bluuebunny/crossref_metadata_2025 huggingface dataset:
Can paternalism be modernised?
Authors: Matthews E
Published: November 2008

The contention that paternalism can be modernised in such a way as to avoid the usual criticisms is examined and dismissed. The alleged 'modernisation' consists simply in going through the motions of achieving the patient's free consent, while leaving the ultimate decision to the physician. Paternalism in this form is no better than the more old-fashioned variety, since it still takes away from patients the fundamental human right to make decisions about their own fate.
An ethical analysis of the policies of British community and hospital care for mentally ill people.
Authors: Pattison S , Armitage P
Published: November 2008

Scant consideration has been given to the ethical implications of the policy of closing down psychiatric hospitals in favour of community care. The recent adherents of this policy in government have been enthusiastic in encouraging its implementation. This paper has three sections: a brief resumé of the history and principles of community care for the mentally ill; a discussion on the merits and de-merits of psychiatric care in the hospital and in the community; and an outline of some preliminary categories for ethical analysis.
Prenatal diagnosis and female abortion: a case study in medical law and ethics.
Authors: Dickens B M
Published: November 2008

Alarm over the prospect that prenatal diagnostic techniques, which permit identification of fetal sex and facilitate abortion of healthy but unwanted female fetuses has led some to urge their outright prohibition. This article argues against that response. Prenatal diagnosis permits timely action to preserve and enhance the life and health of fetuses otherwise endangered, and, by offering assurance of fetal normality, may often encourage continuation of pregnancies otherwise vulnerable to termination. Further, conditions in some societies may sometimes render excusable the inclination to abort certain healthy female fetuses. In places where abortion for fetal sex alone is recognised as unethical, however, medical licensing authorities already possess the power to discipline, for professional misconduct, physicians who prescribe or perform prenatal diagnosis purely to identify fetal sex, or those who disclose fetal sex when that is unrelated to the fetus's medical condition.
'Medical ethics'--an alternative approach.
Authors: Haldane J J
Published: November 2008

Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium.
Health.
Authors: Hare R M
Published: November 2008

Many practical issues in medical ethics depend on an understanding of the concept of health. The main question is whether it is a purely descriptive or a partly evaluative or normative concept. After posing some puzzles about the concept, the views of C Boorse, who thinks it is descriptive, are discussed and difficulties are found for them. An evaluative treatment is then suggested, and used to shed light on some problems about mental illness and to compare and contrast it with physical illness and with political and other deviancies which are not illnesses.
Towards a phenomenology of caregiving: growth in the caregiver is a vital component.
Authors: Daly M E
Published: November 2008

The classical notions of 'virtue' and 'leisure' offer excellent insights into the essentially moral nature of medical practice. This is especially evident in the understanding that professional caregiving has the potential to enhance the moral character as well as the moral awareness of the practitioner. Reflective awareness of the moral nature of the caregiving process can also contribute to coping with negative stress, which almost always has its origins in frustrations rooted in moral quandaries and evaluations. Understanding the process required arises from implementation of caregiving in combination with deliberate, conscious development of spiritual awareness and reflection on moral meaning.
Ethical issues in child and adolescent psychiatry.
Authors: Green J , Stewart A
Published: November 2008

This paper concerns the special ethical problems in child and adolescent psychiatry which relate to the child as a developing being. Two themes are discussed--the sense of responsibility in the child, and the therapist's responsibility towards the child. As a background to understanding the former, ideas on moral and cognitive development are reviewed. The therapist's responsibility is discussed in relation to different styles of therapy and the ethical issues they raise. The article concludes with a number of suggested ethical principles.
Wrongful life: some of the problems.
Authors: Liu A N
Published: November 2008

The author considers that some of the reasonings used by both the American and English courts against recognising a wrongful life claim are far from persuasive. However, there may indeed be strong public policy reasons against judicial recognition of such a claim. If judicial remedy is not possible for children in wrongful life situations, society ought to assist them in the alleviation of some of the practical problems caused by deformities.
Ensoulment and IVF embryos.
Authors: Shea M C
Published: November 2008

This paper examines the metaphysical question of 'ensoulment' in relation to the theory, put forward in an earlier paper, that human life begins when the newly formed body organs and systems of the embryo begin to function as an organised whole, at which stage there is evidence of a change of nature. Although Roman Catholic theology teaches that a human being is a union of physical body and spiritual soul, it is incorrect to interpret this in a dualistic sense. The meaning of 'soul' is considered and the conclusion reached that although both in the religious context and apart from it abortion is difficult to justify at any stage after conception, it does not follow that the use of 'spare' In Vitro Fertilisation (IVF) embryos should be rejected. If 'ensoulment' does not occur until the new organism functions as a whole then a decision not to make use of IVF embryos for medical purposes would be a heavy responsibility and not a 'safe' way out.
QALYfying the value of life.
Authors: Harris J
Published: November 2008

This paper argues that the Quality Adjusted Life Year or QALY is fatally flawed as a way of priority setting in health care and of dealing with the problem of scarce resources. In addition to showing why this is so the paper sets out a view of the moral constraints that govern the allocation of health resources and suggests reasons for a new attitude to the health budget.
Health care ethics: a pattern for learning.
Authors: Evans D
Published: November 2008

The British Medical Association (BMA) has called upon the General Medical Council (GMC) to instruct all medical schools to provide identifiable and substantial courses on medical ethics in their undergraduate curricula. The author reviews a postgraduate scheme of study in the ethics of health-care and suggests that it could provide some useful guidelines for teaching the subject at the undergraduate level.
Teaching medical ethics symposium. Reflections from New Zealand.
Authors: Campbell A V
Published: November 2008

The Medical Faculty of the University of Otago, New Zealand is experimenting with a new approach to the teaching of medical ethics, making it an integral part of several courses in all years of the medical curriculum. During the author's twelve-month period as a visiting professor in the faculty, trial runs in ethics have been introduced in the preclinical sciences, in behavioural science and medical-decision analysis and in every clinical attachment. Proposals for permanent course requirements will be considered by the faculty after a full evaluation of these experiments by both students and teaching staff. If such courses are to be implemented and maintained, medical facilities will need to appoint specialists in ethics, at least on a part-time basis.
Medical ethics and the clinical curriculum: a case study.
Authors: Doyal L , Hurwitz B , Yudkin J S
Published: November 2008

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment which should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff.
Teaching medical ethics symposium. Medical ethics in Manchester.
Authors: Brazier M , Dyson A , Harris J , Lobjoit M
Published: November 2008

Manchester's multi-disciplinary approach to medical ethics combines established methods and new initiatives. There is a longstanding Medical Group and also, plans are evolving for the inclusion of medical ethics teaching in the undergraduate curriculum, the start of an MA in Health Care Ethics in October 1987 and the establishment of the Centre for Social Ethics and Policy to act as a focus within the university for research and study in a wider context.
Surgery to quieten the yelling of a demented old man.
Authors: Gafner G
Published: November 2008

The 84-year-old man's incessant yelling caused him to be unmanageable in all settings--at home with his aged wife, in nursing homes, and on the medical and psychiatric floors of a Veterans Administration Medical Center. A host of behavioural and pharmaceutical interventions were attempted unsuccessfully. Finally, it was proposed that a single, recurrent laryngeal nerve be crushed in order to 'render his voice to be a very acceptable soft tone'.
Attempting to demystify law reports for the non-lawyer.
Authors: Fletcher V A
Published: November 2008

To a non-lawyer, references to law reports can appear confusing and complicated. This brief article attempts to explain how to decode such references and thus get to the reports. Those wishing to pursue the matter further are referred to more detailed explanations. This article deals primarily with English case law and is up to date as of December 1987.
Litigation and complaints procedures: objectives, effectiveness and alternatives.
Authors: Whelan C J
Published: November 2008

Recent debates about redress mechanisms for medical accident victims have been sidetracked by fears of an American-style medical malpractice crisis. What is required is a framework within which the debate can resume. This paper proposes such a framework by focusing on the compensation and deterrence objectives and placing them in the wider context of the social costs of providing medical services. The framework is then used to assess and compare the effectiveness of differing approaches. In particular, the American and British experiences of litigation, including the concept of 'defensive medicine', are evaluated. Also discussed briefly are alternatives to court-based complaints procedures including 'no-fault' schemes, professional ethics and internal complaints mechanisms.
New Danish law: human life begins at conception.
Authors: Holm S
Published: November 2008

A new law has been passed by the Danish Parliament, establishing an ethical council. The law has caused considerable debate in Denmark, particularly because it states that 'the work of the council shall build on the basis that human life takes its beginning at the time of conception'.
Legislative hazard: keeping patients living, against their wills.
Authors: Heintz L L
Published: November 2008

Natural death act legislation which is intended to assist patients who wish to refuse or limit medical treatment may actually erode patients' rights. By use of a 'living will' the legislation intends to extend the patients' role in decision-making to the time when patients can no longer speak for themselves. However, the legislation erodes and constricts the right of refusal. The erosion is the result of two sets of conditions found in the legislation. The first requires that the patient be qualified and certified by others before interventions can be withdrawn or withheld. The second delineates the physical condition which must be present before a living will can be followed. Patients have had to seek the assistance of the courts to enforce their common law rights of refusal of treatment against these requirements. Legislation is needed, but greater care must be taken to avoid the creation of a Kafkaesque legal nightmare for those we intend to assist.
Terminating life-sustaining treatment--recent US developments.
Authors: Mackay R D
Published: November 2008

This paper reviews some recent litigation in the United States which addresses the difficult question of withdrawing food and hydration from both competent and incompetent patients. Whilst the decisions in question have manifested a trend towards favouring patient autonomy, they also indicate an underlying tension between doctors, health care facilities and their dying patients which is not yet close to resolution. The author suggests that the courts in the United States are likely to remain, for the foreseeable future, the final arbiters in that country of disputes relating to the termination of life-sustaining treatment.
Raping and making love are different concepts: so are killing and voluntary euthanasia.
Authors: Davies J
Published: November 2008

The distinction between 'kill' and 'help to die' is argued by analogy with the distinction between 'rape' and 'make love to'. The difference is the consent of the receiver of the act, therefore 'kill' is the wrong word for an act of active voluntary euthanasia. The argument that doctors must not be allowed by law to perform active voluntary euthanasia because this would recognise an infringement of the sanctity of life ('the red light principle') is countered by comparing such doctors with the drivers of emergency vehicles, who are allowed to drive through red lights.
Animals, handicapped children and the tragedy of marginal cases.
Authors: Nelson J L
Published: November 2008

There are human beings whose psychological capacities are rivalled or exceeded by many non-human animals; such humans are often referred to as 'marginal cases'. R G Frey has argued that there is no secure, non-arbitrary way of morally distinguishing between marginal humans and non-human animals. Hence, if the benefits of vivisection justify such painful and lethal procedures being performed on animals, so is the vivisection of marginal humans justified. This is a conclusion Frey is driven to with 'great reluctance', but which he can see no way to avoid. This paper points out a feature of the condition of marginal humans unnoticed by Frey and his critics: such humans have suffered a tragic harm. It points towards an analysis of this harm, in terms of counterfactuals holding for marginal humans but not for psychologically equivalent animals. Finally, it discusses the moral implications of the harm that such humans have suffered, and argues that it serves as the basis of a defence for preferring humans to non-humans in cases of morally inescapable conflict.
When caesarean section operations imposed by a court are justified.
Authors: Kluge E H
Published: November 2008

Court-ordered caesarean sections against the explicit wishes of the pregnant woman have been criticised as violations of the woman's fundamental right to autonomy and to the inviolability of the person--particularly, so it is argued, because the fetus in utero is not yet a person. This paper examines the logic of this position and argues that once the fetus has passed a certain stage of neurological development it is a person, and that then the whole issue becomes one of balancing of rights: the right-to-life of the fetal person against the right to autonomy and inviolability of the woman; and that the fetal right usually wins.
The myth of informed consent: in daily practice and in clinical trials.
Authors: Silverman W A
Published: November 2008

Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests.
Autonomy, welfare and the treatment of AIDS.
Authors: Crisp R
Published: November 2008

Many AIDS-related issues are polarised. At the social level, civil rights or liberties are seen as being in conflict with general utility, and an analogous distinction is often assumed to exist at the one-to-one, individual level at which doctors work. In this paper the latter form of the distinction is argued to be false. By seeing autonomy as part of welfare, doctors can think more directly about such issues as paternalism, confidentiality, and consent. A number of these issues are discussed in the light of the revised conception of welfare, in the form of simplified case studies.
On the trail of the holy humanhood.
Authors: Clinkenbeard W W
Published: November 2008

The progress of the discussion about the 'indicators of humanhood' is reviewed, along with several associated problems. It is argued that a more serious problem is posed by social attitudes about mental handicap. The author concludes that an uncritical use of criteria of humanhood may simply reinforce a morally unjustifiable social attitude.
Euthanasia and the doctors--a rejection of the BMA's report.
Authors: Nowell-Smith P
Published: November 2008

The working party on euthanasia set up by the British Medical Association produced its report in 1988 (1). The first of its terms of reference was 'to examine the ethical problems relating to euthanasia, terminal illness, and suicide' and as far as active voluntary euthanasia (AVE) is concerned it failed conspicuously to do its job. The purpose of this article is not to restate the case for AVE but to examine the reason for the failure. (Figures in square brackets refer to sections in the report.)
Giving answers or raising questions?: the problematic role of institutional ethics committees.
Authors: Fleetwood J E , Arnold R M , Baron R J
Published: November 2008

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver.
Obligation and consent.
Authors: Lesser H
Published: November 2008

It is often supposed, as in Professor Kluge's article (1), that one can only acquire an obligation by free consent. This paper argues that although this is true of some types of obligation, including the ones discussed by Professor Kluge, it is by no means true of all. In particular, it is argued, society may legitimately impose obligations on us without our consent, if the obligations are reciprocated, or if it is simply enforcing an already existing moral obligation.
Islamic medical ethics in the 20th century.
Authors: Rispler-Chaim V
Published: November 2008

While the practice of Western medicine is known today to doctors of all ethnic and religious groups, its standards are subject to the availability of resources. The medical ethics guiding each doctor is influenced by his/her religious or cultural background or affiliation, and that is where diversity exists. Much has been written about Jewish and Christian medical ethics. Islamic medical ethics has never been discussed as an independent field of ethics, although several selected topics, especially those concerning sexuality, birth control and abortions, have been more discussed than others. Islamic medical ethics in the 20th century will be characterised on the basis of Egyptian fatawa (legal opinions) issued by famous Muslim scholars and several doctors. Some of the issues discussed by Islamic medical ethics are universal: abortions, organ transplants, artificial insemination, cosmetic surgery, doctor-patient relations, etc. Other issues are typically Islamic, such as impediments to fasting in Ramadan, diseases and physical conditions that cause infringement of the state of purity, medicines containing alcohol, etc. Muslims' attitudes to both types of ethical issues often prove that pragmatism prevails and the aim is to seek a compromise between Islamic heritage and the achievements of modern medicine, as long as basic Islamic dogma is not violated.
Danish ethics council rejects brain death as the criterion of death -- commentary 2: return to Elsinore.
Authors: Pallis Christopher
Published: November 2008

No discussion of when an individual is dead is meaningful in the absence of a definition of death. If human death is defined as the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe spontaneously (and hence to maintain a spontaneous heart beat) the death of the brainstem will be seen to be the necessary and sufficient condition for the death of the individual. Such a definition of death is not something radically new. It is merely the reformulation -- in the language of the neurophysiologist -- of much older concepts such as the 'departure of the (conscious) soul from the body' and the 'loss of the breath of life'. All death -- in this perspective -- is, and always has been, brainstem death....
Moral intuition, good deaths and ordinary medical practitioners.
Authors: Parker M
Published: November 2008

Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death.
The role of law in reproductive medicine: a new approach.
Authors: Jabbari D
Published: November 2008

It is a common feature of debates on the regulation of reproductive medicine to find law portrayed as a crude form of intervention consisting in the imposition of inflexible rules on doctors and medical researchers. This paper argues that this view must be replaced by a more accurate assessment of the law's potential role in the regulation of reproductive medicine. From an analysis of the White Paper on human fertilisation and embryology, and in particular the proposed Statutory Licensing Authority, the author contends that far from being an inflexible method of regulation law can foster discussion and compromise.
National symposium on problems of presymptomatic testing for Huntington's disease, Cardiff.
Authors: Tyler A , Morris M
Published: November 2008

Presymptomatic testing for Huntington's disease has given rise to several ethical problems relating to such issues as confidentiality, the privacy of the individual, the testing of minors and informed consent in connection with blood sample donation. A multidisciplinary conference of staff from genetic centres involved with presymptomatic testing was organised in Cardiff to discuss these and other problems. Recommendations on good practice are described under four headings: pre- and post-test counselling; confidentiality in relation to test results; collection and storage of DNA, and criteria for testing.
Screening for genetic disorders: therapeutic abortion and IVF.
Authors: Michael M , Buckle S
Published: November 2008

This paper examines a proposal to make use of IVF techniques to provide an alternative to therapeutic abortion of fetuses with genetic abnormalities. We begin by describing the proposed procedure, and then show that, considered in itself, it is morally on a par with therapeutic abortion. However, once the wider practical implications are brought into view, the proposed new procedure loses its initial appeal. The pros and cons are not sufficiently clear-cut entirely to rule out the IVF procedure, so the paper concludes by indicating some further complications which may follow, should the procedure come to be adopted.
Danish ethics council rejects brain death as the criterion of death.
Authors: Rix B A
Published: November 2008

In Denmark, which alone in Western Europe has not accepted brain death as the criterion of death, the newly established Danish Council of Ethics has issued a report suggesting that in Denmark the criterion of death should still be the cessation of cardiac activity. The council bases its conclusion on the concept of death in everyday experience and its ethical implications.
Danish ethics council rejects brain death as the criterion of death -- commentary 1: wanting it both ways.
Authors: Lamb David
Published: November 2008

In this commentary on the recommendations of the Danish Council of Ethics (DCE) concerning criteria for death it is argued that whilst the DCE is correct in stressing the cultural aspects of death, its adoption of cardiac-oriented criteria raises several problems. There are problems with its notion of a 'death process', which purportedly begins with brain death and ends with cessation of cardiac function, and there are serious problems regarding its commitment to a cardiac-oriented definition whilst permitting transplantation when the heart is still beating.
Unfinished feticide.
Authors: Jansen R P
Published: November 2008

A fetus may survive an intentional interference with its intrauterine environment (1) if gestational age is mistaken and the procedure of induced abortion does not kill the fetus, (2) if a change of heart takes place after abortifacient drugs are taken and the abortion does not proceed, and (3) if a high-multiple pregnancy is reduced to a singleton or a twin pregnancy to improve the likelihood that the remaining fetuses will reach viability. In each case, through cause or coincidence, an abnormal baby may be born. The well-intentioned physician, responding to a patient's medical or psychological needs, risks a legal action in negligence or assault brought by a deformed surviving child. This hazard means that medical termination of pregnancy and selective pregnancy reduction put the practising physician at substantial risk in a way not usually associated with induced abortion.
Unfinished feticide: the ethical problems.
Authors: Lesser Harry
Published: November 2008

Dr. Jansen's paper raises three main issues. The one with which he himself is most concerned is the question of which methods of abortion are ethically right, and whether methods which risk the birth of a damaged baby are wrong. But there are two others: first, how the (originally unintended) birth of a live but damaged child alters the moral situation, and secondly, whether the overcoming of sterility by inducing a multiple pregnancy in which some of the fetuses have to be killed in order for any of them to survive is at all morally acceptable.
When keeping secrets may cause harm.
Authors: Ridsdale L
Published: November 2008

A GP is not informed that her patient is HIV-positive. The question is posed-should doctors in special clinics act on the assumption that patients do not want their GP informed? It is argued that this assumption may be false, and that it may deny patients the offer of appropriate and timely support.
Comments on an obstructed death -- a case conference revisited: commentary 1.
Authors: Byrne Peter
Published: November 2008

The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to an ethics deriving from the centrality of moral relationships and virtues. A brief analysis of the connections between moral relationships and moral rules is offered. Such an ethics would lower the value that philosophical fashion places on truth-telling and autonomy and leave decisions about truth-telling and the terminally ill more dependent on the circumstances of particular cases.
The QALY argument: a physician's and a philosopher's view.
Authors: Rawles J , Rawles K
Published: November 2008

The arguments used by Gavin Mooney in his scornful response to Castigating QALYs, are examined. In spite of the rhetoric there is a broad measure of agreement about the deficiencies of QALYs as a means of distributing scarce resources. The main area of conflict is that John Rawles favours compaigning for more resources while Gavin Mooney, constrained by his remit as a health economist, favours acceptance of the present level of funding and better methods of distributing resources.
Two philosophers in search of a contradiction: a response to Singer and Kuhse.
Authors: Long T A
Published: November 2008

Peter Singer and Helga Kuhse reject my claim that because their views on the mortality of infanticide are metaphysically incommensurate with those of Paul Ramsey they cannot refute his position. According to them, I have failed to see that Ramsey contradicts himself. Once this is seen, no further refutation is needed. I argue that there is no contradiction and offer further thoughts on the metaphysically incommensurate.
The Council of Europe's first Symposium on Bioethics: Strasbourg, Dec 5-7 1989.
Authors: Boyd Kenneth
Published: November 2008

This symposium discussed bioethics teaching, research and documentation and also research ethics committees. An international convention for the protection of the integrity of the human body was called for, as was a new European Committee on Ethics. 'The genetic impact' was a major preoccupation of the symposium.
Paying organ donors.
Authors: Harvey J
Published: November 2008

Following an earlier paper in the journal in which Evans argued that it was commercial exploitation, not mere payment, that was morally objectionable about certain sorts of organ donation, this paper looks at the moral issues when commercial exploitation is eliminated from systems of paid organ donation. It argues that there are no conclusive moral arguments against such schemes for non-exploitative paid kidney donation.
The kidney trade: or, the customer is always wrong.
Authors: Brecher B
Published: November 2008

Much of the opinion scandalized by recent reports of kidneys being sold for transplant is significantly inconsistent. The sale of kidneys is not substantially different from practices espoused, and indeed endorsed, by many of those who condemn the former. Our moral concern, I suggest, needs to focus on the customer's actions rather than the seller's; and on the implications for larger questions of the considerations to which this gives rise.
Against the magnanimous in medical ethics.
Authors: Kottow M H
Published: November 2008

Supererogatory acts are considered by some to be part of medicine, whereas others accept supererogation to be a gratuitous virtue, to be extolled when present, but not to be demanded. The present paper sides with those contending that medicine is duty-bound to benefit patients and that supererogation/altruism must per definition remain outside and beyond any role-description of the profession. Medical ethics should be bound by rational ethics and steer away from separatist views which grant exclusive privileges but also create excessive demands, way beyond what physicians perform or are willing and able to offer.
Let the patients smoke: a defence of a patient privilege.
Authors: Lavin M
Published: November 2008

I examine two kinds of arguments in favour of imposing restrictions on smoking by hospitalised psychiatric patients. First, I look at patient-centered arguments in favour of restrictions. These arguments focus on the benefits that patients will receive if their smoking is stopped or curtailed. Second, I examine arguments that seek to justify restrictions by citing the costs that smokers impose on others. Neither kind of argument justifies any meaningful restrictions on the smoking of hospitalised psychiatric patients.
The global distribution of health care resources.
Authors: Attfield R
Published: November 2008

The international disparities in health and health-care provision comprise the gravest problem of medical ethics. The implications are explored of three theories of justice: an expanded version of Rawlsian contractarianism, Nozick's historical account, and a consequentialism which prioritizes the satisfaction of basic needs. The second too little satisfies medical needs to be cogent. The third is found to incorporate the strengths of the others, and to uphold fair rules and practices. Like the first, it also involves obligations transcending those to an agent's relations and fellow-citizens. These conclusions are applied to international health-care provision, which they would transform.
Temperance.
Authors: Telfer E
Published: November 2008

The kind of temperance discussed is the virtue of moderation concerning the pleasures of eating and drinking. A person lacks this moderation if either his desire for such pleasures causes conflicts with his own standards of appropriate behaviour or the standards themselves attach too much importance to the pleasures concerned. Opinions vary about the proper status of these pleasures, but people surely value them too highly if they place them above their health or the moral duty not to cause unnecessary suffering. Temperance concerns medicine because of its connection with health, ethics because it involves not only the good life for the individual but also the welfare of other creatures.
The rights of man and animal experimentation.
Authors: Martin J
Published: November 2008

Since emotions give contradictory signals about animal experimentation in medical science, man's relationship to animals must be based upon reason. Thomas Aquinas argues that man is essentially different from animals because man's intellectual processes show evidence of an abstract mechanism not possessed by animals. Man's rights arise in association with this essential difference. The consequence is that only man possesses true rights by Aquinas's definition; animals have them only by analogy. However, cruelty to animals is illicit and they should be protected, principally not because they have rights, but because he who is cruel to animals is more likely to be cruel to his fellowman. If there is a need for animal experimentation in science for the good of man, this approach gives philosophical justification for experimentation, since man's well-being must come before that of animals because of his unique possession of rights. However, those experiments should be carried out in the kindest way possible, to promote kindness towards man. To see man as solely part of a biological continuum in competition for rights with those beings close to him biologically, detracts from man's dignity.
Embryo research--why the Cardinal is wrong.
Authors: Walton
Published: November 2008

Reasons are given for suggesting that individuation of the human embryo does not begin until the primitive streak forms at about the fourteenth day after conception; this view, though contested by many, is held by very many committed Christians of all denominations. In the conceptus or pre-embryo, after the formation of a blastocyst at about four-five days after fertilisation, biopsy of a single cell from the outer layer of cells (which later can form the membranes and placenta) can be used to determine the sex of the conceptus and will ultimately be used to detect the presence of an abnormal gene such as that for Duchenne-type muscular dystrophy, without detriment to development of the basal cell mass from which the embryo forms. The potential benefits in the prevention of inherited disease are profound.
Death in Denmark.
Authors: Evans M
Published: November 2008

Does it matter that the hearts of 'brainstem dead' patients may persist in beating spontaneously? Hostile reactions, to the Danish inclusion of cardiac criteria in the determination of death, betray reductionist views of human life at the core of 'brainstem' conceptions of death. Such views (whether centred on neurological function or on abstractions concerning 'personhood') supplant the richness of human life and death with the poverty of essentialism: and mask the lethal nature of beating-heart organ retrieval. The affirmation of cardiac criteria for death is not an alternative form of essentialism as some critics suppose, but part of an understanding of human life and death which rejects essentialism altogether. The spontaneously persistent heartbeat does not constitute human life, but most certainly counts for it.
Confidentiality and Huntington's chorea.
Authors: Adams J
Published: November 2008

A doctor has duties towards his patients of both confidentiality and veracity and at times these may conflict, as in the following case. A mother who has the symptoms of Huntington's chorea does not wish her daughters to know. The doctor must try to make her realise how valuable the information can be to the daughters, and thus obtain her consent to inform them. If the mother's consent cannot be obtained, then the doctor must tell the mother that he cannot allow her attitude to deprive the daughters of this information, especially at this crucial time as they plan to have children. The well-being of the daughters' future families must take precedence over the mother's desire for secrecy regarding her condition.
What future for ethical medical practice in the new National Health Service?
Authors: Persaud R D
Published: November 2008

The British Government is implementing some major alterations to the way health services in Great Britain are organised. As well as the introduction of competition between health care providers, their financial interests are to be linked to their output, in efforts to use market forces to increase efficiency and cut costs. This paper looks at the possible impact of these changes of health care organisation on ethical medical practice. This is investigated with particular reference to the country whose health service has embraced most closely these elements of the market--the United States of America. The question to be answered is whether high standards of ethical care are ensured by factors somehow intrinsic to the medical profession, and are therefore immune to changes in the economics of health care. This assumption is shown to be questionable in light of what is known about the determinants of ethical medical practice.
The advertising of doctors' services.
Authors: Irvine D H
Published: November 2008

Medicine is unique among professions and trades, offering a 'product' which is unlike any other. The consequences for patients of being attracted by misleading information to an inappropriate doctor or service are such as to demand special restrictions on the advertising of doctors' services. Furthermore, health care in the UK is organised around the 'referral system', whereby general practitioners refer patients to specialists when necessary rather than have specialists accept patients on self-referral. But this need not inhibit the provision of helpful factual information to those who need it. Recent policy changes by the General Medical Council considerably broaden the scope for general practitioners to make factual information of their services available to local people, while safeguarding the public against promotional activities which are designed to increase demand for certain kinds of specialist service by playing upon individuals' fears and lack of medical knowledge.
The Nordic concept of 'faellesskab'.
Authors: Riis P
Published: November 2008

The complex of cultural, political and societal affiliations, both in a historic and a contemporary perspective, is expressed by a special term in the Nordic languages, 'faellesskab', often with the addition of 'folkelig', as 'folkeligt faellesskab', where 'folkelig' means of the people. No corresponding term exists in English. For medical ethics the concept 'faellesskab', or whatever wording is chosen to serve the semantics of this term, is vital. In research ethics and clinical decision-making complex ethical analyses and normative evaluations are necessary. They cannot be based solely on moral relativism, whether being based on results of opinion polls or on a widespread 'every man minds his own business' concept. 'Faellesskab' possesses the necessary base of common values.
Psychopathic disorder: a category mistake? A legal response to Colin Holmes.
Authors: Mackay I
Published: November 2008

Holmes is concerned with a conflict between law and medicine about the problem of psychopathy, in particular as it relates to homicide. He looks for a consistent set of legal principles based on a variety of medical concepts and in doing so criticises the court for its commonsense approach, its disregard for medical evidence and for employing lay notions of responsibility and illness. This commentary explores how Holmes's notions fit into existing legal rules and explains how the court seeks the assistance of medical evidence when looking at the evidence as a whole to enable it to decide upon issues of defence, which involve legal and not medical concepts.
A nation of people called patients.
Authors: Pickering W G
Published: November 2008

The implications of the causal and ubiquitous use, by doctors health-workers and politicians, of the word 'patient' are here discussed. Given that the many implications of this noun do not include health or normality (rather the contrary), it is questionable who, if anyone, profits from its indiscriminate use--and its use, even, at all.
Prostitutes, workers and kidneys: Brecher on the kidney trade.
Authors: Buttle N
Published: November 2008

Brecher argues that the practices of selling blood and kidneys are akin to the practices of prostitution and wage-labour since they all involve commodification and, by implication, should be subject to legal prohibition. I suggest that these practices need not involve commodification and that they should only be condemned if people are forced into them because of their lack of power. Rather than these practices being prohibited, I suggest that it would be preferable if they were subject to state regulation in order to protect the weak from exploitation.
Buying human kidneys: autonomy, commodity and power.
Authors: Brecher B
Published: November 2008

Buttle's reply to my objections to buying kidneys is helpful but unconvincing in two respects. Doing something freely leaves quite open the possibility that one is thereby making a commodity of a person; and the effects of institutionalising such a practice is itself a matter for concern. And while his emphasis on 'power' is important, the concept is hardly less problematic than 'commodification'.
Enforced death: enforced life.
Authors: Fairbairn G
Published: November 2008

The notion of 'quality of life' frequently features in discussions about how it is appropriate to treat folk at the beginning and at the end of life. It is argued that there is a disjunction between its use in these two areas (1). In the case of disabled babies at the very beginning of life, 'quality of life' considerations are frequently used to justify enforced death on the basis that the babies in question would be better off dead. At times, babies with severe disabilities are thus allowed to die or even killed. In the case of terminally ill people 'quality of life' is also important in guiding the actions of doctors. However, in the case of individuals who do not wish to live any longer because their quality of life is so poor that they would rather be dead, quality of life is likely to be dropped as a guiding principle. Thus patients who wish to die and ask to be killed, will most often be forced to endure enforced life.
The diffusion of medical technology: free enterprise and regulatory models in the USA.
Authors: James A E , Perry S , Warner S E , Chapman J E , Zaner R M
Published: November 2008

The diffusion of technology in the US has taken place in an environment of both regulation and free enterprise. Each has been subject to manipulation by doctors and medical administrators that has fostered unprecedented ethical dilemmas and legal challenges. Understanding these developments and historical precedents may allow a more rational diffusion policy for medical technology in the future.
From the patient's point of view: medical ethics and the moral imagination.
Authors: Elliott C , Elliott B
Published: November 2008

This paper concerns the difficulties of imagining the subjective point of view of another human being, and the relevance of these difficulties to medical decisions. It explores especially the difficulties of imagining the experience of the mentally impaired, and examines several standards for decision-making: the 'prior expressed wishes standard', the 'substituted judgement standard', and the 'best interests standard'.
Resource allocation: idealism, realism, pragmatism, openness.
Authors: Goodman N W
Published: November 2008

Lewis and Charny have come under siege for suggesting remote questioning to decide appropriate medical care. While the criticisms are theoretically valid, the idea is so important practically that Lewis and Charny should be supported and their approach investigated as a way of making medical treatment at least more open and possibly more fair.