bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproduction without Sex—But with the Doctor
Authors: Brody Eugene B. 
Published: June 2007

Nine years after the appearance of the world's first “test tube baby,” the public is being deluged with technical and ethical opinions about non-coital reproduction. U.S. legislators, policymakers, and lawyers, energized by the court battle about “Baby M,” are reconsidering the rights of would-be parents and of the children created by the new technologies. But in the course of this turmoil one salient fact has been ignored: social policy and technological advances in respect to reproduction are mediated for the individual woman through her interaction with her doctor.Doctors have gotten by with remarkably little scrutiny in this regard. The perception of them as benevolent magicians has, indeed, been enhanced. The only criticism has come from religious leaders concerned with the experimental use of fetal or reproductive materials, and from those who see the doctor-scientist “playing God.”
Policy, Ritual, Purity: Gays and Mandatory AIDS Testing
Authors: Mohr Richard D. 
Published: June 2007

for Robert W. Switzer“[T]here is not a good word to be said for anybody's behavior in this whole mess.”—Larry Kramer, The Normal HeartWell after Brown v. the Board of Education, Jackson, Mississippi, maintained racially segregated public swimming pools, claiming that only through segregation could violence and social chaos be avoided there. The federal courts saw through this stratagem, noting that it was a variant of the heckler's veto thinly masking racial animus. But did Jackson integrate its pools? No. The city council voted instead to close them all. This time out, the courts were not so wise.In 1971, the Supreme Court upheld the constitutionality of the pool closings. The Court was snookered by the surface similarity of the policy's treatment of blacks and whites—neither could, after all, use the swimming pools. The practice appeared to treat similar cases similarly. And indeed the pool-closing statute did not refer in any way to blacks.
Fairy Tales Surrogate Mothers Tell
Authors: Annas George J. 
Published: June 2007

How did surrogate motherhood evolve from a hare-brained, fly by night idea of the late 1970s into one that had at least some mainstream, middle-class support in the mid-1980s? Many explanations have been suggested. Although the rate of infertility has not increased, infertility is no longer a secret, and there are major public support groups, like RESOLVE, that advocate for infertile couples. New and powerful techniques like IVF (in vitro fertilization) have been developed, and although they help very few people, they have been widely publicized and approved. And babies are fashionable again. As one movie critic put it: Men and women do not fall in love with each other in the movies anymore. They fall in love with babies. Babies are the new lovers—unpredictable, uncontrollable, impossible and irresistible.These explanations all have some merit. But the core of surrogate motherhood lies in the modern fairy tale that babies can properly be viewed as a consumer product for those with money to purchase them, and that by permitting this transaction we will all live happily ever after. As a product babies have been hyped by slick, white, middle-class professionals and advertised in the free-market environment of the 1980s. We are asked not to look behind the resulting children to see their lower-middle-class and lower-class mothers.
Surrogate Motherhood as Prenatal Adoption
Authors: Steinbock Bonnie 
Published: June 2007

The recent case of Baby M has brought surrogate motherhood to the forefront of American attention. ultimately, whether we permit or prohibit surrogacy depends on what we take to be good reasons for preventing people from acting as they wish. A growing number of people want to be, or hire, surrogates; are there legitimate reasons to prevent them? Apart from its intrinsic interest, the issue of surrogate motherhood provides us with an opportunity to examine different justifications for limiting individual freedom.In the first section of this article, I examine the Baby M case and the lessons it offers. In the second section, I examine claims that surrogacy is ethically unacceptable because it is exploitive, inconsistent with human dignity, or harmful to the children born of such arrangements. I conclude that these reasons justify restrictions on surrogate contracts, rather than an outright ban.
Surrogate Motherhood: The Challenge for Feminists
Authors: Andrews Lori B. 
Published: June 2007

Surrogate motherhood presents an enormous challenge for feminists. During the course of the Baby M trial, the New Jersey chapter of the National Organization of Women met and could not reach consensus on the issue. The feelings ranged the gamut, the head of the chapter, Linda Bowker, told the New York Time. We did feel that it should not be made illegal, because we don't want to turn women into criminals. But other than that, what you may feel about the Baby M case may not be what you feel about another.We do believe that women ought to control their own bodies, and we don't want to play big brother or big sister and tell them what to do, Ms. Bowker continued. But on the other hand, we don't want to see the day when women are turned into breeding machines.
ATVs—The Hidden Danger
Authors: Kitzes William F. 
Published: June 2007

In 1967 Osamu Takeuchi of Honda Research and Development Co., Ltd. took some spare motorcycle parts to an outdoor area in Japan. American Honda Motor Corporation, the United States distributor for Honda Motor Company, Limited of Japan had requested the development of a vehicle to compete with snowmobiles. The result of Mr. Takeuchi's work was the All Terrain Vehicle (ATV), first distributed in the United States in 1970.By the end of 1987, an estimated 2.5 million ATVs had been sold by the major Japanese manufacturers and distributors: Honda, Yamaha, Kawasaki and Suzuki, and by Polaris, the sole American-owned manufacturer and distributor. According to U.S. Consumer Product Safety Commission (CPSC) estimates, over 340,000 hospital-emergency-room treated injuries have been associated with the use of ATVs. Almost 1000 deaths have been recorded by CPSC through their system for tracking state medical examiner's and coroner's offices. Almost half the deaths were children under 16 years of age and approximately 20 percent were children 12 and under. CPSC estimates that approximately 5 percent, or one of every 20 three-wheeled ATVs, is involved in a hospital emergency room treated injury each year.
AIDS: The Ethical Dilemma for Surgeons
Authors: Peterson Lynn M. 
Published: June 2007

“No man is an island entire of itself; every man is a piece of the Continent, a part of the maine.”J. Donne, “Devotions,” XVII“… Father Paneloux evoked the august figure of Bishop Belzunce during the Marseille plague. He reminded his hearers how, toward the end of the epidemic, the Bishop, having done all that it behoved him, shut himself up in his palace, behind high walls, after laying in a stock of food and drink. With a sudden revulsion of feeling, such as often comes in times of extreme tribulation, the inhabitants of Marseille, who had idolized him hitherto, now turned against him, piled up corpses around his house in order to infect it, and even flung bodies over the walls to make sure of his death. Thus in a moment of weakness the Bishop had proposed to isolate himself from the outside world—and lo and behold, corpses rained down on his head! This had a lesson for us all; we must convince ourselves that there is no island of escape in time of plague.A. Camus, The Plague
Reconceptualizing the Euthanasia Debate
Authors: Devettere Raymond J. 
Published: June 2007

For humane reasons, with informed consent a physician may do what is medically necessary to alleviate severe pain, or cease or omit treatment to let a terminally ill patient die, but he should not intentionally cause death.—Current Opinion of the Judicial Council of the American Medical Association—1984This well known position of the AMA Judicial Council implies that the distinction between intentionally causing death and letting a patient die is conceptually clear and ethically significant. Most opponents of active voluntary euthanasia accept the validity of this distinction; proponents inevitably do not. The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research is a notable exception.
Role of in-House Counsel in Decisions about Withdrawal of Life Sustaining Treatment
Authors: Wynstra Nancy A. 
Published: June 2007

For any hospital attorney, but especially for in-house legal counsel, the thought of a dissatisfied patient or other person turning to physical force or violence to achieve a particular outcome is the stuff of which nightmares are made. Apart from the human consequences of such situations, their occurrence means that counsel has failed to prevent problems. Problem prevention is one of the most important roles of any attorney and is the role which many in-house counsel view as their most important.Resort to force within a health care setting is especially troubling, yet the potential for such outcomes exists in a variety of situations about which counsel are likely to be consulted. These include employee terminations, medical student or resident terminations from training programs, and, in the patient care context, situations where patient or family wishes are not mer. Just such an outcome occurred at Rush-Presbyterian-St. Luke Hospital, in Chicago, Illinois, (hereafter “Rush”) when Mr. Rudolfo Linares held hospital staff at gunpoint while he disconnected his infant son's respirator so that the child would die.
Clinical Ethics and Public Policy: Reflections on the Linares Case
Authors: Thomasma David C. 
Published: June 2007

When the Linares case broke in Chicago, the media immediately began contacting ethicists and hospital lawyers in the area. Eventually, and somewhat wistfully as one paper reported, they were unable to find a single ethicist who did not think that the decision should have been made to withdraw treatment from Samuel far earlier in his treatment. Furthermore, ethicists argued that the family and physician should have made that decision. There was no need to consult with lawyers and especially not with courts.On the other hand, most lawyers contacted felt it was necessary to go to court to obtain permission to withdraw the respirator, since the legal status of such decisions in Illinois (as in most other states) was terribly unclear. Lack of “clarity” was a catchword in these interviews.This dichotomy between the instinctive reactions of ethicists and lawyers is natural. It should be so. The ethicists consulted, philosophers, theologians, and physicians, are all skilled in clinical ethics.
Assessing Decision-Making Capacity
Authors: Lo Bernard 
Published: June 2007

Physicians frequently are asked to assess whether a patient has the capacity to make informed decisions about his or her medical care. Such assessments may be difficult and controversial. There are few explicit legal standards for judging competency to make medical decisions. Furthermore, clinical practices for evaluating decision-making capacity are problematic. The following case illustrates some of these problems.Mrs. C., a 74 year old widow with congestive heart failure, angina pectoris, and mild dementia, has been admitted to the hospital for shortness of breath and chest pain. In the past three years she has suffered two heart attacks. During the past two months, her symptoms have worsened despite several medications, including maximally tolerated doses of diltiazem, furosemide and enalapril. She now develops shortness of breath and chest pain when walking one block. Because there are no other medical treatments for her condition, her physician recommends angioplasty or bypass surgery in order to ameliorate her symptoms.
Assuring Quality of Care for the Elderly
Authors: Lohr Kathleen N. , Donaldson Molla S. 
Published: June 2007

Health, Health Care, and the ElderlyHealth means different things to different people, but all people want access to essential health care services of high quality—not too much (the likelihood of benefit should outweigh the likelihood of harm), not too little (necessary and appropriate services must be available, and equitably so), and of a satisfactory technical and interpersonal character. The object of organized quality assurance programs in the private and the public sectors is to ensure that practitioners and institutions deliver care of high caliber.Many developments in health care are drawing attention to its quality. Health care costs conrinue to rise, both for the elderly out-of-pocket and for the Medicare program. In 1987, health care expenditures stood at $500.3 billion, or 11.1 percent of the nation's gross national product, and will be an estimated $647 billion in 1990.
Legal Issues in Nursing Home Admissions
Authors: Ambrogi Donna Myers 
Published: June 2007

Entering a nursing home involves a significant loss of personal autonomy. Whether the resident or someone else, such as a court or conservator, makes the decision, personal freedom becomes subject to rules, policies and practices that often seem to favor the convenience of the facility over the autonomy of the resident. The previously independent resident may now find that a “financial guarantor” must co-sign the admission agreement and a staff nutritionist decide what the resident will eat.As the impact of nursing home care on individual autonomy becomes more apparent, greater attention has focused on the rights of nursing home residents. Many of those rights derive from the admissions agreement signed when the resident enters the facility. While theoretically subject to negotiation, the boilerplate contracts used by most nursing homes subject the consumer to undeniable coercion in making an important consumer choice.
The Doctor's Changing Role in Allocating U.S. and British Medical Services
Authors: Lee Robert G. , Miller Frances H. 
Published: June 2007

Until the fourth decade of this century, British and American patients who could afford physician services paid for them out of their own pockets; those who could not relied on charity care or simply went without. Doctors functioned as independent contractor private practitioners in both Great Britain and the United States, allocating medical services in response to paying-patient demand — and their own consciences.Beginning in the 1930s, health care financing on both sides of the Atlantic was restructured in dramatically different directions, and physicians’ allocational roles in their respective countries began diverging. Under the National Health Service (NHS), British general practitioners became essentially gatekeepers to health services, funneling patients to appropriate hospital and specialist care. As time went by they came more to resemble lockkeepers, regulating the queue for secondary and tertiary treatment resulting from governmental limits on health care spending — and from the limitations and inefficiencies of a system of rationing by waiting. In the U.S., on the other hand, efficiency was not at first a concern.
My Annotated Living Will
Authors: Cantor Norman L. 
Published: June 2007

Both courts and legislatures have gone a long way toward recognizing individual autonomy to shape the extent of medical intervention in the face of a naturally occurring dying process. This autonomy extends beyond the patient's period of capacity to make decisions on his or her own behalf. That is, a person, while still competent, can express treatment preferences, and those preferences will generally be honored after competence to make medical determinations has been lost. This is the message flowing from judicial emphasis on “substituted judgment” as an important guide in the medical handling of incompetent patients, and from the multitude of “natural death” or “living will” statutes adopted over the last 12 years.These statutes prescribe a format for a person to issue instructions about medical treatment or non-treatment to be followed if the person becomes incompetent. Such prior instructions designed to guide future medical decisions can be somewhat problematical. If the instructions are not issued proximately to the moment of their utilization, there may be concern that the issuer's preferences have changed over time.
The Process of Dying with and without Feeding and Fluids by Tube
Authors: Schmitz Phyllis 
Published: June 2007

The process of dying, ultimately, is an experience that will be common to us all. Considering the current trends in health care, I would guess that most of us give more than a passing thought to how that final phase of life will be played out on a personal level. Undoubtedly, that image is shaped by our attitudes and experiences. In addition each of us recognizes that we have had or are likely to have an impact on the dying in our role as family or friend, health care provider or interpreter of the legal or ethical issues. As a member of a hospice team, I have personally cared for hundreds of terminally ill patients, and based on these experiences, I present the following observations regarding the process of dying, with and without feeding and fluid by tube.J.R. was a successful business executive until AIDS intervened; within an eight month period, he was forced to give up both his position and independence because of severe peripheral neuropathy which left him minimally functional and in constant pain.
Does Legislating Hospital Ethics Committees Make a Difference? A Study of Hospital Ethics Committees in Maryland, the District of Columbia, and Virginia
Authors: Hoffmann Diane E. 
Published: June 2007

Nationally, the number of hospital ethics committees grew dramatically during the 1980s. The motivation for establishing such committees, however, was not only internal but included court cases, federal regulations and a Presidential Commission report urging the establishment of such committees by hospitals.While each of these external forces added to the pressures for hospitals to establish their own ethics committees, the establishment of these committees was voluntary in every state until 1987 when the Maryland Patient Care Advisory Committee Act became effective. The Act requires all hospitals within Maryland to establish their own patient care advisory committees or ethics committees, as most hospitals refer to them. Specifically, the Act provides that at the request of a petitioner, these committees must offer advice in cases involving individuals with life-threatening conditions. The committee must consist of at least four members, including a physician, a nurse, a social worker, and a hospital's chief executive officer or designee.
Epidemiology and Ethics
Authors: Last John M. 
Published: June 2007

Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.Several terms used in this definition require discussion. “Study” encompasses (a) observations in public health practice, e.g. to investigate outbreaks of food poisoning, identify the source of an epidemic, trace contacts of sexually transmitted diseases; (b) hypothesis-testing observational studies using cross-sectional, cohort and casecontrol methods; and (c) experiments such as randomized controlled trials, in which there is intervention as well as observation, usually with the aim of evaluating a preventive, diagnostic or therapeutic regimen or procedure. “Distribution” refers to time sequences, places of occurrence, and persons affected. “Determinants” are all the physical, biological and behavioral factors that can influence health. “Health-related states or events” include diseases, injuries, deaths, behaviors such as tobacco addiction, and reactions to preventive, diagnostic or therapeutic regimens or procedures.
Children in HIV/AIDS Clinical Trials: Still Vulnerable after All These Years
Authors: Levine Carol 
Published: June 2007

“All things considered, I chose what was best for my children, or what I thought was best…” confessed Jean- Jacques Rousseau in 1782. What more can one expect from a parent or a professional entrusted with decisions about children? What Rousseau thought was “best” for each of his five infants, however, was to dispatch them to foundling homes in Paris, without even keeping a record of their birthdates, thus leaving them to an unknown but probably dismal fate.Acting from moral and often legal obligations to protect vulnerable persons from harm and to enhance their welfare, adults daily make decisions about and for children. Professionals and policy makers fulfill their social responsibilities by creating and implementing policies and practices that enable children's caregivers to fulfill these same goals.
Some Ethical Costs of Rationing
Authors: Menzel Paul T. 
Published: June 2007

The escalating cost of health care has forced people to confront the possibility of rationing—forgoing beneficial care for patients so that the resources might be used either for other current or prospective patients or for entirely different things in life than health care. Rationing of some sort makes eminent sense, not just economically; only those who are fanatics about health and medicine would urge that everything possible be spent on health care for even the slightest marginal benefit. Yet actual rationing of health care is usually thought to exact high, or at least disturbing, ethical costs.I will examine four of these costs here: (1) the sacrifice of physician loyalty to patients, (2) the substitution of misleading and discriminatory numerical measurements of medicine's human benefit for more sensitive qualitative judgments, (3) the unfair bite that rationing is likely to take first out of poor people's care before it affects wealthier patients, and (4) the general Substitution of public, group standards about life and health for the values and decisions of individuals.
Ethical Dilemmas in HIV Infection: What Have We Learned?
Authors: Lo Bernard 
Published: June 2007

The acquired immunodeficiency syndrome (AIDS) has raised perplexing ethical and public policy dilemmas. Early in the epidemic, closing of bathhouses, testing blood donors for human immunodeficiency virus (HIV) infection, and notifying seropositive blood donors evoked passionate controversies. Current dilemmas include testing and using promising new treatments, notifying partners of seropositive persons, and, most recently, restricting the clinical activities of seropositive health,care workers who perform invasive procedures.These dilemmas about HIV infection involve scientific judgments, cultural norms, and social values. In the HIV epidemic, public rhetoric and political pressure have been prominent. On the one hand, some persons have launched moralistic crusades against homosexuals and injection drug users. For these persons, AIDS symbolizes the breakdown of traditional family values and the social order. On the other hand, some advocates for persons with HIV infection have used confrontational tactics such as sit-ins and disruptive demonstrations.
Special Ethical Issues in the Management of PVS Patients
Authors: Brody Baruch 
Published: June 2007

The patient in a persistent vegetative state (hereafter, the PVS patient) has played a central role in recent American bioethical discussions and in recent litigation involving bioethical issues. From Quinlan’ to Cruzan and Wanglie, some of the most important cases involving ethical issues at the end of life have involved PVS patients. Major American medical groups such as the AMA and the American Academy of Neurology have adopted important policy statements on the care of such patients, statements that have been followed by at least one European group.I have always found this activity a bit of a mystery. There is, after all, a relatively clear consensus about decision-making at the end of life, a consensus embodied in such documents as a report from the President's Commission and a report from the Hastings Center.