bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of the Treatment Setting on the Decision-Making Process: Acute Care Hospitals and Emergency Services
Authors: Weiss Ellen Covner 
Published: June 2007

This paper discusses the obligation of acute care hospitals and emergency services to treat patients. Since care rendered in these settings is, of necessity, provided by health care professionals, not buildings or programs, the obligation may be twofold. First, are there obligations for hospitals and emergency services to offer treatment? Second, do health care professionals practicing in these settings have an independent obligation to treat? How has the Supreme Court decision in Cruzan affected these obligations?The tradition in this country has been that private hospitals had no obligation to treat patients, as opposed to public hospitals which were frequently set up for the very purpose of treating patients who had no other access to care. Over the years, statutes and case law have limited the rights of private hospitals and physicians to refuse to treat patients.
Why Withdrawal of Life-Support for PVS Patients is Not a Family Decision
Authors: Baron Charles H. 
Published: June 2007

We presently are not really leaving withdrawal of treatment decisions to families and there are good reasons why we ought not to do so. To see why this is, we need to focus on what is special about PVS cases as opposed to other kinds of medical cases in which we are forced to make life and death decisions.One thing which is very special about PVS is the fact that it is a condition which intuitively pushes us to rethink, once again, society's definition of “death.” We have already changed our definitions of death to include situations in which respiration and circulation continue but the “whole brain” is dead. Defining death to include irreversible PVS would merely require extending the definition to include situations where the brain stem is functioning but the neocortex is dead. There are, of course, obstacles to overcome in extending the definition in that fashion.
A Response to Gostin, “The HIV-Infected Health Care Professional: Public Policy, Discrimination, and Patient Safety”
Authors: Feldblum Chai R. 
Published: June 2007

On February 21-22, 1991, the Centers for Disease Control convened an Open Meeting on the Risk for Transmission of Bloodborne Pathogens to Patients During Invasive procedures in Atlanta, Georgia. Over 80 organizations testified at that meeting.Almost without fail, every organization testified against the use of mandatory HIV testing to screen out HIV-infected surgeons and dentists from practice. Various groups and individuals, however, advocated that HIV-infected professionals should voluntarily restrict themselves from selected procedures and/or should voluntarily disclose their HIV status to their patients.Larry Gostin, the Executive Director of the American Society of Law and Medicine, argued that HIV-infected health care workers should voluntarily self-defer from selected invasive procedures. I believe that the approach of voluntary self-deferral has legal and practical flaws and is not the appropriate public policy for the CDC to adopt.
Protection of Research Subjects: Do Special Rules Apply in Epidemiology?
Authors: Capron A.M. 
Published: June 2007

Imagine, if you will, a place where health, hospitalization, education, military, employment, law enforcement, housing, tax and financial records, as well as disease registries and the data sources for the census, vital statistics, and all aspects of people's private activities, are meticulously kept, fully linked together, and easily accessible to qualified researchers. What is that place? Epidemiologists’ heaven.Of course, formidable problems face epidemiologists trying to reach heaven. The data sources on many aspects of our lives are incomplete and the means of linking them are typically nonexistent or partial at best. But even if the data all existed, there would be a further “catch”: epidemiologists would probably find themselves facing great obstacles in gaining access to the data.Epidemiologists sometimes think of “ethics” as the source of those obstacles, which are believed to be embodied in the federal rules for the protection of research subjects—colloquially called 45 CFR Part 46—especially as they are interpreted by some institutional review boards (IRBs).
Existing International Ethical Guidelines for Human Subjects Research: Some Open Questions
Authors: Christakis Nicholas A. , Panner Morris J. 
Published: June 2007

International guidelines regarding ethics, and in particular the ethics of clinical research, are problematic on two broad levels. First, by asserting their universality, “international” guidelines obscure real and legitimate crosscultural differences in ethical expectations. International guidelines seek to make homogeneous something which is not necessarily so. Second, existing guidelines are ambiguous about their objectives and purposes. On the one hand, guidelines are structured as a set of goals, largely aspirational in language and content. But on the other hand, such guidelines also suggest a normative function, providing a set of standards by which to judge and, if appropriate, sanction investigators’ conduct.These criticisms are not intended to argue that international guidelines are useless. Nor are they intended to question the good faith under which such guidelines are developed. Rather, we wish to suggest that the role of present international guidelines is somewhat more limited than is ordinarily appreciated.
What's in a Name? The Policy Implications of the CDC Definition of AIDS
Authors: Levine Carol , Stein Gary L. 
Published: June 2007

Disease classification systems and surveillance definitions are ordinarily tools for medical professionals, not matters for political debate and patient advocacy. It is hard to imagine a protest march complaining about the classification system for colon cancer. But when it comes to AIDS, nothing is ordinary.The Centers for Disease Control's (CDC) case definition of AIDS is used by public health officials, researchers, clinicians, hospital administrators, disability specialists, insurance administrators, health economists, legislators, social workers, policy makers, and the media. It has influenced the way the HIV epidemic is perceived, managed, and funded.It is not surprising, then, that the CDC definition of AIDS and its proposed revision is currently the subject of intense scrutiny. The case definition has transcended epidemiology to become a symbol for the inadequacies of the U.S. government's response to the HIV epidemic, and a particular symbol for the failure to address the needs of HIV-infected women.
Germ-line Gene Therapy: A New Stage of Debate
Authors: Fletcher John C. , Anderson W. French 
Published: June 2007

Ethical debate on human germ-line gene therapy is in a new stage. After an era when only individual convictions could be examined, technology is on a threshold of real possibilities. Germ-line gene therapy can conceivably be carried out in either of two practical ways: 1) insertion of a gene into a pre-embryo, which is the subject of this paper, or 2) insertion of a gene into the germ cells of an individual.Transgenic animal research and pre-implantation embryo diagnosis have implications for human embryonic germ-line experiments to correct single gene disorders. When would such experiments be feasible and ethically acceptable? If further animal research supports it, we argue for a moral obligation to learn if human germ-line experiments are feasible and safe to attempt. The obligation is grounded in several social-ethical principles that lead society and researchers to set gods for studies that promisc to relieve and to prevent human suffering and premature death. These principles also shape the practices and restrictions of biomedical research.
Whodunit? Causal Responsibility of Utilization Review for Physicians' Decisions, Patients' Outcomes
Authors: Morreim E. Haavi 
Published: June 2007

In the “olden days,” only a few years ago, physicians were free to order virtually any service they believed their patients needed, confident that virtually everything would be paid for. Reimbursernent was retrospective, fee-for-service and generous, essentially a cost-plus system in which insurers only rarely challenged medical decisions. That system is now gone. Uncontrolled escalations in the cost of health care have prompted those who pay its costs—primarily governments, businesses, and insurers—to initiate a broad array of cost controls in hopes of at least restraining the rise of their expenditures, even if not actually reducing them. Among the most prominent cost-containment mechanisms is utilization review (UR).Insurers have always engaged in retrospective review, denying payment for services that are not medically necessary, or not covered by the patient's policy, or not documented in the patient's records. Recently, however, payers have added prospective review, in which physician and patient must secure advance payer approval for certain interventions if they wish to ensure reimbursement.
An Axiology for National Health Insurance
Authors: Dougherty Charles J. 
Published: June 2007

Approximately 35 million Americans have no health insurance coverage. They receive no health insurance where they work, nor do they qualify for Medicare, Medicaid, or any other program of health insurance. Eighty-five percent of these Americans live in households headed by someone working full time. One third of the 35 million uninsured are children.Several reasonable inferences can be drawn from these statistics. First, the problem of the uninsured is a serious one in the United States. Thirty-five million Americans represent approximately 15 percent of the population. Second, the fact that the vast majority of the uninsured are in households headed by a working American shows that this problem is systemic. It is not simply a matter of unemployment, nor is it linked significantly to laziness or refusal to work. Finally, the fact that over 10 million uninsured Americans are children shows that many of the uninsured have this status beyond any intelligible notion of personal responsibility.
Studying the Acceptability and Feasibility of Medical Abortion
Authors: Winikoff Beverly , Coyaji Kurus , Cabezas Evelio , Coyaji Banoo , Krishna Usha , de la Concepcion Oscar , Eschen Andrea , Sivin Irving , Brady Martha 
Published: June 2007

“Acceptability research” is a term first coined to describe inquiries into individuals’ responses to family planning and contraceptive technology. As defined by WHO, “acceptability” is a “quality which makes an object, person, event, or idea attractive, satisfactory, pleasing or welcome.” In fact, the word “acceptable” in English is distinct from other issues that are also encompassed within “acceptability research.” “Acceptable,” to many, connotes faint praise. It may mean that something is tolerable only to the point of not being protested. On the other hand, the attributes “desirable” and “preferable” are more positive. In fact, all of these qualities are examined within the meaning of “acceptability research” as currently used by the Population Council.Acceptability of a product or a medical procedure is most commonly studied in terms of patients or clients. Do those who will undergo the procedure or be the subjects of the technology find its use acceptable? But, in fact, acceptability can also be tested in relation to the providers of the technologies (i.e., the medical professionals), to the program managers or to policymakers.
Are Adolescents Good Candidates for RU 486 as an Abortion Method?
Authors: Senderowitz Judith 
Published: June 2007

There is little experience with, and virtually no documentation of, adolescents’ use of RU 486 as a means of terminating pregnancy. While this void is understandable presently, it must be filled in order to determine how best to apply this new medical method to a special population—teenagers. It is imperative to know how adolescents might react differently from older women physiologically and psychologically, how they would accept this method of abortion and how health service providers should respond to their special needs. Counseling, for example, is particularly important for adolescent use of any family planning or abortion service.Although it is not possible to review directly adolescent experience with RU 486, it is instructive to examine related attitudinal and behavioral patterns to assess the potential for adolescent use of a medical method of abortion. Documented experience with contraception and surgical abortion underscores the major challenges—present and new—for adoption of a new approach.
Antiprogestin Drugs: Ethical Issues
Authors: Macklin Ruth 
Published: June 2007

Does the prospect of introducing RU 486 into the United States pose any unique ethical issues? Or are the ethical questions raised by antiprogestins similar to those that arise when any new medical technology comes along? The short answer is that the ethical issues are not new or different, but the politics of abortion can seduce us into thinking that antiprogestins bear ethical hazards of a novel sort.One transcending ethical question stands before us: Would it be the right thing to do to introduce RU 486 into the United States today? The deceptive simplicity of that question requires further analysis.
Do Pharmacists Have a Right to Refuse to Fill Prescriptions for Abortifacient Drugs?
Authors: Weinstein Bruce D. 
Published: June 2007

Some pharmacists who believe that abortion is immoral are troubled by the thought that they might be required to fill prescriptions for abortifacient drugs like mifepristone. Do pharmacists have the right to refuse to fill such prescriptions?Questions about the rights of professionals have both moral and legal dimensions. I will assume—although this assumption is by no means axiomatic or uncontested—that the rights and responsibilities of persons in general and professionals in particular ought to be grounded in morality and not the law. For example, a person who breaks the speed limit to bring a critically ill friend to a hospital's emergency room violates the law, but may be morally justified in doing so. There is no legal duty to rescue a person in danger, but many moral communities hold that our moral duty of beneficence requires us to prevent harm to others, at least if in so doing we are not placing ourselves and others at great risk of harm.
Toward a Theory of Process
Authors: Wolf Susan M. 
Published: June 2007

Bioethics has no theory of process. We have labored to develop a widely shared set of substantive values, but have been slow to spell out exactly what processes our values command. Nor have we examined process itself, to gauge the impact of different procedures and debate what we should value in process itself.The little work that has been done on process focuses almost exclusively on what action should be taken in one-to-one encounters. Thus, much has been said on the obligation of the physician to speak with the patient, share information, and seek consent. Indeed, it would have been difficult to advocate respect for patient autonomy at all, without at least requiring this minimal and individualistic sort of procedure. But the requirement of certain behaviors in individual encounters has not been set in any broader vision of institutional process.
Medical Futility
Authors: Miles Steven H. 
Published: June 2007

“Medical futility” may be provisionally defined as a medical conclusion that a therapy is of no value to a patient and should not be prescribed. The current debate about medical futility is one of the most important and contentious in medical ethics. Proponents believe that allowing physicians to determine and withhold futile therapies can he done without disturbing the current paradigm of medical ethics which respects patient autonomy with regard to informed consent and the right to refuse treatment. Others conclude that medical futility is simply an unacceptable form of medical paternalism. Some adopt a middle position that doctors can predict medical futility; they believe that attempting this does not necessarily justify imposing decisions to forgo life-sustaining therapy on patients.Regardless of its policy outcome, this important debate is leading to a reexamination of the nature of a patient's entitlement to health care and of the ends of medicine. It has two aspects. A definitional debate examines rhe concept of medical futility and its derived clinical criteria.
Futility: Not Just a Medical Issue
Authors: Alpers Ann , Lo Bernard 
Published: June 2007

Is it futile to sustain biologic life when the patient will permanently require intensive medical care? Dr. Koch and Dr. Miles agree that such treatment would be futile; however, their concept of futility rests on no explicit standards and reflects no communal judgment. The authors view the lack of widely accepted medical standards as an impediment to answering this question definitively. Dr. Koch laments that patients and their families have seized too much power and have begun deciding that mere biologic life is worth sustaining. And Dr. Miles sees benefit to perceiving a decision not to sustain such life as “primarily biomedical” and “realistic.”Here is where we disagree with these authors. We do not see the problem as a lack of standards that are medical. The question of prolonging a patient's life when the patient has no likelihood of regaining consciousness confronts moral, political, and economic issues.
Prisoners of Progress or Hostages to Fortune?
Authors: Morgan Derek , Nielsen Linda 
Published: June 2007

We shall have to evolve problem-solvers—galore since each problem they solve creates ten problems more— Piet HeinThe new reproductive technologies, especiallyin vitrofertilization (IVF), have extended the possi- bilities of assisted reproduction to the benefit of the childless couples. At the same time these technologies and their added techniques, however, have fragmented reproduction and exposed the human egg to intervention yet unknown:The embryo may be divided into several embryos; may be sold; donated; cryopreserved; borne by another woman and returned; or used for research;Genetic parentage may be present without sexual intercourse, may be different from social parentage and the natural time-span between fertilization and birth may be interrupted.
Japanese Attitudes toward Assisted Procreation
Authors: Shirai Yasuko 
Published: June 2007

The first “test-tube baby” in Japan was born in March, 1983 at Tohoku University Hospital. Since then ten years have passed. Table 1 indicares the clinical results of in vitro fertilization in this country. As it shows, more than 145 institutions perform IVF, and more than 3,000 babies have now been born using this procedure.According to the recommendations issued in October, 1983 by the Japan Society of Obstetrics and Gynecology, IVF is defined as a medical practice for treating infertility, and this procedure is performed only on married couples de jure. Eggs and embryos are not donated for IVF in Japan, nor does any “lending” or “leasing” of wombs take place. However, inFebruary, 1988 the Japan Society of Obstetrics and Gynecology issued new recommendations which allow clinical use of frozen embryos and eggs. The first baby from a frozen embryo was born in 1989, and 60 babies have been born to date.
Moral Grounding for the Participation of Children as Organ Donors
Authors: Ross Lainie Friedman 
Published: June 2007

More than 24,000 patients await organ transplants and the number is increasing yearly. Living donors are an important source of transplant organs. In this paper, I argue that we can morally justify allowing children to serve as donors. Yet, I also argue that their participation must be restricted in order to prevent their exploitation.The paper is divided into six sections. In the first section, I show why the traditional principles of personal autonomy and beneficence are not adequate morally to justify the participation of children in the nontherapeutic role of organ donor. Next, I argue that the moral justification of the child’s participation must be based on the intimate family relationship which permits activities that would be unacceptable in the public domain. In the third section, I argue that family autonomy ought to be limited by the principle of respect for persons. In the fourth section, I propose five principles to guide the participation of children as organ donors. In section five, I discuss the role of the child in the decision-making process. In section six, I critically examine the criteria for equity in donor selection.
Tuberculosis in Prison: Balancing Justice and Public Health
Authors: Greifinger Robert B. , Heywood Nancy J. , Glaser Jordan B. 
Published: June 2007

During the mid-nineteenth century the annual tuberculosis (TB) mortality in the penitentiaries at Auburn, N.Y., Boston, and Philadelphia exceeded 10 percent of the inmate population. At the beginning of the sanatorium era, 80 percent of the prison deaths were attributed to TB. As the mountain air was “commonly known” to be healthful, the first prison sanatorium was opened in the mountains near Dannemora, N.Y. in 1904. It served to isolate contagious prison inmates until the advent of effective chemotherapy for the disease in the 1950’s. Early antibiotic therapy for TB was such a great success that the public health aspects of TB in prisons remained dormant for the next 40 years.In 1991, a correctional officer from Auburn Correctional Facility in Auburn, New York died as a result of multidrug-resistant TB. He had been posted to care for hospitalized patients, from whom he acquired his disease. This death, and the transmission of TB infection to health care workers in the same hospital, brought the nature and extent of modern inmate medical care into finer focus.
Professional Norms and Physician Attitudes Toward Euthanasia
Authors: Preston Thomas A. 
Published: June 2007

The chair of the ethics committee of a major medical center agonized over how he, as a physician, and his organization should deal with Initiative 119, which, if passed, would legalize physician involvement in active, voluntary euthanasia in Washington State. In the end, he said, he could not vote for aid-in-dying because, “However much I want to reduce suffering, I myself just couldn’t do it to one of my patients.” He spoke of a personal distaste for the potential act, of a profound desire not to have to do it. It was not an ethical argument, but an honest and compelling expression of feelings.Why can’t this sincere man do it, even for patients who request such aid? In a 1991 poll, taken in Washington State prior to the vote on Initiative 119, 49 percent of the physicians surveyed supported the initiative, but 75 percent did not want to participate in aid-in-dying.
Toward a New Health Strategy to Control the HIV/AIDS Pandemic
Authors: Mann Jonathan , Tarantola Daniel , O’Malley Jeff 
Published: June 2007

Since its recognition in the early 1980s, the global HIV/AIDS pandemic has continued to grow relentlessly. Early efforts in HIV prevention sought to influence behavior by providing information about the dangers of AIDS along with recommendations for safe behavior. This approach helped to alert people about AIDS, but was insufficient to promote or sustain behavioral change.The second approach attempted to promote individual behavioral change by designing AIDS programs that would deliver a mix of information, materials, and services. This program-based approach emerged within communities, was gradually adopted by some countries, and was subsequently articulated by the World Health Organization as the first Global AIDS Strategy. The emphasis during this period was to ensure that each community and country developed its own comprehensive program by adapting a global model to local and national circumstances.