bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential CD4
+
T-Lymphocyte Apoptosis and Bystander T-Cell Activation in Rhesus Macaques and Sooty Mangabeys during Acute Simian Immunodeficiency Virus Infection
Authors: Meythaler Mareike , Martinot Amanda , Wang Zichun , Pryputniewicz Sarah , Kasheta Melissa , Ling Binhua , Marx Preston A. , O'Neil Shawn , Kaur Amitinder
Published: November 2008

In contrast to pathogenic lentiviral infections, chronic simian immunodeficiency virus (SIV) infection in its natural host is characterized by a lack of increased immune activation and apoptosis. To determine whether these differences are species specific and predicted by the early host response to SIV in primary infection, we longitudinally examined T-lymphocyte apoptosis, immune activation, and the SIV-specific cellular immune response in experimentally infected rhesus macaques (RM) and sooty mangabeys (SM) with controlled or uncontrolled SIV infection. SIVsmE041, a primary SIVsm isolate, reproduced set-point viremia levels of natural SIV infection in SM but was controlled in RM, while SIVmac239 replicated to high levels in RM. Following SIV infection, increased CD8
+
T-lymphocyte apoptosis, temporally coinciding with onset of SIV-specific cellular immunity, and elevated plasma Th1 cytokine and gamma interferon-induced chemokine levels were common to both SM and RM. Different from SM, SIV-infected RM showed a significantly higher frequency of peripheral blood activated CD8
+
T lymphocytes despite comparable magnitude of the SIV-specific gamma interferon enzyme-linked immunospot response. Furthermore, an increase in CD4
+
and CD4
−
CD8
−
T-lymphocyte apoptosis and plasma tumor necrosis factor-related apoptosis-inducing ligand were observed only in RM and occurred in both controlled SIVsmE041 and uncontrolled SIVmac239 infection. These data suggest that the “excess” activated T lymphocytes in RM soon after SIV infection are predominantly of non-virus-specific bystander origin. Thus, species-specific differences in the early innate immune response appear to be an important factor contributing to differential immune activation in natural and nonnatural hosts of SIV infection.
Donor insemination
Authors: Kerr Melville G , Rogers Carol
Published: November 2008

This paper reviews the technical and social problems concerned in donor insemination in the light of recent developments. The most important of these is the declining number of babies available for adoption by subfertile couples because modern methods and attitudes have reduced the number of unplanned births. At the same time the technique of donor insemination is being developed as public attitudes to it are changing.
Cryobanking of human sperm
Authors: Frankel Mark S
Published: November 2008

This brief essay discusses some of the medical and social uses of banking human semen as well as many of the ethical issues which emerge from the application of this technology.
Self-medication with mood changing drugs.
Authors: Grahame-Smith D G
Published: November 2008

The aim of this article is to examine some of the consequences of the recent advances in neurobiology in terms of the ability of drugs to manipulate the mind. Most laymen are totally ignorant of the general mechanism underlying the brain-mind relationship and therefore of the action of mind-altering drugs. Professor Grahame-Smith considers that one of the intrinsic evils of man's neurobiological make up is that a prime motive of the brain seems to be to bring comfort, security and pleasure for itself. Therefore it is not surprising that drugs - notably the barbiturates and more recently the benzodiazepines (tranquilizers) - have been prescribed to give to the brain that peace of mind that it seeks. However, it can be argued that such drugs cannot replace anxiety with peace of mind or unhappiness or depression with happiness. The action of such drugs upon the molecules of the brain is negative - a placebo effect.
Some observations on informed consent in non-therapeutic research.
Authors: Garnham J C
Published: November 2008

The quality of the consent obtained from 41 volunteer subjects in eight experiments is evaluated. Five subjects (all physicians) gave informed consent; 22 subjects gave partially informed consent; and 14 subjects merely gave consent. It is argued that 'informed' consent is obtainable only from medically trained people, and that lip service to this concept in laymen should cease. The concept of medical competence should instead be introduced and a personal medical referee appointed to adjudicate on behalf of the volunteer.
Some ethical issues in dementia research.
Authors: Mahendra B
Published: November 2008

The ethical problems associated with dementia have been thrown into focus by the ageing population. The elderly form a disadvantaged group in society and the author wonders if it is morally justified to pursue research into ways of arresting pathology without concomitant attention being paid to the quality of life of the surviving elderly. Precise diagnosis of dementia requires invasive, and potentially injurious, brain biopsy. Recent thinking has pointed to some of the advantages of biopsy. The question of consent in a patient with impaired mental function has to be borne in mind. As for the special ethical problems associated with Huntington's chorea, it is argued there is no justification for withholding information from, or for authoritarian direction of, patients and 'at risk' relatives but the importance of full discussion before undertaking predictive procedures is stressed.
The positive aspects of medical ethics today.
Authors: Boyd K
Published: November 2008

The author of this comment suggests that some of the important points made by Dr Adrian Rogers are vitiated by a tendency to contrast the worst of modern medical practice with an over-idealised view of the past. The state of medical ethics today, the author suggests, is more hopeful than Dr Rogers allows.
Compulsory health and safety in a free society.
Authors: Boughton B J
Published: November 2008

The ageing population and new technology are both increasing the cost of our free health service, and there are sound economic reasons for extending measures which reduce the diseases common to our society. But if education fails to change public attitudes towards habits such as tobacco smoking and poor diet, to what extent is the State justified in compelling us to be healthy? This issue touches on the sensitive areas of personal freedom and responsibility and involves complex cultural, historical and economic considerations. Both governments and individuals can be criticised for the way this issue has been handled in the past, and it is hoped that the examples discussed in this paper will stimulate further debate.
Health promotion--caring concern or slick salesmanship?
Authors: Williams G
Published: November 2008

There is an increasing tendency for administrators and government to expect both the health services and the education service to 'show results' for the investment of public money in them. One response to this has been the growing commitment to 'health promotion', where measurable objectives may be set in terms of desired behaviour (stopping smoking, breast self-examination, child immunisation etc) and where evaluation can be made on the evidence of statistical improvement. Health workers use the term 'promotion' in a variety of ways which seem to be as confusing to them as they are to their clients --the general public. Since successful promotion is likely to depend on the 'hard sell' (and since the methodology and aims of this may be incompatible with those of health education) this paper looks at some of the questions which the customer might wish to ask the salesman before deciding whether or not to buy.
Teaching medical ethics in other countries.
Authors: Wolstenholme G
Published: November 2008

In the past 20 years, around the world, there has been an explosion in the teaching of medical ethics. As the dust begins to settle, it would appear that such teaching is likely to have its most effective impact not during the undergraduate period but at the immediate postgraduate level and in continuing education. Whilst important contributions can be made by teachers of religion, philosophy and law, probably the essential wisdom, capable of standing a doctor in good stead throughout the developments of a lifetime's career, must largely come from those who have studied both medicine and ethics. It would be appropriate if the study of medical ethics were to lead to better international understanding among doctors.
Advice on good practice from the Standards Committee.
Authors: Happel J S
Published: November 2008

The role of the General Medical Council has changed over the last few years and this paper shows how the GMC now gives advice on good practice, as well as a warning against bad practice.
Ethics, advertising and the definition of a profession.
Authors: Dyer A R
Published: November 2008

In the climate of concern about high medical costs, the relationship between the trade and professional aspects of medical practice is receiving close scrutiny. In the United Kingdom there is talk of increasing privatisation of health services, and in the United States the Federal Trade Commission (FTC) has attempted to define medicine as a trade for the purposes of commercial regulation. The Supreme Court recently upheld the FTC charge that the American Medical Association (AMA) has been in restraint of trade because of ethical strictures against advertising. The concept of profession, as it has been analyzed in sociological, legal, philosophical, and historical perspectives, reveals the importance of an ethic of service as well as technical expertise as defining characteristics of professions. It is suggested that the medical profession should pay more attention to its service ideal at this time when doctors are widely perceived to be technically preoccupied.
Professions as the conscience of society.
Authors: Sieghart P
Published: November 2008

Ethics is no less of a science than any other. It has its roots in conflicts of interest between human beings, and in their conflicting urges to behave either selfishly or altruistically. Resolving such conflicts leads to the specification of rules of conduct, often expressed in terms of rights and duties. In the special case of professional ethics, the paramount rule of conduct is altruism in the service of a 'noble' cause, and this distinguishes true professions from other trades or occupations. If professional ethics come into conflict with national laws, the professional today can test the legitimacy of such laws by reference to internationally agreed legal standards in the field of human rights, and so help to perform the role of 'professions as the conscience of society'.
Psychiatric diagnosis as an ethical problem.
Authors: Shackle E M
Published: November 2008

Psychiatrists diagnose mental illness in patients against a climate of opinion in which the value of diagnosis is questioned and non-medical formulations of the problems of psychiatric patients are put forward. Nevertheless the classic diagnostic terminology shows no sign of disappearing. The patients may find that a psychiatric diagnostic label is a stigma and has bad consequences. They may also object to standard methods of treatment. Given this situation the right of the patient to a full explanation of the diagnosis and the rationale of the treatment offered seems to be incontrovertible. If this information were given to patients it would, in addition, help them to make sense out of their often puzzling experiences and indicate that fellow sufferers existed.
Quality of life--a response to K C Calman.
Authors: Cribb A
Published: November 2008

There is no technical language with which to speak of patients' quality of life, there are no standard measures and no authority to validate criteria of measurement. It is well known that 'professionals' tend, often for institutional reasons, to play down or undervalue factors which are not defined by their particular expertise. It is fortunate that, despite this tendency, there is a growing interest in broadening the evaluation of medical care, but there is still a need to clarify what is at issue in considerations of quality of life. This article examines the strengths and weaknesses of one approach to assessing quality of life, and sketches out the implications for anyone concerned to establish a framework within which both medical and non-medical objectives of care can be taken into account.
The mandatory sentence and Section 2.
Authors: Dell S
Published: November 2008

Sentencing in homicide depends on how psychiatrists view the issues of Section 2. In most killings that do not involve clear-cut mental disorder, strong emotions and stress play a part. Both can be cited in aid of diminished responsibility. If doctors cite them, however tentatively, it becomes feasible for the court to review any mitigating factors and to choose an appropriate penalty. Otherwise, the mandatory penalty is imposed. Thus doctors, by opining not on the medical but on the legal and moral aspects of Section 2, decide who shall automatically get a life sentence and who shall not. Anomaly and injustice are the results. They would be remedied by the abolition of the mandatory sentence for murder.
Informed dissent: the views of some mothers of severely mentally handicapped young adults.
Authors: Simms M
Published: November 2008

Much of the discussion since the Arthur case has centred round the rights of handicapped infants to medical treatment. Little has centred round the question of how far one person can rightly be required to sacrifice her life for another, when she has not been consulted beforehand. This may be due to the fact that most of the discussants are men, while nearly all the carers are women. This small study attempts to redress this balance by asking mothers who have cared for 20 years, whether they felt it was worthwhile.
Why let people die?
Authors: Gillett G R
Published: November 2008

This paper concerns those patients whose brain is irreversibly damaged to the point where they will never recover significant mental life. I examine the reasons which justify the decision to withhold or discontinue active medical intervention in these patients. They involve the identity, quality of life and agency of those beings whom we value as persons.
AIDS legislation--turning up the heat?
Authors: Kirby M D
Published: November 2008

This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context. The hysteria accompanying the outbreak of AIDS is contrasted with the similar hysteria associated with other previous epidemics experienced in Australia over the past two centuries. The paper categorises the responses of lawmakers to the condition, according to the approach taken; from 'full blast', through 'moderate heat' to 'low key' or an attempt to avoid or minimise legal intervention. It is suggested that the appropriate response should depend upon such factors as the present magnitude of the condition, its likely future course, the availability of cures and protections against its spread and objectives being sought by intervention. Unless these factors are taken into account gross over-reaction can occur, causing social disruption and much personal injustice.
Moral dilemmas in surgical training: intent and the case for ethical ambiguity.
Authors: Newton M J
Published: November 2008

It is often assumed that the central problem in a medical ethics issue is determining which course of action is morally correct. There are some aspects of ethical issues that will yield to such analysis. However, at the core of important medical moral problems is an irreducible dilemma in which all possible courses of action, including inaction, seem ethically unsatisfactory. When facing these issues ethical behaviour depends upon an individual's understanding and acceptance of this painful dilemma without recourse to external moral authority.
A classification of clinical paediatric research with analysis of related ethical themes.
Authors: Pearn J
Published: November 2008

Different types of clinical research are associated with different degrees of risk and with varying utility. Usually classified as therapeutic or non-therapeutic, clinical research involving children necessitates a balance between the conflicts of intrusion into a group of vulnerable subjects, and the obvious advantages which such intrusion engenders. To understand better the potential ethical dilemmas of paediatric research the author has expanded the classification of such clinical research involving children. Five types of such research--preventive research, curative research, research to alleviate symptoms, studies to establish norms and baselines, and curiosity research--are discussed in the context of their ethical constraints, and the different ethical questions which confront workers operating in each of these different themes.
Combining law with medical ethics.
Authors: Greaves D
Published: November 2008

A postgraduate Diploma in Medical Ethics and Law was started in October 1984 by the Centre of Medical Law and Ethics at King's College. It is a part-time one year course designed so as to enable students to continue with full-time employment if they wish. It is multidiscipinary and is open to all who have a first degree in a relevant discipline, for example law, philosophy, theology, medicine and nursing studies. It is unique in combining medical law and medical ethics and has attracted students of high calibre from a variety of backgrounds during its first three years. Building on the experience of the diploma the course is being upgraded to an MA in 1987-88. It will be available either full-time for one year or part-time for two years.
Euthanasia, letting die and the pause.
Authors: Gillett G
Published: November 2008

There is a marked disparity between medical intuitions and philosophical argument about euthanasia. In this paper I argue that the following objections can be raised. First, medical intuitions are against it and this is an area in which judgement and sensitivity are required in that death is a unique and complex process and the patient has many needs including the need to know that others have not discounted his or her worth. Also, part of the moral constitution of a good doctor is a devotion to the protection and preservation of life whatever reasons are produced to dissuade her. Finally, we do not know what the final events of a person's life might hold.
What doctors should call their patients.
Authors: Lavin M
Published: November 2008

The paper discusses the moral difficulties physicians encounter when determining the level of formality they will use when addressing their patients. It is argued that physicians ought not to use a patient's first name unless the patient also uses the physician's first name. In short, physicians and patients should always address each other with the same level of formality. It is argued that this is so even when patients invite physicians to address them informally.
Kuhse, Singer and slippery slopes.
Authors: Fairbairn G J
Published: November 2008

Helga Kuhse and Peter Singer recently examined the view expressed by John Lorber that whereas at times it is permissible to allow severely handicapped infants to die, killing them must never be allowed. In attempting to demonstrate the mistaken nature of Lorber's fear that allowing active infanticide would lead us onto a slippery slope Kuhse and Singer make much use of John Harris's paper in the Journal of Medical Ethics in which he criticised Lorber's views. This paper examines some aspects of the case advanced by Kuhse and Singer and of the earlier paper by Harris.
Resolving arguments about the sanctity of life: a response to Long.
Authors: Singer P , Kuhse H
Published: November 2008

Thomas Long has argued that there is an irreconcilable metaphysical difference between the views of those who, like ourselves, believe that on quality-of-life grounds it is sometimes justifiable to end the life of a severely handicapped infant, and those who, like Paul Ramsey, reject this view. Because of this metaphysical difference, Long considers it impossible for our arguments to refute Ramsey's position. We disagree.
To tell or not to tell the diagnosis of schizophrenia.
Authors: Atkinson J M
Published: November 2008

Some patients with schizophrenia are not told their diagnosis. The moral, clinical and practical issues involved in telling or not telling the patient are discussed. In some cases a relative is told the diagnosis but not the patient. The implications for the family and clinical outcome are outlined. A case history illustrating some of these issues is presented.
Which of two individuals do you treat when only their ages are different and you can't treat both?
Authors: Lewis P A , Charny M
Published: November 2008

A relative value of life dependent on age has been produced from a survey of 721 randomly selected individuals together with other observations of professional practice. The results are presented in diagrammatic form. If two identical people, except for age, present for medical treatment for a life-threatening condition and only one can be treated then the diagram indicates what the choice should be.
Legal AIDS: implications of AIDS and HIV for British and American law.
Authors: Orr A
Published: November 2008

In its approach to AIDS and HIV the law has to protect two conflicting interests; it must recognise the right of the public to be protected against the disease and it must recognise the right of the individual not to be unfairly restricted by having or being at risk of the disease. Consequently the law must make some compromise which while protecting public health also protects the individual so that the individual will feel free to come forward for available treatment. In this way prevention of spread of the disease is encouraged. How this compromise is or might be affected by British and American law is examined in several areas, including medico-legal matters, criminal and tort law, employment, insurance and education.
Surgical abortion at twenty weeks: is morality determined solely by the outcome?
Authors: Lilford R J , Johnson N
Published: November 2008

A strong body of opinion contends that late terminations of pregnancy are better carried out by surgical methods. We show that the suggested advantages of greater safety and patient acceptance are based on out-of-date or inaccurate (biased) data. The advantages of medical methods are, however, equally unproven. However, we argue that the adverse emotional and symbolic effects of late surgical termination have moral force. We therefore contend that in the absence of strong patient preference, medical termination is the preferable method; and will remain of that opinion unless clear demonstration of the greater safety of surgical methods can be made at some future date.
An experimental case-conference programme for obstetrics and gynaecology clinical students.
Authors: ten Have H , Essed G
Published: November 2008

Since the founding of the University of Limburg (1974), in The Netherlands, an innovative medical curriculum has been guided by educational principles of problem-orientation, continuous assessment, student initiative and attitude development. The teaching of medical ethics was built into the preclinical curriculum from the start. However, the clinical years remained largely unaffected, and only recently has an effort been made to extend the educational philosophy to this more or less traditional part of medical education. Within this context, an experiment of clinical ethics teaching was introduced in the Obstetrics and Gynaecology (Ob/Gyn) clerkships. The objectives, methods and results of this experimental programme are described in this paper. The success of the teaching is based on three features of the programme: 1) its student-centred approach; 2) the programme is designed in a way similar to regular patient conferences; 3) the programme is taught by a team consisting of both clinician and ethicist. Before starting a longitudinal programme of ethics teaching during the clinical years, it proved very helpful to experiment with a well designed and evaluated pilot programme.
Castigating QALYs.
Authors: Rawles J
Published: November 2008

The ethical problem of how to apportion limited resources amongst the needy has been forced on us by arbitrary limitation of health expenditure. Its solution would not be required if health expenditure were higher. Distribution of resources according to best value for money, assessed as Quality Adjusted Life Years (QALYs) per unit cost, has been suggested as a possible solution, but leads to absurd anomalies. In the calculation of QALYs the implied value of life is no more than the absence of suffering. The use of QALYs for the comparison of treatments that are symptomatic or life-saving therefore leads to serious undervaluation of life and treatments that prolong it. Moreover, distribution of resources by best value for money, however assessed, is inequitable since for a given degree of suffering those whose illnesses happen to be cheaper to treat will be treated in preference to those whose treatments are more expensive.
Evaluating the work of ethical review committees: an observation and a suggestion.
Authors: Harding T , Ummel M
Published: November 2008

Eight research protocols which had previously been approved by Ethical Research Committees (ERCs) were reviewed in simulated review committees set up during a symposium on medical ethics. Only three protocols were considered to provide fully adequate information to allow ethical review and only one protocol was thought to provide sufficient guarantees on the ethical issues raised by the proposed research. For five other protocols additional safeguards were considered necessary, in particular covering the problem of informed consent. Two protocols were considered to raise unresolvable ethical issues. This artificial exercise does not establish that review by ERCs is ineffective. It does highlight the lack of objective criteria in ethical review. Peer review by exchange of protocols between ERCs could assist in increasing the consistency in the application of ethical standards.
Unfinished feticide: a legal commentary.
Authors: Brazier Margaret
Published: November 2008

Jansen expresses concern as to the legal implications of both selective reduction of pregnancy and unsuccessful attempts at termination of pregnancy using mifepristone. This commentary examines the legality of both procedures and concludes that Jansen is over-optimistic in his belief that neither procedure is likely to fall foul of the criminal laws on induced abortion. By contrast his anxieties about civil liability arising from the subsequent live birth of a damaged infant are, it is suggested, unnecessarily pessimistic. Such an action is most unlikely to succeed if brought by the infant herself and any claim on the part of the mother will normally be dependent on proof of negligence. The commentary focusses on the law in England with relevant references to other common law jurisdictions.
Fetal tissue transplantation: can it be morally insulated from abortion?
Authors: Strong C
Published: November 2008

Ethical controversy over transplantation of human fetal tissue has arisen because the source of tissue is induced abortions. Opposition to such transplants has been based on various arguments, including the following: rightful informed consent cannot be obtained for use of fetal tissue from induced abortions, and fetal tissue transplantation might result in an increase in the number of abortions. These arguments were not accepted by the National Institutes of Health (NIH) Human Fetal Tissue Transplantation Research Panel. The majority opinion of the panel stated that abortion and fetal tissue use are entirely separate issues, and that tissue use is ethically acceptable because it can be morally insulated from the issue of abortion. In support of this view, panel members and others have replied to the arguments put forward by opponents of fetal tissue use. However, replies to the two arguments mentioned above have been unsatisfactory, and the shortcomings of those replies are identified herein. Examination of the arguments pro and con suggests that fetal tissue use cannot be completely insulated from the issue of abortion. Thus, in seeking an ethical justification for fetal tissue transplantation we must consider reasons other than those put forward by the NIH panel. In this paper it is argued that whatever wrong is involved in using fetal tissue from induced abortions must be balanced against the benefits for patients, and it is on this basis that fetal tissue transplantation can be ethically justified.
Literature and medicine.
Authors: Downie R S
Published: November 2008

There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.
How I was almost aborted: reflections on a prenatal brush with death.
Authors: Berkowitz J M
Published: November 2008

After recently meeting with his biological parents, the author--a 29-year-old-married male--learned he had been an hour away from being aborted, being 'saved' only by extraordinary circumstances. In the paper the author reflects upon previous strong pro-choice beliefs and reasserts his commitment to a pro-choice philosophy, integrating his new personal experience. The paper pays particular attention to the biological mother's experience and how her fresh insights have reinforced the author's views on abortion.
Prolonging dying is the same as prolonging living--one more response to Long.
Authors: Kuhse H , Singer P
Published: November 2008

In earlier publications, we had argued that Paul Ramsey is inconsistent because he simultaneously asserts that (i) 'all our days and years are of equal worth' and (ii) 'that it is permissible to refrain from prolonging the lives of some dying patients'. Thomas Long has suggested that we have not shown that Paul Ramsey is inconsistent. Ramsey and we, he holds, start from incommensurable metaphysical views: for Ramsey, the dying process has religious significance--God is calling his servant home. While it is normally a good thing to keep a patient alive, it would, for Ramsey, show deafness to God's call to keep a dying patient alive. It is true we do not share Paul Ramsey's religious views. It is, however, not necessary to rely on any particular metaphysical views to refute Ramsey's position. For Ramsey's view to be internally consistent, Ramsey would have to be able to distinguish between dying and non-dying patients. We examine some of Ramsey's examples and show that his practical judgements do not allow us to draw this distinction. This means that, contra Long, we hold fast to our charge that Ramsey's view is inconsistent.
Reversibility and death: a reply to David J Cole
Authors: Lamb David
Published: November 2008

In this reply to David J Cole it is argued that the medical concept of death as an irreversible phenomenon is correct and that it does not conflict with ordinary concepts of death.
Rosencrantz and Guildenstern are 'dead'?
Authors: Catherwood J F
Published: November 2008

The article recently published in this journal by Dr B A Rix, a member of the Danish Council of Ethics (DCE), was heavily criticised by Dr David Lamb and Mr Christopher Pallis in subsequent commentaries. The editorial column by Professor Raanan Gillon also criticised the position put forward by Rix. In this article I contend that the definition of death put forward by Pallis and Lamb suffers certain philosophical shortcomings, that the position put forward by Rix deserves fuller consideration, and that Rix is not to be dismissed easily.
Death and reductionism: a reply to John F Catherwood.
Authors: Lamb D
Published: November 2008

This reply to John F Catherwood's criticism of brain-related criteria for death argues that brainstem criteria are neither reductionist nor do they presuppose a materialist theory of mind. Furthermore, it is argued that brain-related criteria are compatible with the majority of religious views concerning death.
On lying and deceiving.
Authors: Bakhurst D
Published: November 2008

This article challenges Jennifer Jackson's recent defence of doctors' rights to deceive patients. Jackson maintains there is a general moral difference between lying and intentional deception: while doctors have a prima facie duty not to lie, there is no such obligation to avoid deception. This paper argues 1) that an examination of cases shows that lying and deception are often morally equivalent, and 2) that Jackson's position is premised on a species of moral functionalism that misconstrues the nature of moral obligation. Against Jackson, it is argued that both lying and intentional deception are wrong where they infringe a patient's right to autonomy or his/her right to be treated with dignity. These rights represent 'deontological constraints' on action, defining what we must not do whatever the functional value of the consequences. Medical ethics must recognise such constraints if it is to contribute to the moral integrity of medical practice.
Attitudes of a Mediterranean population to the truth-telling issue.
Authors: Dalla-Vorgia P , Katsouyanni K , Garanis T N , Touloumi G , Drogari P , Koutselinis A
Published: November 2008

The attitudes of the Greeks, a Mediterranean population, to the issue of telling the truth to the patient have been studied. There is no clear answer to the question: 'Do the Greeks wish to be informed of the nature of their illness?'. The answer is: 'It depends'. It depends on age, education, family status, occupation, place of birth and residence and on whether or not they are religious people. However, it does not depend on their sex--men and women have similar reactions to the issue of truth-telling. Although the present study shows lower percentages of those who wish to know the truth than studies on other populations, the conclusion is that, emphasising the need for good communication between doctors and patients, doctors should not lie, but should disclose to their patients the part of the truth they are ready to accept.
HIV infection and AIDS: the ethics of medical confidentiality.
Authors: Boyd K M
Published: November 2008

An Institute of Medical Ethics working party argues that an ethically desirable relationship of mutual empowerment between patient and clinician is more likely to be achieved if patients understand the ground rules of medical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice of different doctors and specialties. Matters might be clarified, it suggests, by identifying moral factors which tend to recur in medical decisions about maintaining or breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients.
On visibility: AIDS, deception by patients, and the responsibility of the doctor.
Authors: Dunbar S , Rehm S
Published: November 2008

Contrary to the usual discussion of lying or deceiving in medical ethics literature where the lying or deceiving is done by the doctor or surgeon, this paper deals with lying or deceiving on the part of the patient. Three cases involving HIV-infected male homosexual or bisexual persons are presented. In each case the patient deceives or wants the doctor to deceive a third party on his behalf. Are such deceptions or lies expressions of compassion? Are they in the patient's best interests? Do they compromise the doctor's integrity? It is submitted that societal attitudes towards male homosexual acts were internalised by the men described in these cases. Thus, a dichotomy was created between the private life and the public image. Fear of condemnation by the doctor or others restricted communication towards the goal of the maintenance of the patient's health. The lack of trust which inhibits truth-telling results in mutual and progressive isolation and impedes the provision of optimal care.
The medical ethics of the 'father of gynaecology', Dr J Marion Sims.
Authors: Ojanuga D
Published: November 2008

Vesico-vaginal fistula (VVF) was a common ailment among American women in the 19th century. Prior to that time, no successful surgery had been developed for the cure of this condition until Dr J Marion Sims perfected a successful surgical technique in 1849. Dr Sims used female slaves as research subjects over a four-year period of experimentation (1845-1849). This paper discusses the controversy surrounding his use of powerless women and whether his actions were acceptable during that historical period.
The ethics of medical involvement in torture.
Authors: Downie R S
Published: November 2008

The difficulties of establishing a definition of torture are discussed, and a definition is suggested. It is then argued that, irrespective of general ethical questions, doctors in particular should never be involved because of their social role.
The ethics of postmortem examinations in contemporary Islam.
Authors: Rispler-Chaim V
Published: November 2008

Postmortem examinations have recently become common practice in Western medicine: they are used to verify the cause of death and to obtain additional scientific information on certain diseases, as well as to train medical students. For religious people of the monotheistic faiths postmortems present several ethical questions even though the advantages attributed to postmortems in the West are also acknowledged by Jews, Christians and Muslims. The Islamic way of dealing with such questions will be surveyed via contemporary fatawa (legal opinions) issued primarily by Egyptian scholars; Islamic law, which was formulated in the eighth to ninth centuries, did not speak of postmortems. I will therefore depict the means whereby contemporary scholars approach postmortems in the absence of clear legal reference. The difficulties that postmortems create for Muslims at present will be weighed against some shar i instructions which may help circumvent them. While the ethical and religious debate continues, postmortems seem to be accepted but not, however, without certain reservations.
Ethics and statistical methodology in clinical trials.
Authors: Palmer C R
Published: November 2008

Statisticians in medicine can disagree on appropriate methodology applicable to the design and analysis of clinical trials. So called Bayesians and frequentists both claim ethical superiority. This paper, by defining and then linking together various dichotomies, argues there is a place for both statistical camps. The choice between them depends on the phase of clinical trial, disease prevalence and severity, but supremely on the ethics underlying the particular trial. There is always a tension present between physicians primarily obligated to their own patients (the weight of 'individual ethics') and ethical committees responsible for the scientific merit of the trial and its long-term implications ('collective ethics'). Individual ethics, it is proposed, favour the Bayesian approach; collective ethics, the frequentist. Though in some situations the choice appears clear-cut, there remain other where both methodologies can be appropriate.
The nurse under physician authority.
Authors: May T
Published: November 2008

A medical centre is an institution established for a specific purpose: to facilitate the health and health-related welfare of the medical centre's patients. Within this institution, there are a variety of professionals who act and interact to serve this purpose. Of particular interest is the interaction between physician and nurse. Generally, the nurse is thought to be under a certain obligation to implement a physician's orders unless there is good reason not to do so. This qualifier places a conflicting obligation upon the nurse not to implement some physician orders. How should a judgement about which orders there is 'good reason' not to implement be made? I propose to approach this question through an analysis of the obligation the nurse has to implement the order of a physician, and the conditions under which the order does not pose such obligations. This analysis will consist of an examination of the obligation in terms of the purposive authority of the physician. For example, in the context of the medical centre, the physician's medical training qualifies her as best able to make determinations of what treatment would promote the patient's health. However, this purpose not only serves as the basis of the physician's authority, but also serves as a limitation upon the physician's authority (for example, an order which would harm the patient would not reflect the purpose for which the physician has been given authority). Thus, a philosophical investigation into the nature of the obligation to implement a physician's orders can help to clarify those occasions when a nurse should not implement an order.
Assessing the clinical ethical competence of undergraduate medical students.
Authors: Mitchell K R , Myser C , Kerridge I H
Published: November 2008

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context.
The care of the mentally abnormal offender and the protection of the public
Authors: Rollin Henry R
Published: November 2008

When a serious crime—say a murder—is committed by someone who has been discharged or has absconded from prison the public reaction is extreme. And public anger is not appeased by psychiatrists and sociologists who argue in the media the case either for all mental disorders being capable of treatment leading at least to partial cure or that all crime springs from unfortunate social circumstances. In the two papers which follow the situation is described how psychopathic and other mentally abnormal offenders are dealt with at the present time, and how the Aarvold and Butler Committees were set up. The Aarvold Committee (Chairman, Mr Justice Aarvold) was to be concerned with tightening the provisions of the law as it now stands whereas the Butler Committee (Chairman, Lord Butler) was asked to look into and recommend changes in the law relating to these offenders. The Aarvold Committee reported swiftly and the Butler Committee made its final report in 1975. (An interim report was produced in 1974.) It is with the Butler Report that Dr Rollin and Dr Norton are principally concerned here. The fundamental aim of both committees was to maintain a balance between `what is best for those guilty of dangerous offences and the right of the public to be protected'. Both writers describe the various forms of detention for psychopathic offenders in operation and proposed, and both conclude that the Butler Report offers wise and realistic guidance but fear that continuing official inertia will preclude the recommendations ever being implemented. Dr Norton deals particularly with the concept of `dangerousness', and the controversial issue of the Butler `reviewable sentences' for mentally abnormal offenders.
Medical practice: defendants and prisoners.
Authors: Bowden P
Published: November 2008

It is argued in this paper that a doctor cannot serve two masters. The work of the prison medical officer is examined and it is shown that his dual allegiance to the state and to those individuals who are under his care results in activities which largely favour the former. The World Health Organisation prescribes a system of health ethics which indicates, in qualitative terms, the responsibility of each state for health provisions. In contrast, the World Medical Association acts as both promulgator and guardian of a code of medical ethics which determines the responsibilities of the doctor to his patient. In the historical sense medical practitioners have always emphasized the sanctity of the relationship with their patients and the doctor's role as an expert witness is shown to have centered around this bond. The development of medical services in prisons has focused more on the partnership between doctor and institution. Imprisonment in itself could be seen as prejudicial to health as are disciplinary methods which are more obviously detrimental. The involvement of medical practitioners in such procedures is discussed in the light of their role as the prisoner's personal physician.
Dilemmas of medical ethics in the Canadian Penitentiary Service.
Authors: Roy C
Published: November 2008

There is a unique hospital in Canada-and perhaps in the world-because it is built outside prison walls and it exists specifically for the psychiatric treatment of prisoners. It is on the one hand a hospital and on the other a prison. Moreover it has to provide the same quality and standard of care which is expected of a hospital associated with a university. From the time the hospital was established moral dilemmas appeared which were concerned with conflicts between the medical and custodial treatment of prisoners, and also with the attitudes of those having the status of prisoner-patient. Dr Roy describes these dilemmas and attitudes, and in particular a special conference which was convened to discuss them. Not only doctors and prison officials took part in this meeting but also general practitioners, theologians, philosophers, ex-prisoners, judges, lawyers, Members of Parliament and Senators. This must have been a unique occasion and Dr Roy's description may provide the impetus to examine these prison problems in other settings.
Attitudes of women to fetal tissue research.
Authors: Anderson F , Glasier A , Ross J , Baird D T
Published: November 2008

The use of human fetal tissue for scientific research has enormous potential but is subject to government legislation. In the United Kingdom the Polkinghorne Committee's guidelines were accepted by the Department of Health in 1990. These guidelines set out to protect women undergoing termination of pregnancy from exploitation but in so doing may significantly restrict potential research. Although the committee took evidence from a wide variety of experts they did not seek the views of the general public. We asked 108 women about to have a therapeutic abortion; 167 women who had had a pregnancy terminated in the past, and 419 women who had never had an abortion, their views on research using human fetal tissue. Regardless of their past experiences the women were overwhelmingly in favour of research using fetal tissue (94 per cent). They made little distinction between basic research and research with obvious clinical relevance and supported the concept of using transplanted fetal tissue for the treatment of adult disease such as Parkinsonism. Women about to undergo an abortion were significantly more likely (p < 0.001) to approve of all types of research including that aimed at improving methods of abortion and research using live fetuses in utero.