to the medical encounter, entangling and producing the patient to participate in the medical encounter in a particular manner. Content Type Journal ArticleDOI 10.1007/s11673-009-9195-9Authors Christopher Mayes, University of Sydney Centre for Values, Ethics and the Law in Medicine Sydney Australia Journal Journal of Bioethical InquiryOnline ISS...

Murray, Samantha. 2008. The fat female body.

Journal of Bioethical Inquiry — Tue, 27 Oct 2009 09:09:46 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9194-xAuthors Paul A. Komesaroff, The Alfred Hospital Centre for Ethics in Medicine and Society, Monash University Commercial Road Prahran Victoria 3181 Australia Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

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Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

BMC Medical Ethics — Tue, 27 Oct 2009 00:00:00 +0100

Conclusion: Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (Source: BMC Medical Ethics)

The dead donor rule, voluntary active euthanasia, and capital punishment

Bioethics — Mon, 26 Oct 2009 00:00:00 +0100

We argue that the dead donor rule, which states that multiple vital organs should only be taken from dead patients, is justified neither in principle nor in practice. We use a thought experiment and a guiding assumption in the literature about the justification of moral principles to undermine the theoretical justification for the rule. We then offer two real world analogues to this thought experiment, voluntary active euthanasia and capital punishment, and argue that the moral permissibility of terminating any patient through the removal of vital organs cannot turn on whether or not the practice violates the dead donor rule. Next, we consider practical justifications for the dead donor rule. Specifically, we consider whether there are compelling reasons to promulgate the rule even though ...

Current functions of italian ethics committees: a cross-sectional study

Bioethics — Mon, 26 Oct 2009 00:00:00 +0100

Conclusions: A common European model should be developed, defining EC functions, member selection modalities, necessary member competences, decision-making criteria and measures for work verification. In the absence of sound empirical evidence, it would be interesting to study the effectiveness and efficiency of the different existing models. (Source: Bioethics)

Deeper problems for noonan's probability argument against abortion: on a charitable reading of noonan's conception criterion of humanity

Bioethics — Mon, 26 Oct 2009 00:00:00 +0100

In 'An Almost Absolute Value in History' John T. Noonan criticizes several attempts to provide a criterion for when an entity deserves rights. These criteria, he argues are either arbitrary or lead to absurd consequence. Noonan proposes human conception as the criterion of rights, and justifies it by appeal to the sharp shift in probability, at conception, of becoming a being possessed of human reason. Conception, then, is when abortion becomes immoral. The article has an historical and a philosophical goal. The historical goal is to carefully present the probability argument in a charitable manner. The philosophical goal is to offer a unique criticism of Noonan's probability argument against abortion. I argue that, even on a very charitable reading of Noonan's argument for the conception ...

David, Koepsell. 2009. Who owns you? The corporate gold rush to patent your genes

Journal of Bioethical Inquiry — Thu, 22 Oct 2009 19:01:49 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9192-zAuthors Aaron Fellmeth, Arizona State University College of Law P.O. Box 877906 Tempe AZ USA Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

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Response

Journal of Bioethical Inquiry — Wed, 21 Oct 2009 02:29:06 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9190-1Authors Aidan Davison, University of Tasmania School of Geography & Environmental Studies Private Bag 78 Hobart TAS 7001 Australia Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

Introduction: Symposium on a Regulated Market in Transplantable Organs.

The Journal of Medicine and Philosophy — Tue, 20 Oct 2009 23:00:00 +0100

Authors: Hippen BE PMID: 19846477 [PubMed - as supplied by publisher] (Source: The Journal of Medicine and Philosophy)

Why Should We Compensate Organ Donors When We Can Continue to Take Organs for Free? A Response to Some of My Critics.

The Journal of Medicine and Philosophy — Tue, 20 Oct 2009 23:00:00 +0100

Authors: Cherry MJ In Kidney for Sale by Owner: Human Organs, Transplantation, and the Market, I argued that the market is the most efficient and effective-and morally justified-means of procuring and allocating human organs for transplantation. This special issue of The Journal of Medicine and Philosophy publishes several articles critical of this position and of my arguments mustered in its support. In this essay, I explore the core criticisms these authors raise against my conclusions. I argue that clinging to comfortable, but unfounded, notions that human body parts are not commodities, that the physician-patient relationship transcends commercial practices, and that medicine rises above market-place morality (where "market-place morality" is presented rhetorically as a criticism) ...

Autonomy, Moral Constraints, and Markets in Kidneys.

The Journal of Medicine and Philosophy — Tue, 20 Oct 2009 23:00:00 +0100

This article concerns the morality of establishing regulated kidney markets in an effort to reduce the chronic shortage of kidneys for transplant. The article tries to rebut the view, recently defended by James Taylor, that if we hold autonomy to be intrinsically valuable, then we should be in favor of such markets. The article then argues that, under current conditions, the buying and selling of organs in regulated markets would sometimes violate two Kantian principles that are seen as moral constraints. One principle forbids expressing disrespect for the dignity of humanity; the other forbids treating others merely as means. In light of the moral danger posed by regulated markets, the article advocates an alternative way of diminishing the current organ shortage, namely opt-out systems o...

Response

Journal of Bioethical Inquiry — Thu, 15 Oct 2009 18:40:37 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9193-yAuthors Brian William Head, University of Queensland Institute for Social Science Research St Lucia Queensland 4072 Australia Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

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Conceptual analysis and empirical research in medical philosophy and medical ethics

Medicine, Health Care and Philosophy — Thu, 15 Oct 2009 06:30:37 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s11019-009-9225-8Authors Wim Dekkers, UMC St Radboud Nijmegen 114 IQ Healthcare, Section Ethics PO Box 9101 6500 HB Nijmegen The NetherlandsBert Gordijn, UMC St Radboud Nijmegen 114 IQ Healthcare, Section Ethics PO Box 9101 6500 HB Nijmegen The Netherlands Journal Medicine, Health Care and PhilosophyOnline ISSN 1572-8633Print ISSN 1386-7423 (Source: Medicine, Health Care and Philosophy)

Overcoming barriers to pain relief in the caribbean

Developing World Bioethics — Tue, 13 Oct 2009 23:00:00 +0100

This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated ...

Research integrity in china: problems and prospects

Developing World Bioethics — Tue, 13 Oct 2009 23:00:00 +0100

In little more than 30 years, China has recovered from the intellectual stagnation brought about by the Cultural Revolution to become a global leader in science and technology. Like other leading countries in science and technology, China has encountered some ethical problems related to the conduct of research. China's leaders have taken some steps to respond to these problems, such as developing ethics policies and establishing oversight committees. To keep moving forward, China needs to continue to take effective action to promote research integrity. Some of the challenges China faces include additional policy development, promoting education in responsible conduct of research, protecting whistle-blowers, and cultivating an ethical research environment. (Source: Developing World Bioethic...

Microbicides Development Programme: Engaging the community in the standard of care debate in a vaginal microbicide trial in Mwanza, Tanzania

BMC Medical Ethics — Thu, 08 Oct 2009 23:00:00 +0100

Conclusions: Participatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registration: Current Controlled Trials ISRCTN64716212 (Source: BMC Medical Ethics)

Film Review ETIENNE!: A Film about the Little Things in Life

Journal of Bioethical Inquiry — Thu, 08 Oct 2009 07:08:49 +0100

Content Type Journal ArticleDOI 10.1007/s11673-009-9189-7Authors Katrina A. Bramstedt, California Pacific Medical Center (CPMC) Program in Medicine & Human Values 2395 Sacramento Street, 3rd floor San Francisco CA 94115 USA Journal Journal of Bioethical InquiryOnline ISSN 1872-4353Print ISSN 1176-7529 (Source: Journal of Bioethical Inquiry)

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Palliative care, public health and justice: setting priorities in resource poor countries

Developing World Bioethics — Tue, 06 Oct 2009 23:00:00 +0100

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberat...

On how to interpret the role of the future within the abortion debate [Response]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

In a previous paper, I had argued that Strong’s counterexamples to Marquis’s argument against abortion—according to which terminating fetuses is wrong because it deprives them of a valuable future—fail either because they have no bearing on Marquis’s argument or because they make unacceptable claims about what constitutes a valuable future. In this paper I respond to Strong’s criticism of my argument according to which I fail to acknowledge that Marquis uses "future like ours" and "valuable future" interchangeably. I show that my argument does not rely on not acknowledging that "future like ours" and "valuable future" are interchangeable; and that, rather, it is exactly by replacing "future like ours" with "valuable future" that I construct my argument a...

"Personality disorder" and capacity to make treatment decisions [Brief reports]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of "personality disorder" is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, in itself, a therapeutic intervention. (Source: Journal of Medical Ethics)

Locked inpatient units in modern mental health care: values and practice issues [Brief reports]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

Locked inpatient units are an increasing phenomenon, introduced in response to unforseen abscondences and suicides of patients. This paper identifies some value issues concerning the practice of locked psychiatric inpatient units. Broad strategies, practicalities and ethical matters that must be considered in inpatient mental health services are also explored. The authors draw on the published research and commentary to derive relevant information to provide to patients and staff regarding the aims and rationales of locked units. Further debate is warranted in relation to best practice. Inpatient staff need to be aware of their practice values, be able to access education and supervision and negotiate apparent contradictions. Further patient/clinician focused enquiry is necessary to mitiga...

Obtaining informed consent: observations from community research with refugee and impoverished youth [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

This paper presents challenges facing researchers in applying basic ethical principles while conducting research with youth in a developing country context. A discussion of the cultural and social challenges to adherence to the elements of informed consent: disclosure, comprehension, capacity, voluntariness and consent is presented. The authors argue that the current institutional review board requirements that guide research reflect values and stem from western contexts that may not be fully applicable to non-western contexts. More dialogue is needed among researchers in developing world contexts on challenges of and possible revisions to requirements that maintain respect for persons, beneficence, autonomy and justice, particularly when working with youth. (Source: Journal of Medical Eth...

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Mixed motives, mixed outcomes when accused parents won't agree to withdraw care [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

One of the basic tenets of paediatric ethics is that competent parents may render healthcare decisions for children who are too young or too incapacitated to make meaningful medical choices for themselves. In the USA, many jurisdictions have expanded this principle to include the right to terminate a child's life support, including nutrition and hydration, when that child enters a persistent vegetative state. However, this approach to the withdrawal of care in the paediatric setting has been put to the test by an increasing number of cases in which one or both parents are themselves accused of causing the child's life-threatening injuries. In such "mixed-motive" situations, parents may express a desire to keep a child on life support for religious or moral reasons; at the same time, forest...

Clinical obligations and public health programmes: healthcare provider reasoning about managing the incidental results of newborn screening [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (Source: Journal of Medical Ethics)

The robustness of medical professional ethics when times are changing: a comparative study of general practitioner ethics and surgery ethics in The Netherlands [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be...

Death and organ donation: back to the future [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:31 +0100

The practice of transplantation of vital organs from "brain-dead" donors is in a state of theoretical disarray. Although the law and prevailing medical ethics treat patients diagnosed as having irreversible total brain failure as dead, scholars have increasingly challenged the established rationale for regarding these patients as dead. To understand the ethical situation that we now face, it is helpful to revisit the writings of the philosopher Hans Jonas, who forcefully challenged the emerging effort to redefine death in the late 1960s. (Source: Journal of Medical Ethics)

Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

This article reviews the ethical and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that "unfair" advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally ...

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All hail the new flesh: some thoughts on scarification, children and adults [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

Body art as expressed through non-therapeutic bodily modification is extremely popular, with techniques ranging from the commonplace such as ear piercing to the more esoteric forms such as tongue splitting. Scarification is one such body art practice that is becoming popular as an alternative to tattooing and ear piercing. This paper begins by outlining the regulatory problems that scarification poses. It then goes on to argue that although there is a reasonable case for permitting competent adults to make use of scarification, the practice should not be made available to minors. (Source: Journal of Medical Ethics)

Undertreating pain violates ethical principles [Papers]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pa...

Is it ethical for a general practitioner to claim a conscientious objection when asked to refer for abortion? [Controversies]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

Abortion is one of the most divisive topics in healthcare. Proponents and opponents hold strong views. Some health workers who oppose abortion assert a right of conscientious objection to it, a position itself that others find unethical. Even if allowance for objection should be made, it is not clear how far it should extend. Can conscientious objection be given as a reason not to refer when a woman requests her doctor to do so? This paper explores the idea of the general practitioner (GP) who declines to make a direct referral for abortion, asking the woman to see another GP instead. The purpose is to defend the claim that an appeal to conscientious objection in this way can be reasonable and ethical. (Source: Journal of Medical Ethics)

Unanswered questions and ethical issues concerning US biodefence research [Controversies]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

Unanswered questions and ethical issues associated with US biodefence medical research over the past five decades are discussed. Objective scientific standards are essential for making policy decisions that can stand the test of time. For decades, scholars have reported that the human anthrax vaccine field trials conducted in the 1950s by Brachman and his colleagues were single-blind rather than double-blind. Nevertheless, in March 2005, Dr Philip S Brachman reported in a letter to the US Food and Drug Administration that his study had been double-blind. It is here argued that, rather, the field trial of a human anthrax vaccine should continue to be deemed as single-blind unless more detailed information is provided to explain exactly how the investigators were kept unaware of which subjec...

Eyewitness in Erewhon Academic Hospital [Eyewitness]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

(Source: Journal of Medical Ethics)

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Free riding and organ donation [Editorial]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

(Source: Journal of Medical Ethics)

The concise argument [The concise argument]

Journal of Medical Ethics — Wed, 30 Sep 2009 17:01:30 +0100

(Source: Journal of Medical Ethics)

[Response] On how to interpret the role of the future within the abortion debate

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Brief reports] "Personality disorder" and capacity to make treatment decisions

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Brief reports] Locked inpatient units in modern mental health care: values and practice issues

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

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[Papers] Obtaining informed consent: observations from community research with refugee and impoverished youth

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Papers] Mixed motives, mixed outcomes when accused parents won't agree to withdraw care

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Papers] Clinical obligations and public health programmes: healthcare provider reasoning about managing the incidental results of newborn screening

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Papers] The robustness of medical professional ethics when times are changing: a comparative study of general practitioner ethics and surgery ethics in The Netherlands

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Papers] Death and organ donation: back to the future

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

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[Papers] Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Papers] All hail the new flesh: some thoughts on scarification, children and adults

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Papers] Undertreating pain violates ethical principles

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100

[Controversies] Is it ethical for a general practitioner to claim a conscientious objection when asked to refer for abortion?

Journal of Medical Ethics — Tue, 29 Sep 2009 23:00:00 +0100