Clinical Ethics
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Why I Wrote ... Holding On? Vacant Possession, Paternity, Double Trouble, Right to Die - novels addressing key medical ethical dilemmas
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(Source: Clinical Ethics)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: McHaffie, H. Tags: Papers Source Type: journals
Splitting hairs over the definition of murder: Thomas Aquinas and the doctrine of double effect
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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 unintend...
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Papanikitas, A. Tags: Papers Source Type: journals
Substituted misjudgement
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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 judg...
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Woo, J. A, Prager, K. M Tags: Papers Source Type: journals
Confidentiality and consent in living kidney transplantation: is it essential for a donor to know that their recipient has HIV disease?
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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 ...
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Elias, R. Tags: Papers Source Type: journals
Experiencing bad treatment: qualitative study of patient complaints concerning their treatment by public health-care practitioners in the County of Stockholm
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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)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Wessel, M, Helgesson, G, Lynoe, N Tags: Empirical Ethics Source Type: journals
Subject positions in research ethics committee letters: a discursive analysis
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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 res...
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: O'Reilly, M., Armstrong, N., Dixon-Woods, M. Tags: Empirical Ethics Source Type: journals
Cutting through red tape: non-therapeutic circumcision and unethical guidelines
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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 w...
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Shaw, D. Tags: Public Policy & Law Source Type: journals
Competent minors and health-care research: autonomy does not rule, okay?
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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)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Biggs, H. Tags: Public Policy & Law Source Type: journals
Truth-telling in health care
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(Source: Clinical Ethics)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Slowther, A. Tags: Five-Minute Focus Source Type: journals
Clinical Ethics Committee Case 8: Should we carry out a predictive genetic test in our young patient?
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(Source: Clinical Ethics)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Newson, A. J Tags: Case Studies Source Type: journals
Ethics in collaborative global health research networks
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(Source: Clinical Ethics)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Parker, M., Bull, S. Tags: Editorials Source Type: journals
Focusing clinicians on ethics
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(Source: Clinical Ethics)
Source: Clinical Ethics - November 17, 2009 Category: Medical Ethics Authors: Slowther, A. Tags: Editorials Source Type: journals
Why I wrote Children's Consent to Surgery
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(Source: Clinical Ethics)
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Alderson, P. Tags: Papers Source Type: journals
Donating one's brain for research - a very personal perspective
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(Source: Clinical Ethics)
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Clayton-Turner, A. Tags: Papers Source Type: journals
Strengths and limitations of considering patients as ethics 'actors' equal to doctors: reflections on the patients' position in a French clinical ethics consultation setting
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The Clinical ethics centre in Paris offers its services equally to doctors and patients/proxies. Its primary goal is to re-equilibrate doctor–patient roles through giving greater voice to patients individually in medical decisions. Patients are present at virtually all levels, initiating consults, providing their point of view and receiving feedback. The implications of patients' involvement are threefold. At an operational level, decision-making is facilitated by repositioning the debate on ethical grounds and introducing a dynamic of decisional partnership, although contact with patients can make it difficult to de...
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Rari, E., Fournier, V. Tags: Papers Source Type: journals
Patient involvement in clinical ethics services: from access to participation and membership
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Ethics consultation is a novel paradigm in European health-care institutions. In this paper, patient involvement in all clinical ethics activities is scrutinized. It is argued that patients should have access to case consultation services via clearly defined access paths. However, the right of both health-care professionals and patients indicates that patients should not always be notified of a consultation. Ethics education, another well-established function of an ethics committee, should equally be available for patients, lay people and hospital staff. Beyond access and utilization, lay membership on a clinical ethics se...
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Neitzke, G. Tags: Papers Source Type: journals
The role of patients in clinical ethics support: a snapshot of practices and attitudes in the United Kingdom
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This study reports the first specific investigation of patient contact with UK CECs. A questionnaire study was carried out with representatives from UK CECs. Results suggest that patient participation in clinical ethics consultation is low and unlikely to change significantly in the near future. Attitudes towards patients having a role in clinical ethics consultation are mixed, with a variety of reasons put forward both for and against patient participation. These results are discussed in the light of common themes in the literature and the practical and political context of clinical ethics support in the UK. (Source: Clinical Ethics)
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Newson, A. J Tags: Empirical Ethics Source Type: journals
Clinical ethics consultation in Europe: a comparative and ethical review of the role of patients
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Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation of clinical ethics consultation services (Cecs), as well as the init...
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Fournier, V., Rari, E., Forde, R., Neitzke, G., Pegoraro, R., Newson, A. J Tags: Empirical Ethics Source Type: journals
Involving patients and relatives in a Norwegian clinical ethics committee: what have we learned?
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To date, few Norwegian clinical ethics committees (CECs) have included patients or next of kin in case discussions. In 2008, Rikshospitalet's (The National Hospital's) CEC began to routinely invite patients and relatives into case discussions. In this paper, we describe seven cases discussed by this committee in 2008. Six involved life and death decision-making in collaboration with the next of kin, while one related case did not include relatives. In our opinion, representing the patient's perspective was advantageous to the discussion itself, to the conclusion made and to the next of kin's acceptance of the resolution. W...
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Forde, R., Hansen, T. W. R. Tags: Empirical Ethics Source Type: journals
A plea for precaution with public health: the xenotransplantation example
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In this paper we argue that while individual private interests such as autonomy and the need for a medical procedure or treatment are important in the provision and delivery of health care and the utilization of biotechnologies, these concepts need to be balanced with other interests such that in certain situations they do not take priority. We use as an example a particular developing biotechnology, xenotransplantation, to suggest that interest in the health of the public is such that this biotechnology should not be permitted to move to the clinical trial stage because of the particular risk of harm it poses to the poten...
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Fovargue, S., Ost, S. Tags: Public Policy & Law Source Type: journals
Planning for and managing pandemic influenza
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(Source: Clinical Ethics)
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Slowther, A. Tags: Five-Minute Focus Source Type: journals
Clinical ethics committee case 7: our young patient is in heart failure but has multiple co-morbidities. How can we best care for him and his family?
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(Source: Clinical Ethics)
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Newson, A. J Tags: Case Studies Source Type: journals
The role of patients in European clinical ethics consultation
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(Source: Clinical Ethics)
Source: Clinical Ethics - August 31, 2009 Category: Medical Ethics Authors: Newson, A. J, Neitzke, G., Reiter-Theil, S. Tags: Editorial Source Type: journals
Why I wrote... The Wounded Storyteller: a recollection of life and ethics
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(Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Frank, A. W Tags: Papers Source Type: journals
Obtaining consent from minors with parental responsibility
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This article explores these controversies through four case scenarios. These scenarios are loosely based on the authors' prior experiences as paediatric surgeons. In light of current statutory guidance, and the paucity of legal precedent, there are few answers to be offered. However, exploring the issues, enabling them to be thoughtfully considered by health professionals, is in itself valuable. (Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Macharia, E, Milanovic, D Tags: Papers Source Type: journals
Ethical decision-making in two patients with locked-in syndrome on the intensive care unit
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In conclusion, most patients with LIS are competent and intellectually intact. In The Netherlands the autonomy of the patient is respected by law. In respecting this autonomy, medical choices can be different in comparable patients. (Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Kompanje, E J O Tags: Papers Source Type: journals
Use or ornament? Clinical ethics committees in infertility units: a qualitative study
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This paper examines the role of clinical ethics committees (CECs) in infertility clinics in the UK, focusing on whether they usefully support infertility clinicians' ethical decision-making. The overall aim of the study reported here was to investigate how infertility clinicians approached and handled ethical problems in their everyday practice and this paper reports on one aspect of these data – what they thought about the use of CECs. This paper gives an overview of what arrangements there are for such committees in infertility clinics; considers why the clinicians used CECs; and examines how these committees provi...
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Frith, L. Tags: Empirical Ethics Source Type: journals
Being 'one cog in a bigger machine': a qualitative study investigating ethical challenges perceived by junior doctors
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There is increasing recognition among bioethicists that health-care practitioners' everyday ethical challenges ought to be the focus of ethical analysis. Interviews were conducted with Australian junior doctors to identify some of the kinds of situations that they found ethically challenging, as a basis for this type of grounded philosophical analysis and for further empirical research into junior doctors' ethical issues. Fourteen doctors in their first to fourth year of work from six hospitals in Melbourne participated. Issues discussed included involvement in treatment perceived as inappropriate, seniors discouraging dis...
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: McDougall, R J Tags: Empirical Ethics Source Type: journals
Seven-year-old children's perceptions of participating in a comprehensive clinical birth cohort study
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While several studies have explored parents' perceptions of their children's participation in research, very few studies have described the children's own perceptions of their participation in research. The aim of this study was to describe children's perceptions of their participation in a comprehensive longitudinal clinical study. Semi-structured qualitative interviews were conducted with 17 children aged seven participating in the Copenhagen Prospective Study on Asthma in Childhood. The interviews were audiotaped, transcribed and analysed using the template analysis method. The children rated their experiences with vene...
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Gammelgaard, A., Bisgaard, H. Tags: Empirical Ethics Source Type: journals
Alcohol dependence in public policy: towards its (re)inclusion
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Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association's recent attempt to improve policy on alcohol in the UK by introducing strategies which have been shown to control ...
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Williamson, L. Tags: Public Policy & Law Source Type: journals
Should doctors ever be professionally required to change their attitudes?
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The General Medical Council instructs doctors not to allow their personal beliefs to interfere with their practice. But if attitudes can threaten to impact negatively on a doctor's practice then the question arises: should doctors ever be professionally required to change their attitudes? In this paper I suggest that doctors should be required to amend their attitudes if two conditions are met, namely: (1) the doctor has an attitude that if neglected by the doctor will (or is very likely to) compromise his or her fitness to practise; and (2) the only way in which the doctor can prevent that attitude from compromising his o...
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Whiting, D. Tags: Public Policy & Law Source Type: journals
Organ donation
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(Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Slowther, A. Tags: Five-Minute Focus Source Type: journals
Clinical Ethics Committee case 6: Our patient wishes to take an unlisted drug even though we're not sure of his diagnosis
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(Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Newson, A. J Tags: Case Studies Source Type: journals
Mad dogs and (arguably) madder Scotsmen: biomedical ethics in an Asian context
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(Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Campbell, A. V Tags: Guest Editorial Source Type: journals
Reflections on the ethics of translational research
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(Source: Clinical Ethics)
Source: Clinical Ethics - May 22, 2009 Category: Medical Ethics Authors: Williams, C. Tags: Guest Editorial Source Type: journals
The rule of rescue in clinical practice
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People often have a strong intuitive sense that we ought to rescue those in serious need, even in cases where we could produce better outcomes by acting in other ways. It has become common in such cases to refer to this as the Rule of Rescue. Within the medical field this rule has predominantly been discussed in relation to decisions about whether to fund particular treatments. While, in this setting, the arguments in favour of the Rule of Rescue have generally been found to be unconvincing, there are some reasons for thinking that it may have more of a role to play at the clinical level. In this article, we examine three ...
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Hughes, J., Walker, T. Tags: Papers Source Type: journals
When is deception in research ethical?
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This article examines when deceptive withholding of information is ethically acceptable in research. The first half analyses the concept of deception. We argue that there are two types of accounts of deception: normative and non-normative, and argue that non-normative accounts are preferable. The second half of the article argues that the relevant ethical question which ethics committees should focus on is not whether the person from whom the information is withheld will be deceived, but rather on the reasonableness of withholding the information from the person who is deceived. We further argue that the reasonableness of ...
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Athanassoulis, N., Wilson, J. Tags: Papers Source Type: journals
Hope and terminal illness: false hope versus absolute hope
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Sustaining hope in patients is an important element of health care, allowing improvement in patient welfare and quality of life. However in the palliative care context, with patients who are terminally ill, it might seem that in order to maintain hope the palliative care practitioner would sometimes have to deceive the patient about the full nature or prospects of their condition by providing a ‘false hope’. This possibility creates an ethical tension in palliative practice, where the beneficent desire to improve patient welfare through sustaining hope appears to be in conflict with an autonomy-based requiremen...
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Garrard, E., Wrigley, A. Tags: Papers Source Type: journals
Philosophical clinical ethics
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Dawson, A., Wilkinson, S. Tags: Papers Source Type: journals
Why I wrote ... Euthanasia, Ethics and the Law: From Conflict to Compromise
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Huxtable, R. Tags: Papers Source Type: journals
The Shock of the Human: how the media can change the way we think about ethical dilemmas in medicine
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The relationship between the media and the medical profession is often one of mutual mistrust. However, the media, and especially television, is a powerful tool for telling individual stories and for providing a medium for medico-ethical dilemmas to be portrayed to a wide audience. The extent to which the use of individual narratives can or should influence public opinion about complex medical issues is examined in this paper from the perspective of a former television journalist with a postgraduate degree in medical law and ethics. (Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Barclay, S. Tags: Papers Source Type: journals
Reasoning about physician-assisted suicide: analysis of comments by physicians and the Swedish general public
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Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public and physicians, with the former mainly in favour of PAS and the latter mainly...
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Helgesson, G., Lindblad, A., Thulesius, H., Lynoe, N. Tags: Empirical Ethics Source Type: journals
A response to 'Death and best interests'
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Bridgeman, J. Tags: Public Policy & Law Source Type: journals
The Doctrine of Double Effect and end-of-life decisions
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Tuckey, L., Slowther, A. Tags: Five-Minute Focus Source Type: journals
Clinical Ethics Committee case 5: Should we discharge our vulnerable patient to a family who seem unable to look after her?
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Newson, A. J Tags: Case Studies Source Type: journals
A missed opportunity to reform an outdated law
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Sheldon, S. Tags: Guest Editorial Source Type: journals
Tomorrow's doctors - the place of creativity
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(Source: Clinical Ethics)
Source: Clinical Ethics - February 17, 2009 Category: Medical Ethics Authors: Farsides, B., Eckstein, S. Tags: Editorials Source Type: journals
Why we wrote... Medicine, Patients and the Law
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(Source: Clinical Ethics)
Source: Clinical Ethics - November 24, 2008 Category: Medical Ethics Authors: Brazier, M., Cave, E. Tags: Papers Source Type: journals
A closer look at the Nuffield Council on Bioethics
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The Nuffield Council on Bioethics examines ethical issues raised by new developments in biology and medicine. Established by the Nuffield Foundation in 1991, the Council is an independent body, funded jointly by the Foundation, the Medical Research Council and the Wellcome Trust. Independence and quality are the underlining principles of the Council, and the way the Council works has been designed to ensure that its reports are thorough, authoritative and provide a novel, policy-oriented approach to difficult ethical dilemmas. Recent reports have considered the issues raised by public health and critical care decisions in ...
Source: Clinical Ethics - November 24, 2008 Category: Medical Ethics Authors: Whittall, H. Tags: Papers Source Type: journals
Through thick and thin: rationalizing the public bioethical debate over therapeutic cloning
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Beauchamp and Childress (1994) elaborated an approach to bioethical deliberations based on four universalistic principles. This framework of ‘principlism’ has been criticized from within biomedical ethics as insufficient and problematic. However, this article considers a more radical sociological critique by John Evans (2002) that rejects the entire approach of defining ‘principles’ a priori. This sociological critique is based on classical sociologist Max Weber's (1925) distinction between instrumental (‘thin’) and substantive (‘thick’) rationality. As an exploratory assessm...
Source: Clinical Ethics - November 24, 2008 Category: Medical Ethics Authors: Jensen, E. Tags: Papers Source Type: journals
