bluuebunny/crossref_metadata_2025_split huggingface dataset:
AIDS-Related Legislation in the Context of the Third AIDS Pandemic
Authors: Jayasuriya D. C. 
Published: June 2007

The first AIDS-related legislation was enacted in 1983. By this time, policy-makers as well as legislators in several countries had set in motion the process of formulating legislative measures to deal with a new and critical problem about which very little was known. This process gathered momentum over the years, partly as a response to the recognition that the problem of discrimination against AIDS patients and persons with HIV infection, which first began with homosexuals and persons of Haitian and African origin, will assume more critical dimensions with devastating social, economic, political and cultural implications and reactions. It is these implications and reactions which have come to be described as the “Third AIDS Pandemic:”The third epidemic closely follows the first two, of HIV infection and AIDS. It is the epidemic of economic, social, political and cultural reaction. In the words of Javier Perez de Cuellar,… “AIDS raises crucial social, humanitarian, and legal issues threatening to undermine the fabric of tolerance and understanding upon which our societies function.”
Neocortical Death and Human Death
Authors: Devettere Raymond J. 
Published: June 2007

Proposals to make neocortical death, sometimes called cerebral death, a medical and legal indication of human death are becoming more common. Increased sensitivity to the futility and costs of providing life support for patients long after they could be considered dead guarantees that interest in the proposals will continue for some time. Neocortical death would be an acceptable indication of human death if 1) it is consistent with our concepts of human death, 2) it can be diagnosed with certainty and 3) it is sufficiently understood by the general public to be accepted as public policy.In this paper the phrase “neocortical death” will refer to permanent loss of consciousness due to the irreversible cessation of whatever chemical and biological functions of the brain are needed to support consciousness. By consciousness is meant “the state of awareness of the self and the environment.”
Procedural Paternalism in Competency Determination
Authors: Van McCrary S. , Walman A. Terry 
Published: June 2007

In recent years, the competency of patients to refuse life-sustaining treatment has been widely discussed. Generally, competence has been recognized to be a legal concept, holding that the patient is presumed competent unless a court declares the person incompetent and designates a guardian. It has been noted, however, that clinical medical practice often diverges markedly from this standard. Some authors have suggested that in many cases the implicit medical presumption may be that many persons, particularly the aged, are presumed incompetent to refuse treatment until they demonstrate to their physician's satisfaction that they are competent. This gap between legal theory and medical practice presents numerous difficulties to both legal and medical professionals seeking to accommodate the competing values of patient self-determination and best interests.This paper will present and discuss a case exemplifying a particular problem that can arise in the competency evaluation process.
Abortion Law in England: The Medicalization of a Crime
Authors: Grubb Andrew 
Published: June 2007

Abortion is the most divisive issue in American society today, but that is not unique because the issue troubles many other Western countries as well. Acrimonious debate has ensued in America in the wake of the Supreme Court's latest pronouncement in Webster v. Reproductive Health Services. Anxiety about the future of the law in America has been widely expressed by pro-life and prochoice groups alike. These could well be the visible skirmishes of the abortion battle and the conflict over the existence of a woman's right to choose in almost any Western jurisdiction. Perhaps only the intensity of debate and venue of battle vary.In the wake of Roe v. Wade the American battle fronts have mainly been in the courts. A plethora of cases in both state and federal courts has tested the constitutionality of legislation passed by State legislatures restricting the availability of abortion.
Identifying Appropriate Decision-Makers and Standards for Decision
Authors: Pollock Stewart G. 
Published: June 2007

Judges, like lawyers, love to make disclaimers. So, at the outset, I disclaim any expertise in medicine or bioethics. My views are those of a generalist, a judge who has been required to decide cases involving bioethical questions such as the termination of medical treatment.As Chief Judge Wachtler has explained, the New York Court of Appeals, like the Supreme Court of Missouri in Cruzan, has decided to require clear and convincing evidence before permitting the termination of life-sustaining treatment for an incompetent patient who is not terminally ill. Other courts, including the New Jersey Supreme Court, have reached a different conclusion.It is not my purpose today to persuade you that the position of our court is correct. Instead, I propose to look at the Cruzan case to see what it does and does not tell us about the identity of the decision-maker and the standard for decision-making in the termination-of-medical-treatment cases.
The Authority of Families to Make Medical Decisions for Incompetent Patients after theCruzanDecision
Authors: King Patricia A. 
Published: June 2007

I want to approach this difficult topic not from the professional perspective of a lawyer, but rather as the person I am in multiple relationships: wife, mother, step-mother, daughter, and step-daughter. I would suggest to you that none of us can avoid thinking about the role of families in making decisions for incompetent patients without viewing the questions that arise through lenses created by the roles we play in multiple relationships. I would also suggest to you that none of us can avoid thinking about the possibility of becoming incompetent ourselves without thinking about the relationships we have with our families.My remarks here will be addressed primarily to theCruzandecision, so they will be most obviously applicable to patients in a persistent vegetative state. However, I intend for my reflections to apply to decision-making about all incompetent adult patients.
Issues in Preparing Ethical Guidelines for Epidemiological Studies
Authors: Dickens Bernard M. 
Published: June 2007

The Nuremberg Code of 1947 is often taken to mark the beginning of the modern age of ethical codes for medical and health-related research with human subjects. The 1947 Code was fashioned in response to inhumane medical experimentation revealed at the Nuremberg War Crimes Tribunal. The fact that, prior to 1939, Germany had an ethical code for human research in medicine that appears sensitive and sophisticated even by current standards indicates that codes in themselves do not assure ethical conduct. Nevertheless, calls continue for the preparation of codes of conduct to guide the exercise of ethical judgment in health-related research.Medical research concerned with individual subjects as such now possesses codes or guidelines at many levels, including funding agency, research institutional, national and international levels. The World Medical Association's Helsinki Code is now in its fourth version, and the Guidelines proposed in 1982 by the World Health Organization affiliate, the Council for International Organizations of Medical Sciences (CIOMS) is about to be revised to take account of a decade of significant developments.
Case Studies of Expedited Review: AZT and L-Dopa
Authors: Kaitin Kenneth I. 
Published: June 2007

The HIV epidemic has led to a reassessment of attitudes regarding public access to new therapeutic agents for the treatment of life-threatening and severely debilitating diseases. People with AIDS and their advocates have relentlessly attacked the process by which new drugs are developed and approved for marketing in this country, a process characterized as overly conservative, risk-averse, and paternalistic. In response to growing pressure to accelerate access to important new therapeutic agents, the Food and Drug Administration (FDA) has issued several bold initiatives designed to facilitate the development of experimental drugs used in the treatment of serious or immediately life-threatening diseases.The clinical testing and regulatory review of new therapeutic agents in the United States are lengthy processes. A recent analysis of new chemical entities (NCE) approved by the FDA in 1987,1988, and 1989 has revealed that, on average, the clinical development phase for new drugs exceeds five years (63 months).
Introduction of Abortion Technologies: A Quality of Care Management Approach
Authors: Greenslade Forrest C. , Winkler Judith , Leonard Ann H. 
Published: June 2007

The development of antiprogestins and their use for early legally induced abortion have caused considerable heated debate concerning the appropriateness of this new technology for introduction into health care settings around the world. This debate is obviously complicated by broader issues such as abortion itself, women's rights and reproductive freedom, hormone-related medications, and other controversies. While these issues cannot be completely separated, this paper focuses on the management challenges that surround the introduction of new reproductive health technologies. This problem is central to the availability, accessibility, and applicability of new abortion technologies such as the RU 486/Prostaglandin combination.Introduction of new contraceptive and abortion technologies has yielded important lessons that can guide decision-making regarding RU 486/Prostaglandin. Specifically, these experiences have highlighted the need to concentrate on quality of care concerns in introducing technologies, to ensure new services’ acceptability and, thereby, their effectiveness.
Futility: A Concept in Search of a Definition
Authors: Cranford Ronald , Gostin Lawrence 
Published: June 2007

In the landmark case of Crzan v. Director, Missouri Department of Health; the United States Supreme Court went out of its way to emphasize that the state was paying for Nancy Cruzan's care. The court refused to allow removal of the artificial nutrition and hydration that was maintaining Nancy Cruzan in a persistent vegetative state (PVS). What if, instead of the state's paying for the care, the parents had to “spend down” in order to be eligible for Medicaid? Could the state opt for life and require the family to pay for the care? If not, do constitutional rights depend on who can or will pay the cost of care?Now turn the facts of Cruzan around and assume that the parents want to keep the child alive. Could the parents force the state to bear the cost of keeping a PVS patient alive indefinitely? If not, why should the state, but not the parents, have a constitutional right to preserve life? Do constitutional rights boil down to dollars?
Required Reconsideration of “Do-Not-Resuscitate” Orders in the Operating Room and Certain other Treatment Settings
Authors: Cohen Cynthia B. , Cohen Peter J. 
Published: June 2007

Incoming patients across the country, as a requirement of the Patient Self-Determination Act,’ are met on the threshold of hospitals and informed of their right to accept or refuse treatment. They are also offered information about formulating advance directives to govern the use of lifesustaining treatment should they lose decision-making capacity. It is generally assumed that instructional directives covering specific treatment interventions must be followed in every setting within the hospital.’ This assumption is reinforced by the requirements of the Patient Self-Determination Act, since options accepted by patients at the portals of a health care institution are likely to be perceived as in force throughout the facility.The “Do-Not-Resuscitate” (DNR) order is a specific directive mandating that cardiopulmonary resuscitation (CPR), a dramatic intervention that can restore breathing and heartbeat to patients who have experienced cardiac arrest, should not be performed on patients. Patients or their surrogates who agree to the entry of DNR orders into their medical records usually do so because they believe CPR would be useless or disproportionately burdensome.
How Physicians Talk about Futility: Making Words Mean Too Many Things
Authors: Solomon Mildred Z. 
Published: June 2007

“There's glory for you!”“I don't know what you mean by ‘glory,’ ” Alice said.Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’”“But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected.“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said Humpty Dumpty, “which is to be master, that's all.”When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn?
Thoughts on the Law and the Public's Health
Authors: Burris Scott 
Published: June 2007

One understanding of health conceives of it as a state of freedom from pathology, achieved by an individual, through the mediation of a doctor. On this view, improvements in health flow from the application of science to specific ills of the body, and access to medical care is the chief determinant of health. This “medicalized” view of health underlies the current debate over medical care payment reform. This is the dominant way of talking about health.An alternative is the view of health commonly associated with the practice of public health. On this view, health is an attribute of communities in social and physical environments. Health takes its shape in large numbers—in morbidity and mortality statistics—and, ideally, includes not just a high level of well-being for some, but also its even distribution throughout a society. Improvements in health are seen to arise from healthful changes in the environment.
Commentary: A Call for Authoritative CDC Guidelines for HIV-Infected Health Care Workers
Authors: Hermann Donald H. J. 
Published: June 2007

Recent court decisions imposing liability on physicians who fail to inform patients that they carry the human immunodeficiency virus (HIV) before performing invasive procedures create an urgent need for the Centers for Disease Control and Prevention (formerly the Centers for Disease Control) to reopen the issuance of guidelines and to address authoritatively the question of the appropriate limits within which HIV-infected health care providers can treat patients.Public fear of HIV-infected physicians (polls show 80 to 90 percent of patients surveyed want to know if their physicians are HIV-infected) were kindled by reports, beginning in 1990, that Dr. David Acer, an HIV-infected dentist, had infected a number of his patients. However, great skepticism has arisen as to whether Dr. Acer’s patients were infected as a result of procedures conducted in accordance with universal precautions against transmission. Moreover, look back studies have failed to identify even one patient, among the thousands who have undergone procedures administered by HIV-infected physicians, who contracted the virus directly from his/her physician.
Sentinel Effect of Drug Testing for Anabolic Steroid Abuse
Authors: Fuentes Robert J. , Davis Art , Sample Barry , Jasper Kim 
Published: June 2007

George Will, the well-known pundit, once observed: “A society's recreation is charged with moral significance. Sport—and a society that takes it seriously—would be debased if it did not strictly forbid things that blur the distinction between the triumph of character and the triumph of chemistry.” In opposition, Dan Duchaine, the highly publicized “steroid guru” and counter-culture columnist, declared: “There comes a time for many in competitive athletics where winning is more important than those initial goals of health, recreation, and relaxation.” Theparallels of these twophilosophies to life in general are patent simply by substituting “sports” and “winning” for “career” and “success,” respectively.This paper will review the basis for banning anabolic steroids in athletics, and consider especially the recent medical findings that support this prohibition. This survey leads into a discussion of the available deterrents, and the secondary, but essential, role of random drug testing as a final safeguard.
Critical Interests and Sources of Familial Decision-Making Authority for Incapacitated Patients
Authors: Nelson James Lindemann 
Published: June 2007

How ought we to understand the sources and limits of the authority of family members to make health care decisions for their decisionally incapacitated relatives? This question is becoming increasingly crucial as the population ages and the power of medical technology waxes. It is also becoming increasingly contested, as faith in advance directives shows signs of waning, and the moral complexities of intimate relationship become more theoretically patent.This last point—the newly visible moral richness of intimate relationship—provides this paper with its field. I am interested in probing the images of the relationship between self and other, particularly self and intimate other, that seem presupposed by some leading attempts to determine the basis for proxy decision-making authority, and what constraints it must observe. In the light of both recent work in the philosophy of mind and considerations closer to common experience, the reigning images seem too slight to support the weight of current practices and beliefs about proxy authority; supplanting them with images more faithful to our experience will have implications for our practice with proxies.
Should We Hold the (Germ) Line?
Authors: Parens Erik 
Published: June 2007

In 1982, the President's Commission produced its report on human gene therapy. One of that report's recommendations was to expand the Recombinant DNA Advisory Committee (RAC) to the National Institutes of Health to include a subcommittee on human gene therapy. In 1984, the Human Gene Therapy Subcommittee was established, and in 1989 it produced a document—“Points to Consider for Protocols for the Transfer of Recombinant DNA into Human Subjects”—that stated the RAC's position on what sorts of protocols it would approve.In assessing the impact of the President's Commission report, Alexander Capron wrote,[t]he line [the report] drew between somatic cell and germ-line therapies has shaped subsequent discussions and policy formulation. Its conclusion … that somatic cell therapy resembles medical treatment is the basic premise of the RAC subcommittee's “Points to Consider,” while the Commission's view that ethical as well as technical barriers preclude present attempts to alter germ cells continues to be generally accepted by scientists and nonscientists alike.
Ethically Important Distinctions among Managed Care Organizations
Authors: Christensen Kate T. 
Published: June 2007

Due to society's need to control health care costs and to the failure of legislated health care reform, managed care is expanding at a rapid rate and will soon be the predominate form of health care delivery. Plans by Congress to bring Medicare and Medicaid under managed care will further consolidate this trend. Barring some legislative fiat, managed care is here to stay.The termmanaged caredescribes a diverse set of organizational forms. Wide variations in approach, financing, physician involvement, and philosophy exist among the different types of managed care organizations (MCOs). While many articles on the ethics of managed care acknowledge this variety, most analyses focus on the for-profit entities, paying less attention to the ethical distinctions among the different forms of managed care. This paper discusses the key distinctions among MCO types, in particular the difference between for-profit and non-profit plans; the relationship of the physician to the MCO; the incentives used to control costs; the incentives that improve patient care; and the organizational features that nurture the principled practice of medicine.
Ethics Consultation: Persistent Brain Death and Religion: Must a Person Believe in Death to Die?
Authors: Spike Jeffrey , Greenlaw Jane 
Published: June 2007

We first heard about this case from nurses in one of our intensive care units (ICUs) while we were conducting an inservice. When the session was over, we discussed it between ourselves, and decided that it must have been misrepresented. The case had been presented as one of a teenager who was brain dead, had been so for six months, yet had been brought into the ICU for treatment. We have run into this before, we thought: medical professionals confusing brain death with persistent vegetative state (PVS). But, of course, we reasoned, no one can be brain dead for six months. To us, as it would to many, the case sounded like a clinical and ethical impossibility.A week later, we were called by an attending physician from another ICU, at the urging of that unit's nursing staff. They had a patient who was brain dead, whose presence was causing distress among the staff. Ronald Chamberlain, a fifteen-year-old boy, had been a patient at a nearby longterm rehabilitation facility that is equipped to care for ventilator-dependent patients.
Nevada Court Clarifies Recovery in Wrongful Birth Claim
Authors: Gralton Sean H. 
Published: June 2007

On March 30, 1995, the Supreme Court of Nevada, in Greco v. United States, determined that medical professionals who fail to make a timely diagnosis of gross and disabling fetal defects, thereby denying a pregnant woman her right to terminate a pregnancy, had acted negligently, and a malpractice claim could be brought against them. The court supported the plaintiff's claim of “wrongful birth,” but determined that the disabled child born to the plaintiff has no personal cause of action for “wrongful life.”Sundi Greco, the plaintiff, alleged that her doctors at Nellis Air Force Base in Nevada failed to make a timely diagnosis of her son's physical defects and abnormalities before his birth. Their negligence denied her the opportunity to terminate her pregnancy, causing her damages attendant to the avoidable birth of a child with birth defects. On her child's behalf, Greco asserted that the physicians' negligence, and resultant denial of his mother's right to terminate the pregnancy, allowed him to be born into a “grossly abnormal life of pain and deprivation.”
Genetic Privacy
Authors: Gostin Lawrence O. 
Published: June 2007

Human genomic information is invested with enormous power in a scientifically motivated society. Genomic information has the capacity to produce a great deal of good for society. It can help identify and understand the etiology and pathophysiology of disease. In so doing, medicine and science can expand the ability to prevent and ameliorate human malady through genetic testing, treatment, and reproductive counseling.Genomic information can just as powerfully serve less beneficent ends. Information can be used to discover deeply personal attributes of an individual's life. That information can be used to invade a person's private sphere, to alter a person's sense of self- and family identity, and to affect adversely opportunities in education, employment, and insurance. Genomic information can also affect families and ethnic groups that share genetic similarities.