International Library of Ethics, Law, and the New Medicine – serie

This book arises from a two-fold conviction. The first is that autonomy, despite recent critiques about its importance in bioethics and philosophy of medicine, and the traditional resistance of medicine to its "intrusion" into the doctor-patient relation, is a fundamental building block of an individual's identity and mechanisms for dealing with illness, disease, and incapacity. As such it is an essential component in the health care professional's armamentarium employed to bring about healing. Furthennore, it functions in a similar way to assist the health professional in his or her relations to the sick and injured. The second conviction follows from the fITst. Autonomy is far more complex than appears from the philosophical use of the concept. In this conviction we join those who have criticized the over-reliance on autonomy in modem, secular bioethics originating in the United States, but gaining ascendancy in other cultures. This critique relies on appeals to the richer contexts of persons' lives. Elsewhere the contemporary critique of autonomy appears in a variety of alternative ethical models like narrative ethics, casuist ethics, and contextualism. Indeed, postmodern criticism of all bioethics argues that there is no defensible foundation for claims that one ought to respect autonomy or any other principle as a way of ensuring that one is ethical.

In industrialized countries, HIV/AIDS is now increasingly perceived as a chronic condition. Yet initially, before combination therapy became available, this pandemic was widely associated with premature or even imminent death. Receiving the diagnosis typically led to a dramatic biographical disruption. This highly original book turns this basic feature of life with HIV into the vantage point for a fascinating analysis of Western subjectivity. Combining a host of empirical observations with the debate on the modern self, the author argues that the self-construction of people with HIV highlights the precarious yet indispensable status of the self in contemporary Western society. Constructing one's biography in terms of self-actualization is in fact a manifestation of nihilism: it evokes a standard of certainty which, on closer examination, cannot be sustained. Written in a lucid style, this unique book will appeal to scholars and students in the fields of sociology, social psychology, social anthropology, social theory and philosophy, as well as anybody interested in the relationship between the self and society or the experience of living with HIV/AIDS.

Preventive Medicine between Obligation and Aspiration is a study of ethical questions regarding mass screening, vaccination, and health policy programmes. These interventions aim to enhance public health but may also constrain personal autonomy and cause harm, and influence our moral views. So far, these issues have hardly been subject to systematic ethical analysis. This study aims to fill this gap by providing an overview of moral problems in preventive medicine and by explicating norms for good practice. Throughout the book it is argued that some moral concerns about prevention - namely concerns about medicalization - cannot be adequately grasped in terms of strict and binding moral norms. Various moral concepts and types of norms `beyond obligation' are explored and developed in order to give practical meaning to these rather vague concerns. In this way the book contributes to applied ethics as well as to ethical theory. It is of interest to professionals in public health and preventive medicine and to scholars in applied ethics and moral philosophy.

Ethics and Law in Modern Medicine is a unique book that explores the field of medical ethics and health care decision-making through hypothetical case studies. The truly unique feature of this volume is that each chapter sets forth a hypothetical fact pattern which includes role assignments to encourage participants to actively take part in group discussions and debate the controversial and cutting-edge topics that are presented. Each chapter includes in-depth discussion questions which thoroughly explore issues raised by the hypothetical fact patterns, and suggested readings provide background for participants. Additionally, the volume contains excerpts from key statutes and case law which govern the decision-making process presented in each chapter. The volume covers a wide variety of issues including HIV, the health care rights of minors, consent and confidentiality, assisted reproductive technology, property rights in bodily organs, research ethics, religious freedom and the right to refuse care, rationing of scarce resources, surrogate decision-making, and several other traditional as well as unique ethical, legal, and social issues.

PERSONHOOD AND HEALTH CARE This book arose as a result of a pre-conference devoted to the topic held June 28, 1999 in Paris, France. The pre-conference preceded the Annual Congress of the International Academy ofLaw and Mental Health. Other chapters were solicited after the conference in order to more completely explore the relation of personhood to health care. The pre­ conference was held in honor of Yves Pelicier who led so many of our French colleagues in medicine, philosophy, and ethics as Christian Herve notes in his Tribute. As health care is aimed at healing persons, it is important to realize how difficult it is to construct a theory of personhood for health care, and thus, a theory of how healing in health care comes about or ought to occur. The book is divided into four parts, Concepts of the Person, Theories of Personhood in Relation to Health Care and Bioethics, Person and Identity, and Personhood and Hs Relations. Each section explores a critical arena in constructing the relation of personhood to health care. Although no exploration ofthis nature can be exhaustive, every effort was made to present both conflicting and complementary views of personhood from within similar and different philosophical and religious traditions. PART ONE: CONCEPTS OF THE PERSON Tracing the origins of the concept of person from antiquity through present day, Jean Delemeau provides an historical sketch of the development of a wide range of meanings.

In this book, developed by a group of collaborating scholars in bioethics from different European countries, an overview is given of the most salient themes in present-day bioethics. The themes are discussed in order to enable the reader to have an in-depth overview of the state of the art in bioethics. Introductory chapters will guide the reader through the relevant dimensions of a particular area, while subsequent case discussions will help the reader to apply the ethical theories to specific clinical problems and health policy queries. The book focuses on perspectives typical for the European context. This highlights not only particular bioethical themes such as social justice, choices in health care, and health policy (e.g., in post-communist countries), it also emphasizes specific approaches in ethical theory, in relation to Continental philosophies such as phenomenology and hermeneutics. Because of its articulation of what is typical for the European health care setting as well as for bioethical debate, this book is unique in comparison to existing textbooks in bioethics. The book is an introductory textbook acquainting the reader with the major issues in present-day health care as well as the various theoretical and practical approaches to clarify these issues.

Mental health issues are a growing concern in our modern Western society. This is part of an increasing interest in questions about health, quality of life, personal development, and self-fulfilment. However, most of what has been written so far has had its focus on mental illness or disease, the negative side of the coin, and few attempts have been made to discuss more thoroughly, from a philosophical perspective, what it is to be mentally healthy. The present book is such an attempt. The author's aim is to analyze, philosophically, the notion of `positive mental health'. In so doing a number of ideas found in the literature are presented and discussed. The author also raises some important methodological questions. The final result of the analysis is a formal and a material reconstruction of the concept of "positive mental health". The book will be of value to all professionals within the health care sector, in particular to psychiatrists, clinical psychologists, and psychotherapists. It will also be of interest to philosophers and social scientists working with health questions.

Demographic studies foreshadow a dramatic increase in the proportion of "older" members of our global population. The task of allocating public and private resources to accommodate present and future generations is a daunting challenge for all nations. Not surprisingly, planning for the health of an ageing society raises profound issues in law, ethics, and public policy. "Culture, Health, and Social Change" is the first of three volumes on aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "ageing" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of ageing is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.

Positive conceptions of "healthy aging" are rightly displacing negative ageist perceptions of older members of our society. Nevertheless, at some stage, most elderly citizens will require some form of assistance from other members of society. When, through the natural course of aging or due to illness or injury, the body or mind begins to fail, a legitimate need for intervention - and care - will arise. In such cases, the aging process can indeed lead one down the path toward vulnerability, or at the very least, reliance on some form of support. Scholars from a range of disciplines address some of the major issues in elder care facing modern nations: familial duties of care, the future of social welfare systems, housing, dementia, abuse and neglect.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

Culture, Health, and Social Change is the first of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "aging" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of aging is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.

For decades, health professionals have asserted the importance of public participation in interventions for health. Medicine has pursued patient participation in clinical decision-making. In the public health realm, target groups have been asked to assist in the design and implementation of initiatives for health. In practice, however, patients and populations expect health professionals to give advice and - in some cases - to make decisions on their behalf. This implies limits to the ideal of participation. In this innovative work, the author contrasts public and professional understandings of health and the best ways to achieve health. The result is a model of lay participation in the structuring of medical and public health activity. The book is unique due to its policy-applicable, quantitative studies and its theoretical analysis of works by René Dubos and Aaron Antonovsky. It will be of value to professionals in health promotion, health education, medical anthropology, and social epidemiology.

This is a contribution to the much-debated area of the value that we should place on human life. With the euthanasia issue highlighted in the public arena this book argues for a non-absolutist highest value on life ethic and explores how that fits with society's emphasis on individual autonomy. Not only are the arguments for and against placing a highest value on life explored but the way of arguing particularly the use of slippery slopes is discussed. By the use of everyday examples, the impact of placing a high value on life is explored. A futuristic intensive care ward round illustrates the ethical and resource issues with which we would be challenged in adopting a highest value on life policy for medical decisions.

In the mid-1990s, new treatment options opened a new era of AIDS. This book is a study of the shaping of this new era. Well informed by ethnographic as well as statistical data it reveals the complex and ambiguous processes of change in the field of HIV/AIDS and beyond. The main trail of the investigation leads to the changing conceptions of disease and body, moves to the re-defined roles of patients and physicians, and eventually engages with the wide-ranging shifts the production and diffusion of knowledge that the health care system underwent. In doing so, the book captures the new era of AIDS from multiple perspectives and through the voices of physicians as well as people with HIV, and it offers an accessible and engaging account of the wide-ranging responses it caused. As an original and timely contribution to questions of considerable currency in medicine and the social sciences, the book meets the interests of specialists, professionals, researchers and students alike.

whether the patient is suffering? Should the ability to think and reason be considered as the most important factor? For instance, should a patient with Amyotrophic lateral sclerosis (ALS) who is mentally alert yet unable to move from the neck down be allowed to refuse medical treatment; and, if so, at what point in her treatment should one consider her life no longer worth living? Is there a difference between not inserting a respirator into a patient who is unable to breathe and not inserting a feeding tube into a patient who is unable to eat? In other words, where does one draw the line between a life worth living and one that is beyond hope, and what criteria should be used? Several of my cases address this issue. 2. What are the religious influences that affect the decision-making process? Israelis all seem to agree that they are a “Jewish state” and that their Jewishness is extremely important to their collective identity; however, they have a difficult time defining what this means. There is a great deal of ambivalence, especially among the less religious, as to what role religion should be allowed to play in their lives. Many resent the control that the religious have over their lives; yet, they also feel that it is beneficial and should play some role in affecting the morals of the country.

Public Health Policy and Ethics brings together philosophers and practitioners to address the foundations and principles upon which public health policy may be advanced. What is the basis that justifies public health in the first place? Why should individuals be disadvantaged for the sake of the group? How do policy concerns and clinical practice work together and work against each other? Can the boundaries of public health be extended to include social ills that are amenable to group-dynamic solutions? These are some of the crucial questions that form the core of this volume of original essays sure to cause practitioners to engage in a critical re-evaluation of the role of ethics in public health policy. This volume is unique because of its philosophical approach. It develops a theoretical basis for public health and then examines cutting-edge issues of practice that include social and political issues of public health. In this way the book extends the usual purview of public health. Public Health Policy and Ethics is of interest to those working in public health policy, ethics and social philosophy. It may be used as a textbook for courses on public health policy and ethics, medical ethics, social philosophy and applied or public philosophy.

Public Health Policy and Ethics brings together philosophers and practitioners to address the foundations and principles upon which public health policy may be advanced. What is the basis that justifies public health in the first place? Why should individuals be disadvantaged for the sake of the group? How do policy concerns and clinical practice work together and work against each other? Can the boundaries of public health be extended to include social ills that are amenable to group-dynamic solutions? These are some of the crucial questions that form the core of this volume of original essays sure to cause practitioners to engage in a critical re-evaluation of the role of ethics in public health policy. This volume is unique because of its philosophical approach. It develops a theoretical basis for public health and then examines cutting-edge issues of practice that include social and political issues of public health. In this way the book extends the usual purview of public health. Public Health Policy and Ethics is of interest to those working in public health policy, ethics and social philosophy. It may be used as a textbook for courses on public health policy and ethics, medical ethics, social philosophy and applied or public philosophy.

The morality of capital punishment has been debated for a long time. This however has 1 not resulted in the settlement of the question either way. Philosophers are still divided. In this work I am not addressing the morality of capital punishment per se. My question is different but related. It is this. Whether or not capital punishment is morally right, is it moral or immoral for medical doctors to be involved in the practice? To deal with this question I start off in Chapter One delineating the sort of involvement the medical associations consider to be morally problematic for medical doctors in capital punishment. They make a distinction between what they call 2 “medicalisation” of and “involvement” in capital punishment, and argue that there is a moral distinction between the two. Whilst it is morally acceptable for doctors to be “involved” in capital punishment, according to the medical associations, it is immoral to medicalise the practice. I clarify this position and show what moral issues arise. I then suggest that there should not be a distinction between the two. The medical associations argue that the medicalisation of capital punishment, especially the use by medical doctors of lethal injection to execute condemned prisoners is immoral and therefore should be prohibited, because it involves doctors in doing what is against the aims of medicine.

Dorothy Wertz and John Fletcher pioneered the first international study of ethical and social issues in genetics in 18 nations. This book reports and discusses their second and more representative study in 36 nations. The survey focused on actual situations that occur in the practice of medical genetics, presented as case vignettes that can also be used in teaching and policy discussion. Among the issues discussed are privacy, prenatal diagnosis, patient autonomy, directiveness in counseling, sex selection, forensic DNA banking, "genetic discrimination," and "eugenics". This is Dorothy Wertz's final book, as she died in April, 2003. It is a one of a kind cross-cultural study of complex ethical issues in the uses of genetic information. No one else has attempted to look at the international aspects of medical genetics on such a broad scale. The results provide a resource for discussion both within and among nations. Much bioethical and policy discussion now occurs in an information vacuum. The survey showed that what people would do, and their reasons for doing it, differed considerably from what ethicists think they "should" do. Many will be surprised at the results, especially in nations where bioethical discussion is just beginning. Genetics and Ethics in Global Perspective is of interest to medical geneticists, genetic counselors, social scientists and anthropologists who study cross-cultural issues, bioethicists and bioethics centers and health policy makers.

Public Health Policy and Ethics brings together philosophers and practitioners to address the foundations and principles upon which public health policy may be advanced. What is the basis that justifies public health in the first place? Why should individuals be disadvantaged for the sake of the group? How do policy concerns and clinical practice work together and work against each other? Can the boundaries of public health be extended to include social ills that are amenable to group-dynamic solutions? These are some of the crucial questions that form the core of this volume of original essays sure to cause practitioners to engage in a critical re-evaluation of the role of ethics in public health policy. This volume is unique because of its philosophical approach. It develops a theoretical basis for public health and then examines cutting-edge issues of practice that include social and political issues of public health. In this way the book extends the usual purview of public health. Public Health Policy and Ethics is of interest to those working in public health policy, ethics and social philosophy.It may be used as a textbook for courses on public health policy and ethics, medical ethics, social philosophy and applied or public philosophy.

The Dutch experience has influenced the debate on euthanasia and death with dignity around the globe, especially with regard to whether physician-assisted suicide and euthanasia should be legitimized or legalized. A review of the literature reveals complex and often contradictory views about the Dutch experience. Some claim that the Netherlands offers a model for the world to follow; others believe that the Netherlands represents danger, rather than promise, and that the Dutch experience is the definitive answer regarding why we should not make active euthanasia and physician-assisted suicide part of our lives. Given these contradictory views, it has become clear that fieldwork is essential to developing a more informed opinion. Having investigated the Dutch experience for a number of years, and after thoroughly reading the vast literature published in English, I went to the Netherlands for one month in the summer of 1999 to get a feel for the local situation. I felt that this would provide the basis on which I could better interpret the findings of the available literature. I visited the major centers of medical ethics, as well as some research hospitals, and spoke with leading figures in the euthanasia policy and practice. The time spent was extremely beneficial and enriching. I followed in the footsteps of Carlos Gomez, who 1 published a book following one month of extensive research in the Netherlands.

Moral capacity is an important feature of what it means to be human. In this volume, the contributors have taken on the daunting task of trying to distinguish between legal and moral capacity. This distinction is difficult at times for clinicians, philosophers and legal scholars alike. Part of the challenge of defining moral capacity lies in the difficulty of adequately categorizing it. For this reason, the editors have chosen to divide the book into three parts. The first looks at the concepts involved in the discussion of moral capacity; the second considers the role of moral capacity in the lives of professionals; and the final part reflects on case studies of moral capacity or incapacity illustrating the challenge that moral capacity presents - its definition lying between two seemingly incommensurable models, those of the threshold and continuum. This volume takes a multidisciplinary approach to the subject, and ties the disciplines of medicine, philosophy and law into the health context. It will be of interest to medical health professionals as well as researchers working in the areas of philosophy and law.

Having been originally introduced as a term to facilitate discussion of a specific group of patients regarded as entering a state of unawareness following coma, the ‘Persistent Vegetative State’ (PVS) has established itself as an apparently discrete medical condition with clear-cut implications for ethicists and lawyers that exceed any scientifically based understanding. As a consequence of this upgrading, conclusions drawn about the status and hence the management of this uncommon condition have been increasingly extended to other patients with much more common forms of disability.This book traces the origins of prevailing perceptions about PVS and submits these to critical examination. In doing this it comes to the conclusion that inadequate attention has been paid to acknowledging what is not known about affected individuals and that assumptions have consistently come to be traded as facts. Re-examination of the basis of the PVS and the adoption of a more scientific approach is long overdue and is owed to the community at large which has generally been provided by many medical practitioners with a ‘dumbed-down’ account of the condition.The book will be of interest to philosophers, medical graduates and neuroscientists but is also intended to remain accessible to the general reader with an interest in the wider implications of trends in medical thinking for attitudes towards many classes of patient. It has an extensive bibliography and will be of specific interest to bioethicists and lawyers with professional interests in PVS.

What happens when two systems, law and medicine, are joined in the arena of the court? This work deals with the structure and the premises of two diverse discourse models; the approach is anthropological.Several chapters are preponderantly based on legal research, addressing cases requiring testimony by expert witnesses on recent technologies used in the laboratories of medical scientists. Descriptions of other societies and cultures consider the identical problems of rights, privileges, and duties, and provide perspectives to cultural self-knowledge.This volume can be used as a text for courses taught in medical schools and law schools. It will be of particular interest to students taking courses in health science, public health, medical anthropology, forensic anthropology, psychology, sociology, public justice, behavioral sciences, forensic psychiatry, legal anthropology, social welfare, as well as courses on research models.

Dorothy Wertz and John Fletcher pioneered the first international study of ethical and social issues in genetics in 18 nations. This book reports and discusses their second and more representative study in 36 nations. The survey focused on actual situations that occur in the practice of medical genetics, presented as case vignettes that can also be used in teaching and policy discussion. Among the issues discussed are privacy, prenatal diagnosis, patient autonomy, directiveness in counseling, sex selection, forensic DNA banking, "genetic discrimination," and "eugenics". This is Dorothy Wertz's final book, as she died in April, 2003. It is a one of a kind cross-cultural study of complex ethical issues in the uses of genetic information. No one else has attempted to look at the international aspects of medical genetics on such a broad scale. The results provide a resource for discussion both within and among nations. Much bioethical and policy discussion now occurs in an information vacuum. The survey showed that what people would do, and their reasons for doing it, differed considerably from what ethicists think they "should" do. Many will be surprised at the results, especially in nations where bioethical discussion is just beginning. Genetics and Ethics in Global Perspective is of interest to medical geneticists, genetic counselors, social scientists and anthropologists who study cross-cultural issues, bioethicists and bioethics centers and health policy makers.

Bioethicists, moral philosophers and social policy analysts have long debated about how we should decide who shall be saved with scarce, lifesaving resources when not all can be saved. It is often claimed that it is fairer to save younger persons and that age is an ethically relevant consideration in such tragic decisions. Medical benefit should be maximized and final selection should aim to minimize the contaminating influence of chance. These claims are challenged by Duff R. Waring in Medical Benefit and the Human Lottery, one of the few books that attempts a sustained defence of random patient selection. This book combines ethics and political philosophy in its novel and strict egalitarian approach to patient selection for transplantable organs. Waring addresses the question of whether we should choose between lives on the basis of fair chances or best outcomes. He argues that final selection criteria should be based on fair chances that equalize opportunity as opposed to best outcomes. His defence of "hardy" egalitarianism aims to show that random selection by lottery can affirm both a common humanity and the equal value of lives. The notion of patient selection by lottery has not fared well in bioethics and has been regarded by some as a moral affront. Waring argues that a human selection lottery may be neither as crude nor as ethically anomalous as some have supposed. Indeed, it can reflect a familiar conception of equality as a political and moral ideal. This conception abstracts from many undeniable differences between patients and claims that scarce resources should be allocated on the principled assumption that each of their lives is equally worth saving. The book is also notable for its critiques of some recent utilitarian notions of medical benefit which can have an age-biased impact on elderly patients. Waring then argues against the leading, contemporary age-based approaches to patient selection. He explores the way randomselection by lottery can affirm his egalitarian ethos in cases where eligible transplant candidates have each passed a threshold level of prospective medical benefit that has been set by democratic deliberation. Taming chance with a human lottery is defended as the most lucid means of ensuring equal opportunity. In so doing, Waring argues that we give the principle of equal concern and respect a radical expression: above a noncomparative threshold of medical benefit, each candidate can have an equal claim to life.

Religion is a dominant force in the lives of many Americans. It animates, challenges, directs and shapes, as well, the legal, political, and scientific agendas of the new Age of Biotechnology. In a very real way, religion, biomedical technology and law are - epistemologically - different. Yet, they are equal vectors of force in defining reality and approaching an understanding of it. Indeed, all three share a synergetic relationship, for they seek to understand and improve the human condition.This book strikes a rich balance between thorough analysis (in the body), anchored in sound references to religion, law and medical scientific analysis, and a strong scholarly direction in the end notes. It presents new insights into the decision-making processes of the new Age of Biotechnology and shows how religion, law and medical science interact in shaping, directing and informing the political processes.This volume will be of interest to both scholars and practitioners in the fields of religion and theology, philosophy, ethics, (family) law, science, medicine, political science and public policy, and gender studies. It will serve as a reference source and can be used in graduate and undergraduate courses in law, medicine and religion.

A theory of Clinical Bioethics based on the integration of the moral logic of health care practice ("internal morality") and the larger social concerns and processes ("external morality")Clinical Bioethics. A Search for the Foundations compares major theoretical models in the foundation of clinical bioethics and explains medicine as a normative practice. The goals of medicine are discussed with particular reference to the subjectivisation of health and the rationalisation of health care institutions. This volume provides a consistent reconstruction of bioethical judgment both at the level of epistemological statute and institutional context, i.e. clinical ethics committees and clinical ethics consultation.

Within contemporary society, globalization has emerged as a key concern at the centre of ethical, legal and policy debates relating to health care. Conflicts between public interests and individual rights, the challenge of regulating health professionals and access to health services, and the effects of a global market all feature prominently in these discussions. As a result of globalization, these issues can no longer be understood solely within the political boundaries that define traditional notions of individuals and communities. Rather, solutions demand a global conception of rights and obligations, which in turn requires new approaches to health policy formulation and a reevaluation of existing ethical and legal frameworks. In essence, the impact of globalization on human health is testing the robustness of modern regulatory systems, legal doctrines and ethical paradigms. PUBLIC HEALTH: DEVELOPING GLOBAL CONCERNS The interconnectedness of the global economy presents new challenges in public health. While globalization has facilitated improvements in health care, it has also created new hazards and avenues for the exploitation of vulnerable persons. It is becoming increasingly apparent that both national and international responses are required. Indeed, as the chapters in this section convey, public health is rightly a global concern. Globalization has led to a sharing of both risks and responsibilities in public health. Belinda Bennett reminds us of the ease with which infectious diseases can spread within the global community, given the speed of modern travel and trade.