Do people of differing ethnicities, cultures, and races view medicine and bioethics differently? And, if they do, should they? Are doctors and researchers taking environmental perspectives into account when dealing with patients? If so, is it done effectively and properly?
In African American Bioethics, Lawrence J. Prograis Jr. and Edmund D. Pellegrino bring together medical practitioners, researchers, and theorists to assess one fundamental question: Is there a distinctive African American bioethics?
The book's contributors resoundingly answer yes—yet their responses vary. They discuss the continuing African American experience with bioethics in the context of religion and tradition, work, health, and U.S. society at large—finding enough commonality to craft a deep and compelling case for locating a black bioethical framework within the broader practice, yet recognizing profound nuances within that framework.
As a more recent addition to the study of bioethics, cultural considerations have been playing catch-up for nearly two decades. African American Bioethics does much to advance the field by exploring how medicine and ethics accommodate differing cultural and racial norms, suggesting profound implications for growing minority groups in the United States.
By analyzing the amalgam of Greek philosophy, Jewish and Christian teachings, and secular humanism that composes our dominant ethical system, the authors of this volume explore the question of whether or not Western and non-Western moral values can be commingled without bilateral loss of cultural integrity. They take as their philosophical point of departure the observation that both ethical relativism and ethical absolutism have become morally indefensible in the context of the multicultural American life, and they variously consider the need for an ethical middle ground.
Roman Catholic moral theology is the point of departure for this multifaceted exploration of the challenge of allocating scarce medical resources.
The volume begins its exploration of discerning moral limits to modern high-technology medicine with a consensus statement born of the conversations among its contributors. The seventeen essays use the example of critical care, because it offers one of the few areas in medicine where there are good clinical predictive measures regarding the likelihood of survival. As a result, the health care industry can with increasing accuracy predict the probability of saving lives—and at what cost.
Because critical care involves hard choices in the face of finitude, it invites profound questions about the meaning of life, the nature of a good death, and distributive justice. For those who identify the prize of human life as immortality, the question arises as to how much effort should be invested in marginally postponing death. In a secular culture that presumes that individuals live only once, and briefly, there is an often-unacknowledged moral imperative to employ any means necessary to postpone death. The conflict between the free choice of individuals and various aspirations to equality compounds the challenge of controlling medical costs while also offering high-tech care to those who want its possible benefits. It forces society to confront anew notions of ordinary versus extraordinary, and proportionate versus disproportionate, treatment in a highly technologically structured social context.
This cluster of discussions is enriched by five essays from Jewish, Orthodox Christian, and Protestant perspectives. Written by premier scholars from the United States and abroad, these essays will be valuable reading for students and scholars of bioethics and Christian moral theology.
With the advent of CRISPR gene-editing technology, designer babies have become a reality. Françoise Baylis insists that scientists alone cannot decide the terms of this new era in human evolution. Members of the public, with diverse interests and perspectives, must have a role in determining our future as a species.
During the past few decades, high-profile cases like that of Terry Schiavo have fueled the public debate over forgoing or withdrawing artificial nutrition and hydration from patients in a persistent vegetative state (PVS). These cases, whether involving adults or young children, have forced many to begin thinking in a measured and careful way about the moral legitimacy of allowing patients to die. Can families forgo or withdraw artificial hydration and nutrition from their loved ones when no hope of recovery seems possible?
Many Catholics know that Catholic moral theology has formulated a well-developed and well-reasoned position on this and other end-of-life issues, one that distinguishes between "ordinary" and "extraordinary" treatment. But recent events have caused uncertainty and confusion and even acrimony among the faithful. In his 2004 allocution, Pope John Paul II proposed that artificial nutrition and hydration is a form of basic care, thus suggesting that the provision of such care to patients neurologically incapable of feeding themselves should be considered a moral obligation. The pope's address, which seemed to have offered a new development to decades of Catholic health care ethics, sparked a contentious debate among the faithful over how best to treat permanently unconscious patients within the tenets of Catholic morality.
In this comprehensive and balanced volume, Ronald Hamel and James Walter present twenty-one essays and articles, contributed by physicians, clergy, theologians, and ethicists, to reflect the spectrum of perspectives on the issues that define the Catholic debate. Organized into six parts, each with its own introduction, the essays offer clinical information on PVS and feeding tubes; discussions on the Catholic moral tradition and how it might be changing; ecclesiastical and pastoral statements on forgoing or withdrawing nutrition and hydration; theological and ethical analyses on the issue; commentary on Pope John Paul II's 2004 allocution; and the theological commentary, court decisions, and public policy resulting from the Clarence Herbert and Claire Conroy legal cases.
A valuable resource for students and scholars, this teachable volume invites theological dialogue and ethical discussion on one of the most contested issues in the church today.
Once rarely discussed in medical circles, the relationship between spirituality and health has become an important topic in health care. This change is evidenced in courses on religion and medicine taught in most medical schools, articles in journals such as the New England Journal of Medicine, and conferences being held all over the country. Yet, much of the discussion of the role of religion and spirituality in health care keeps the critical distance of only being about spirituality. A Balm for Gilead goes further, offering a work of spirituality.
Sulmasy moves between the poetic and the speculative, addressing his subject in the tradition of great spiritual writers like Augustine and Bonaventure. He draws from philosophical and theological sources—specifically, Hebrew and Christian scripture—to illuminate how the art of healing is integrally tied to a sense of the divine and our ultimate interconnectedness. Health care professionals—and anyone else involved with the care of the sick and dying—will find this series of meditations both inspiring and instructive.
Sulmasy addresses the spiritual malaise that physicians, nurses, and other health care workers experience in their professional lives, and explores how these Christian healers can be inspired to persevere in the care of the sick. Drawing on the parable of the prodigal son, for instance, Sulmasy illustrates how some physicians have put financial gain ahead of their patients, and how genuine spirituality might change their hearts. He examines both enigmatic topics such as the relationship between sinfulness, sickness, and suffering and the spirituality of more routine topics such as preventive medicine. In one especially stirring and poignant meditation, he reflects on the spirituality of dying in the light of Christian hope.
A Balm for Gilead interweaves prayer and reflection, pointing the way to a twenty-first-century spirituality for health care professionals and their patients.
Although the subject of federally mandated Institutional Review Boards (IRBs) has been extensively debated, we actually do not know much about what takes place when they convene. The story of how IRBs work today is a story about their past as well as their present, and Behind Closed Doors is the first book to meld firsthand observations of IRB meetings with the history of how rules for the treatment of human subjects were formalized in the United States in the decades after World War II.
Drawing on extensive archival sources, Laura Stark reconstructs the daily lives of scientists, lawyers, administrators, and research subjects working—and “warring”—on the campus of the National Institutes of Health, where they first wrote the rules for the treatment of human subjects. Stark argues that the model of group deliberation that gradually crystallized during this period reflected contemporary legal and medical conceptions of what it meant to be human, what political rights human subjects deserved, and which stakeholders were best suited to decide. She then explains how the historical contingencies that shaped rules for the treatment of human subjects in the postwar era guide decision making today—within hospitals, universities, health departments, and other institutions in the United States and across the globe. Meticulously researched and gracefully argued, Behind Closed Doors will be essential reading for sociologists and historians of science and medicine, as well as policy makers and IRB administrators.
Research with human subjects has long been controversial because of the conflicts that often arise between promoting scientific knowledge and protecting the rights and welfare of subjects. Twenty-five years ago the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research addressed these conflicts. The result was the Belmont Report: Ethical Principles and Guidance for Research Involving Human Subjects, a report that identified foundational principles for ethical research with human subjects: respect for persons, beneficence, and justice.
Since the publication of Belmont, these three principles have greatly influenced discussions of research with human subjects. While they are often regarded as the single-most influential set of guidelines for biomedical research and practice in the United States (and other parts of the world), not everyone agrees that they provide adequate guidance. Belmont Revisited brings together a stellar group of scholars in bioethics to revisit the findings of that original report. Their responses constitute a broad overview of the development of the Belmont Report and the extent of its influence, especially on governmental commissions, as well as an assessment of its virtues and shortcomings.
Belmont Revisited looks back to reexamine the creation and influence of the Belmont Report, and also looks forward to the future of research—with a strong call to rethink how institutions and investigators can conduct research more ethically.
In Beyond a Western Bioethics, physicians Angeles Tan Alora and Josephine M. Lumitao join eight other contributors to provide a comprehensive exploration of bioethical issues outside of the dominant American and western European model. Using the Philippines as a case study, they address how a developing country's economy, religion, and culture affect the bioethical landscape for doctors, patients, families, and the society as a whole.
American principles of medical ethics assume the primacy of individual autonomy, the importance of truth-telling, and secular standards of justice and morality. In the Philippines, these standards are often at odds with a culture in which family relationships take precedence over individualism, and ideas of community, friendship, and religion can deeply influence personal behavior. Pervasive poverty further complicates the equation. Contributors move from a general discussion of the moral vision informing health care decisions in the Philippines to an exploration of a wide range of specific cases: family planning, care of the elderly, organ transplants, death and dying, medical research, AIDS care, doctor-patient relationships, informed consent, and the allocation of scarce health-care resources.
Written for both students and professionals, the book provides a much-needed perspective on how medical ethics are practiced in a developing nation, and it successfully challenges the wisdom of global bioethical standards that do not account for local cultural and economic differences.
Bioethics In Social Context
edited by Barry Hoffmaster Temple University Press, 2001 Library of Congress R724.B4826 2001 | Dewey Decimal 174.2
The problems of bioethics are embedded in people's lives and social worlds. They are shaped by individual biographies and relationships, by the ethos and institutions of health care, by economic and political pressures, by media depictions, and by the assumptions, beliefs, and values that permeate cultures and times. Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.
The original essays in this volume use qualitative research methods to expose the multiple contexts within which the problems of bioethics arise, are defined and debated, and ultimately resolved. In a provocative concluding essay, one contributor asks his fellow ethnographers to reflect on the ethical problems of ethnography.
Some of humankind's greatest tools have been forged in the research laboratory. Who could argue that medical advances like antibiotics, blood transfusions, and pacemakers have not improved the quality of people's lives? But with each new technological breakthrough there comes an array of consequences, at once predicted and unpredictable, beneficial and hazardous.
Outcry over recent developments in the reproductive and genetic sciences has revealed deep fissures in society's perception of biotechnical progress. Many are concerned that reckless technological development, driven by consumerist impulses and greedy entrepreneurialism, has the potential to radically shift the human condition—and not for the greater good. Biotechnology and the Human Goodbuilds a case for a stewardship deeply rooted in Judeo-Christian theism to responsibly interpret and assess new technologies in a way that answers this concern.
The authors jointly recognize humans not as autonomous beings but as ones accountable to each other, to the world they live in, and to God. They argue that to question and critique how fields like cybernetics, nanotechnology, and genetics might affect our future is not anti-science, anti-industry, or anti-progress, but rather a way to promote human flourishing, common sense, and good stewardship.
A synthetic work drawing on the thought of a physician, ethicists, and a theologian, Biotechnology and the Human Good reminds us that although technology is a powerful and often awe-inspiring tool, it is what lies in the heart and soul of who wields this tool that truly makes the difference in our world.
Since the 1970s health care costs in the United States have doubled, insurance premiums have far outpaced inflation, and the numbers of the uninsured and underinsured are increasing at an alarming rate. At the same time the public expects better health care and access to the latest treatment technologies. Governments, desperate to contain ballooning costs, often see a market-based approach to health care as the solution; critics of market systems argue that government regulation is necessary to secure accessible care for all.
The Catholic Church generally questions the market's ability to satisfy the many human needs intrinsic to any care delivery system yet, although the Church views health care as a basic human right, it has yet to offer strategies for how such a right can be guaranteed. Mary J. McDonough, a former Legal Aid lawyer for medical cases, understands the advantages and disadvantages of market-based care and offers insight and solutions in Can a Health Care Market Be Moral?
Drawing on Catholic social teachings from St. Augustine to Pope John Paul II, McDonough reviews health system successes and failures from around the world and assesses market approaches to health care as proposed by leading economists such as Milton Friedman, Regina Herzlinger, Mark Pauly, and Alain Enthoven. Balancing aspects of these proposals with Daniel Callahan's value-dimension approach, McDonough offers a Catholic vision of health care in the United States that allows for some market mechanisms while promoting justice and concern for the least advantaged.
Often the switch to telecare—technology used to help caretakers provide treatment to their patients off-site—is portrayed as either a nightmare scenario or a much needed panacea for all our healthcare woes. This widely researched study probes what happens when technologies are used to provide healthcare at a distance. Drawing on ethnographic studies of both patients and nurses involved in telecare, Jeannette Pols demonstrates that instead of resulting in less intensive care for patients, there is instead a staggering rise in the frequency of contact between nursing staff and their patients. Care at a Distance takes the theoretical framework of telecare and provides hard data about these innovative care practices, while producing an accurate portrayal of the pros and cons of telecare.
People do not choose to suffer from catastrophic illnesses, but considerable human choice is involved in the ways in which the participants in the process treat and conduct research on these diseases. Catastrophic Diseases draws a powerful and humane portrait of the patients who suffer from these illnesses as well as of the physician-investigators who treat them, and describes the major pressures, conflicts, and decisions which confront all of them. By integrating a discussion of "facts" and "values," the authors highlight the forces which affect new developments in medicine—such as kidney and heart transplants—and the controversial issues they generate. Katz and Capron explore these issues through the use of dual conceptual perspectives. Their study first examines and evaluates the authority which should be vested in each of the chief participants in the catastrophic disease process—the physician-investigator, the patient-subject and his relatives, the professionals, and the state. Challenging questions are raised concerning medical education, informed consent, and professional responsibility. The authors next explore how the roles and capacities of the participants vary not only according to the basic issues they face but also according to the point in decision-making at which these issues arise. The process of investigating and treating catastrophic diseases, the authors believe, can thus usefully be divided into three decision-making stages—the formulation of policy, the administration of research and therapy, and the review of the decisions and their consequences. In conclusion, Katz and Capron demonstrate the need for a variety of individuals and groups with diverse values to be involved in decision-making in a manner which will not unnecessarily impede the scientific investigation of these diseases.
Christian health care professionals in our secular and pluralistic society often face uncertainty about the place religious faith holds in today's medical practice. Through an examination of a virtue-based ethics, this book proposes a theological view of medical ethics that helps the Christian physician reconcile faith, reason, and professional duty.
Edmund D. Pellegrino and David C. Thomasma trace the history of virtue in moral thought, and they examine current debate about a virtue ethic's place in contemporary bioethics. Their proposal balances theological ethics, based on the virtues of faith, hope, and charity, with contemporary medical ethics, based on the principles of beneficence, justice, and autonomy. The result is a theory of clinical ethics that centers on the virtue of charity and is manifest in practical moral decisions.
Using Christian bioethical principles, the authors address today's divisive issues in medicine. For health care providers and all those involved in the fields of ethics and religion, this volume shows how faith and reason can combine to create the best possible healing relationship between health care professional and patient.
Cochlear Implants in Children: Ethics and Choices addresses every facet of the ongoing controversy about implanting cochlear hearing devices in children as young as 12 months old and in some cases, younger. Authors John B. Christiansen and Irene W. Leigh and contributors Jay Lucker and Patricia Elizabeth Spencer analyzed the sensitive issues connected with the procedure by reviewing 439 responses to a survey of parents with children who have cochlear implants. They followed up with interviews of the parents of children who have had a year's experience using their implants, and also the children themselves. Their findings shape the core of this useful and telling study.
Cochlear Implants begins with a history of their development and an explanation of how implants convert sound into electric impulses that stimulate the brain. The second section focuses on pediatric implants, starting with the ways parents coped with the discovery that their child was deaf. Parents share how they learned about cochlear implants and how they chose an implant center. They also detail their children's experiences with the implants after surgery, and their progress with language acquisition and in school.
The final part treats the controversy associated with cochlear implants, particularly the reaction of the Deaf community and the ethics of implanting young children without their consent. Cochlear Implants concludes with sage observations and recommendations for parents and professionals that complete it as the essential book on the pros and cons of this burgeoning technology.
John B. Christiansen is Professor of Sociology at Gallaudet University.
Irene W. Leigh is Professor of Psychology at Gallaudet University.
Competence to Consent
Becky Cox White Georgetown University Press, 1994 Library of Congress R724.W47 1994 | Dewey Decimal 174.2
Free and informed consent is one of the most widespread and morally important practices of modern health care; competence to consent is its cornerstone. In this book, Becky Cox White provides a concise introduction to the key practical, philosophical, and moral issues involved in competence to consent.
The goals of informed consent, respect for patient autonomy and provision of beneficent care, cannot be met without a competent patient. Thus determining a patient's competence is the critical first step to informed consent. Determining competence depends on defining it, yet surprisingly, no widely accepted definition of competence exists. White identifies nine capacities that patients must exhibit to be competent. She approaches the problem from the task-oriented nature of decision making and focuses on the problems of defining competence within clinical practice. Her proposed definition is based on understanding competence as occurring in a special rather than a general context; as occurring in degrees rather than at a precise threshold; as independent of consequential appeals; and as incorporating affective as well as cognitive capacities.
Combining both an ethical overview and practical guidelines, this book will be of value to health care professionals, bioethicists, and lawyers.
As David Kelly writes, "Catholic moral theology has not been completely constant over the centuries; it has learned and developed." In Contemporary Catholic Health Care Ethics he demonstrates how Catholic health care ethics can—and should—evolve similarly in response to the lightning speed of modern medical advances. Kelly draws on and analyzes the Catholic tradition of medical ethics—but he does not shy away from criticizing it as well, giving health care professionals, hospital ethics committees, and students a fresh treatment of Catholic health care ethics emphasizing theology, methodology, and application.
First discussing the Catholic understanding of the human person, Kelly proposes a Catholic Christian approach to the meaning of human life as it applies specifically to health care. He includes a brief history of the relationship between religion and medicine, and makes strong claims about how theology ought and ought not to be applied in health care ethics. Drawing from the terminology and approaches used by secular bioethics, he suggests how a Catholic perspective on health care can utilize certain secular moral-philosophical positions, even as they apply to the issues of birth control, and end-of life concerns. As practitioners, patients, and families face the difficult decision to continue or stop treatment for dying patients, Kelly compassionately, but practically, explores their concerns in light of American law and ethics. Finally, he provides measured insight on pain management, hospital ethics committees, stem cell research, genetic engineering, and allocation of health care resources.
Contemporary Catholic Health Care Ethics is informed, challenging, articulate, and bold—bringing to the extremely important field of Catholic health care ethics a much-needed and welcome voice, unafraid to speak to the most difficult issues of the 21st century.
Contemporary Catholic Health Care Ethics, Second Edition, integrates theology, methodology, and practical application into a detailed and practical examination of the bioethical issues that confront students, scholars, and practitioners. Noted bioethicists Gerard Magill, Henk ten Have, and David F. Kelly contribute diverse backgrounds and experience that inform the richness of new material covered in this second edition.
The book is organized into three sections: theology (basic issues underlying Catholic thought), methodology (how Catholic theology approaches moral issues, including birth control), and applications to current issues. New chapters discuss controversial end-of-life issues such as forgoing treatment, killing versus allowing patients to die, ways to handle decisions for incompetent patients, advance directives, and physician-assisted suicide. Unlike anthologies, the coherent text offers a consistent method in order to provide students, scholars, and practitioners with an understanding of ethical dilemmas as well as concrete examples to assist in the difficult decisions they must make on an everyday basis.
When Richard A. McCormick's The Critical Calling was first published, Andrew M. Greeley commented that "in years to come scholars will look back on Father McCormick's work and say, 'This was a man who knew what he was talking about!'" In this reissue, with a new foreword by Lisa Sowle Cahill, both first-time readers and those opening the pages for a return visit with an honored friend will find Greeley's characterization remains valid.
Father McCormick begins The Critical Calling with his personal affirmation of the work of Vatican II: "I believe the Council was a work of the Spirit—desperately needed, divinely inspired, devotedly and doggedly carried through." Yet, he stresses this was no uncritical endorsement of everything the Council did and said. Part One includes a discussion of fundamental moral theology that looks at the relationship between the church hierarchy and individual moral decision making and several chapters addressing issues precipitated by actions involving Cardinal Josef Ratzinger, now Pope Benedict XVI. Part Two focuses on practical and pastoral questions that touch on contemporary concerns ranging from abortion to AIDS, divorce, homosexuality, and teenage sexuality.
Cahill suggests that "those who lived through the tumultuous 1960s and '70s" as well as "those who came to maturity after the Council" will find this book to be an accurate and evocative reflection of the passions that imbued all those early debates and a helpful explanation why those passions ran so high. All readers will benefit from the wise insights into the controversies of that era and the more recent struggles, challenges, and debates that confront today's church.
The rapid rise of managed care in the United States has introduced new complexities into ethical dilemmas in health care by changing the traditional relationships among health plans, payers, providers, and patients. Through twenty case studies that provide snapshots of a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care.
Accompanying each case are questions for consideration and a pair of commentaries by prominent contributors from diverse fields. Through the cases and commentaries, this book clarifies the internal workings of managed care, explains relevant concepts, and offers practical, constructive guidance in addressing the ethical and policy issues.
The cases address a broad spectrum of issues concerning rationing shared resources, financial incentives, quality of care, and responsibilities to patients, vulnerable populations, and the community. Specific topics range from coverage of emergency services through funding medical education to respecting patients' religious beliefs and caring for the seriously mentally ill.
This casebook offers a wealth of insights into critical issues that affect the delivery of managed care in an increasingly competitive market. It will be invaluable for those managing the delivery and financing of health care and for students and practitioners of the health professions and health administration, as well as interested recipients of managed care.
This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such high-tech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent patients, rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics.
The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development.
Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions.
In the wake of the successful cloning of animals and the promises—or fears—of stem cell research, new discoveries in science and medicine need more than ever to be accompanied by careful moral reflection. Contending that concern over the ethical dimensions of these and other like issues are no longer just in the domain of those involved in medical practice, the third edition of Ethics of Health Care claims these are vital topics that should matter deeply to all citizens.
While stressing the Catholic tradition in health care ethics, Ethics of Health Care is ecumenical, incorporating a broader Christian tradition as well as humanistic approaches, and takes as common ground for mutual understanding the Universal Declaration of Human Rights of the United Nations. This new third edition is a response to the many developments in theology and the startlingly rapid changes in the arenas of medicine and health care over the past decade, from the dominance of managed care to increased surgery on an "outpatient" basis; from hospice care for the dying to the increasing use of drugs in the treatment of mental illness.
Revised and thoroughly up-to-date, this third edition continues with its valuable teaching aids, including case studies, study questions, chapter summaries, a bibliography, and complete index.
Van Rensselaer Potter created and defined the term "bioethics" in 1970, to describe a new philosophy that sought to integrate biology, ecology, medicine, and human values. Bioethics is often linked to environmental ethics and stands in sharp contrast to biomedical ethics. Because of this confusion (and appropriation of the term in medicine), Potter chose to use the term "Global Bioethics" in 1988. Potter's definition of bioethics from Global Bioethics is, "Biology combined with diverse humanistic knowledge forging a science that sets a system of medical and environmental priorities for acceptable survival."
The rural community presents not only distinct health care delivery challenges but also ethical problems for clinicians and administrators of small, rural health care facilities. Health care delivered in a rural context—in closely knit, tightly interdependent small community settings—poses unique ethical considerations for clinical practitioners. For example, a provider in a resource-poor rural setting may be faced with treating a family member, friend, business associate, or neighbor, since the role separation between clinician and patient that predominates in the urban setting is less likely to occur in a small town. Because of the unique rural context, the solutions that health care providers develop to resolve complex ethics dilemmas may differ from solutions reached in urban areas. The Handbook for Rural Health Care Ethics is designed to be a useful resource for clinicians and administrators in rural settings. It draws on the available research and real-life examples to paint a picture of challenging, yet all-too-familiar ethics conflicts while offering strategies for a proactive, preventive approach to ethical issues.
The term bioethics was first used in the early 1970s by biologists who were concerned about ethical implications of genetic and ecological interventions, but was soon applied to all aspects of biomedical ethics, including health care delivery, research, and public policy. Its literature draws from disciplines as varied as clinical medicine and nursing, scientific research, theology and philosophy, law, and the social sciences—each with its own distinctive vocabulary and expressions.
A Handbook of Bioethics Terms is a handy and concise glossary-style reference featuring over 400 entries on the significant terms, expressions, titles, and court cases that are most important to the field. Most entries are cross-referenced, making this handbook a valuable addition to the bookshelves of undergraduate and graduate students in health care ethics, physicians and nurses, members of institutional ethics committees and review boards, and others interested in bioethics.
A sampling of terms from the handbook: AbortionDNR (Do Not Resuscitate)Eugenics Gene therapy Living will Natural lawPrimum non nocere Single-payer systemSurrogate consent Schiavo case
Formalism: In ethical theory, a type of deontology in which an action is judged to be right if it is in accord with a moral rule, and wrong if it violates a moral rule.
Xenograft: Organ or tissue transplanted from one individual to another individual of another species. (See Transplantation, organ and tissue)
What, exactly, does it mean to be human? It is an age-old question, one for which theology, philosophy, science, and medicine have all provided different answers. But though a unified response to the question can no longer be taken for granted, how we answer it frames the wide range of different norms, principles, values, and intuitions that characterize today's bioethical discussions. If we don't know what it means to be human, how can we judge whether biomedical sciences threaten or enhance our humanity?
This fundamental question, however, receives little attention in the study of bioethics. In a field consumed with the promises and perils of new medical discoveries, emerging technologies, and unprecedented social change, current conversations about bioethics focus primarily on questions of harm and benefit, patient autonomy, and equality of health care distribution. Prevailing models of medical ethics emphasize human capacity for self-control and self-determination, rarely considering such inescapable dimensions of the human condition as disability, loss, and suffering, community and dignity, all of which make it difficult for us to be truly independent.
In Health and Human Flourishing, contributors from a wide range of disciplines mine the intersection of the secular and the religious, the medical and the moral, to unearth the ethical and clinical implications of these facets of human existence. Their aim is a richer bioethics, one that takes into account the roles of vulnerability, dignity, integrity, and relationality in human affliction as well as human thriving. Including an examination of how a theological anthropology—a theological understanding of what it means to be a human being—can help us better understand health care, social policy, and science, this thought-provoking anthology will inspire much-needed conversation among philosophers, theologians, and health care professionals.
Health Care Ethics is a comprehensive study of significant issues affecting health care and the ethics of health care from the perspective of Catholic theology. It aims to help Christian, and especially Catholic, health care professionals solve concrete problems in terms of principles rooted in scripture and tested by individual experience; however, its basis in real medical experience makes this book a valuable resource for anyone with a general interest in health care ethics.
This fifth edition, which includes important contributions by Jean deBlois, C.S.J., considers everyday ethical questions and dilemmas in clinical care and deals more deeply with issues of women's health, mental health, sexual orientation, artificial reproduction, and the new social issues in health care. The authors devote special attention to the various ethical theories currently in use in the United States while clearly presenting a method of ethical decision making based in the Catholic tradition. They discuss the needs of the human person, outlining what it means to be human, both as an individual and as part of a community.
This volume has been significantly updated to include new discussions of recent clinical innovations and theoretical issues that have arisen in the field:
• the Human Genome Project• efforts to control sexual selection of infants• efforts to genetically modify the human genotype and phenotype• the development of palliative care as a medical specialty• the acceptance of non-heart beating persons as organ donors• embryo development and stem cell research• reconstructive and cosmetic surgery• nutrition and obesity• medical mistakes• the negative effects of managed care on the patient-physician relationship• recent papal allocution regarding care of patients in a persistent vegetative state and palliative care for dying patients
This fourth edition of Health Care Ethics provides a contemporary study of broad and major issues affecting health care and the ethics of health care from the perspective of Catholic teachings and theological investigation.
It aims to help Christian, and especially Catholic, health care professionals solve concrete problems in terms of principles rooted in Scripture and tested by individual experience.
Since the last edition of Health Care Ethics, there have been many changes in the fields of health care medicine and theology that have necessitated a fourth edition. Ashley and O'Rourke have revised their seminal work to address the publication of significant documents by the Church and the restructuring of the health care system.
Features of the revised fourth edition: • Discusses significant Church documents issued since the third edition includes "The Splendor of Truth" (Veritatis Splendor), and the "Gospel of Life" (Evangelium Vitae); the "Instruction on the Vocation of Theologians"; the Catechism of the Catholic Church; and the Revised Ethical and Religious Directives for Catholic Health Services.
• Examines the implications of managed care techniques.
• Probes such changes in the practice of medicine as the new emphasis on preventive care, the involvement of individuals in their own care, greater use of pharmaceuticals in psychiatry, and the greater role of genetics in diagnosis and prognosis.
• Explores the quest for more compassionate care of the dying.
This book illuminates issues in medical ethics revolving around the complex bond between healer and patient, focusing on friendship and other important values in the healing relationship. Embracing medicine, philosophy, theology, and bioethics, it considers whether bioethical issues in medicine, nursing, and dentistry can be examined from the perspective of the healing relationship rather than external moral principles.
Distinguished contributors explore the role of the health professional, the moral basis of health care, greater emphasis on the humanities in medical education, and some of the current challenges facing healers today.
Exploring the moral foundations of the healing relationship, Edmund D. Pellegrino and David C. Thomasma offer the health care professional a highly readable Christian philosophy of medicine. This book examines the influence religious beliefs have on the kind of person the health professional should be, on the health care policies a society should adopt, and on what constitutes healing in its fullest sense.
Helping and Healing looks at the ways a religious perspective shapes the healing relationship and the ethics of that relationship. Pellegrino and Thomasma seek to clarify the role of religious belief in health care by providing a moral basis for such commitment as well as a balancing role for reason. This book establishes a common ground for believers and skeptics alike in their dedication to relieve suffering by showing that helping and healing require an involvement in the religious values of patients. It clearly argues that religion provides crucial insights into medical practice and morality that cannot be ignored, even in our morally heterogeneous society.
Central to the authors' message is the concept of patients' vulnerabilities and the need to help them recover not only from the disease but also from an existential assault on their personhood. They then show how this understanding can move caregivers to view their professions as vocations and thereby change the nature of health care from a business to a community of healing.
Physicians, nurses, administrators, clergy, theologians, and other health professionals and church leaders will find this volume helpful for their own reflections on the role of religion in the health care ministry and for making a religious commitment integral to their professional lives.
Where should physicians get their ethics? Professional codes such as the Hippocratic Oath claim moral authority for those in a particular field, yet according to medical ethicist Robert Veatch, these codes have little or nothing to do with how members of a guild should understand morality or make ethical decisions. While the Hippocratic Oath continues to be cited by a wide array of professional associations, scholars, and medical students, Veatch contends that the pledge is such an offensive code of ethics that it should be summarily excised from the profession. What, then, should serve as a basis for medical morality?
Building on his recent contribution to the prestigious Gifford Lectures, Veatch challenges the presumption that professional groups have the authority to declare codes of ethics for their members. To the contrary, he contends that role-specific duties must be derived from ethical norms having their foundations outside the profession, in religious and secular convictions. Further, these ethical norms must be comprehensible to lay people and patients. Veatch argues that there are some moral norms shared by most human beings that reflect a common morality, and ultimately it is these generally agreed-upon religious and secular ways of knowing—thus far best exemplified by the 2005 Universal Declaration on Bioethics and Human Rights—that should underpin the morality of all patient-professional relations in the field of medicine.
Hippocratic, Religious, and Secular Medical Ethics is the magnum opus of one of the most distinguished medical ethicists of his generation.
The ancient Hippocratic oath that every doctor pledges upon graduation from medical school is a code based on genuine devotion to people and a desire to serve them. It is also a code in urgent need of updating to reflect the technological and moral changes of modern society and the complicated dilemmas facing every practicing physician.
This collection of essays by some of the wisest observers of modern medicine probes the various forces affecting health care today: the power of the new technology in diagnosing and treating illnesses, the growing appreciation of mind/body interactions, the emergence of corporate hospitals and health care centers, and, most importantly, the essence of physicianhood—what makes a doctor want to practice medicine.
In considering these issues, the essayists question whether the medical-industrial complex will destroy physicians as we know them, making doctors employees of large profit-making institutions and more responsible to their companies than to their patients. Will increasing versatility in technological medicine remove doctors even further from the patient's bedside, weakening the diminishing bond between patient and doctor? Are there points of contact between western "scientific" medicine and holistic practices? Is there a place in modern medicine for work therapy and the placebo effect?
Each of these issues prevalent in medicine today has, in its own particular way, an effect upon the core relationship between doctor and patient. In Search of the Modern Hippocrates is dedicated to the premise that current changes in medicine can produce an altered and strengthened medical profession resolved to preserve the inextricable link between commitment and care. Ending with the development of a modern oath of ethics, it provides an important guide to medicine in the complex world we now face.
Wear develops an efficient and flexible model of informed consent that accommodates both clinical realities and legal and ethical imperatives. In this second edition, he has expanded his examination of the larger process within which informed consent takes place and his discussion of the clinician's need for a wide range of discretion.
Inquiries in Bioethics
Stephen G. Post Georgetown University Press, 1993 Library of Congress R724.P665 1993 | Dewey Decimal 174.2
The biological revolution, with its attendant technological powers to alter nature and human nature, demands fundamental and cautionary reflection on questions of the highest ethical importance. In this thoughtful book on contemporary issues in bioethics, Stephen G. Post explores nine major topics ranging from birth and adolescence to aging and death. Using an interdisciplinary approach, Post clearly illuminates the issues, probes the ethical alternatives, and examines the cultural changes that shape current presuppositions about the right and good. This book will be of interest to scholars in bioethics, philosophy, and religious studies; health-care professionals; and the general reader concerned with these pressing questions of life and death.
The twelve essays in this stimulating volume, written by health care professionals and others working with the important issue of institutional ethics, focus on the world of academic health centers and provide rich, informed commentaries on significant problems integral to the character and work of those centers. Daniel Steiner demonstrates how the viability of independent research may be threatened by university liaisons with industry. Donald Frederickson traces the history of the National Institutes of Health response to the ethical challenges in clinical investigation and fetal research. Edmund Pellegrino recommends ways in which health-related institutions may translate their concern into action. Robert Coles examines the tensions between institutional and personal values in a very provocative way. Other directions are explored by essayists Roger Bulger, Stephen Toulmin, H. Tristram Engelhardt, Kim Dunn, Mitchell Rabkin, James Haughton, Lawrence Green, and the editors themselves.
Every essay in this wide-ranging collection reveals the implications and effects of institutional values. The end result is a clear picture of conflicts of values: ethical, social, economic, ethnic, cultural, and pedagogic. Integrity in Health Care Institutions points out the need for a deliberate attempt to sort out the values of institutions and, when they are fully and clearly displayed, to use priorities as a guide to satisfying the obligations of academic health centers to those who work within their walls; to the patients, students, scientists, and teachers they serve; and to society in general.
Physicians and nurses, hospital and university administrators, attorneys, sociologists, and everyone concerned about the moral interaction between institutions and individuals will want to read this book.
Leavened with compassion, common sense, and a readable style, this introduction to complicated bioethical issues from both Jewish and Catholic perspectives is as informative as it is undaunting. Aaron Mackler takes the reader through methodology in Roman Catholic moral theology and compares and contrasts it with methodology as it is practiced in Jewish ethics. He then skillfully wends his way through many topics foremost on the contemporary ethical agenda for both Jewish and Catholic ethicists: euthanasia and assisted suicide, end-of-life decisions, abortion, in vitro fertilization, and the ever-growing problem of justice regarding access to health care and medical resources. A concluding chapter summarizes general tendencies in the comparison of the two traditions, and addresses the significance of convergence and divergence between these traditions for moral thinkers within each faith community, and generally in western democracies such as the United States.
As Mackler overviews these issues, he points out the divergences and the commonalities between the two traditions—clarifying each position and outlining the structure of thinking that supports them. At the heart of both Catholic and Jewish perspectives on bioethics is a life-affirming core, and while there may be differences in the "why" of those ethical divergences, and in the "how" each arrived at varying—or the same—conclusions, both traditions, in the words of James McCartney as quoted in the introduction, "are guided by the principle that life is precious; that we are bidden to preserve and guard our health; that we are bidden to intervene in nature to raise the human estate; and that our lives are not our own, but are part of the legacy bequeathed to us by the Creator." This book has been carefully crafted in that spirit.
Intuition is central to discussions about the nature of scientific and philosophical reasoning and what it means to be human. In this bold and timely book, Hillel D. Braude marshals his dual training as a physician and philosopher to examine the place of intuition in medicine.
Rather than defining and using a single concept of intuition—philosophical, practical, or neuroscientific—Braude here examines intuition as it occurs at different levels and in different contexts of clinical reasoning. He argues that not only does intuition provide the bridge between medical reasoning and moral reasoning, but that it also links the epistemological, ontological, and ethical foundations of clinical decision making. In presenting his case, Braude takes readers on a journey through Aristotle’s Ethics—highlighting the significance of practical reasoning in relation to theoretical reasoning and the potential bridge between them—then through current debates between regulators and clinicians on evidence-based medicine, and finally applies the philosophical perspectives of Reichenbach, Popper, and Peirce to analyze the intuitive support for clinical equipoise, a key concept in research ethics. Through his phenomenological study of intuition Braude aims to demonstrate that ethical responsibility for the other lies at the heart of clinical judgment.
Braude’s original approach advances medical ethics by using philosophical rigor and history to analyze the tacit underpinnings of clinical reasoning and to introduce clear conceptual distinctions that simultaneously affirm and exacerbate the tension between ethical theory and practice. His study will be welcomed not only by philosophers but also by clinicians eager to justify how they use moral intuitions, and anyone interested in medical decision making.
Walker Percy brought to his novels the perspective of both a doctor and a patient. Trained as a doctor at Columbia University, he contracted tuberculosis during his internship as a pathologist at Bellevue Hospital and spent the next three years recovering, primarily in TB sanitoriums. This collection of essays explores not only Percy’s connections to medicine but also the underappreciated impact his art has had—and can have—on medicine itself. The contributors—physicians, philosophers, and literary critics—examine the relevance of Percy’s work to current dilemmas in medical education and health policy. They reflect upon the role doctors and patients play in his novels, his family legacy of depression, how his medical background influenced his writing style, and his philosophy of psychiatry. They contemplate the private ways in which Percy’s work affected their own lives and analyze the author’s tendency to contrast the medical-scientific worldview with a more spiritual one. Assessing Percy’s stature as an author and elucidating the many ways that reading and writing can combine with diagnosing and treating to offer an antidote to despair, they ask what it means to be a doctor, a writer, and a seeker of cures and truths—not just for the body but for the malaise and diseased spirituality of modern times. This collection will appeal to lovers of literature as well as medical professionals—indeed, anyone concerned with medical ethics and the human side of doctoring.
Contributors. Robert Coles, Brock Eide, Carl Elliott, John D. Lantos, Ross McElwee, Richard Martinez, Martha Montello, David Schiedermayer, Jay Tolson, Bertram Wyatt-Brown, Laurie Zoloth-Dorfman
Let Them Go Free offers families a way to cope with a problem particular to our time: what to do when medical treatment sustains life but does not cure or resuscitate a critically ill loved one. This straightforward and empathic guide helps such families affirm that their choice to remove life support is morally acceptable, warranted, and made in the spirit of love and care for the patient.
With an emphasis on maintaining openness and trust among all involved in the decision-making process, this helpful guide skillfully addresses the questions that must be asked to assess the best course of care for a loved one:
• What is the patient’s medical condition?
• What are the medical options?
• Has the patient expressed any wishes regarding his or her treatment?
• What if the patient hasn’t expressed any wishes regarding treatment?
• Do we have to do everything possible to keep the patient alive?
• Do we have to use artificial means of feeding?
• How do we handle disagreements?
• What should we do about donating organs?
Let Them Go Free also includes an ecumenical prayer service to be conducted as life support is withdrawn. Woven with readings and prayers from Hebrew and Christian scripture, the service is intended to give family and friends a moment to express their love for the patient, to say goodbye, and to find a sense of closure as they embark on the first stage of the grieving process.
An authoritative introduction to bioethics, Life Choices examines a comprehensive range of ethical questions and brings together some of the most probing and instructive essays published in the field.
Some of the articles are classics in the literature of bioethics, while others address current issues. Topics include moral decision making, abortion, euthanasia and assisted suicide, life-sustaining technologies, organ transplantation, reproductive technologies, and the allocation of health care resources.
This second edition features new sections on the goals and allocation of medicine and on the cloning of human beings. It also includes new articles on genetics, the duty to die, and ethical theory.
Written by the foremost authorities in bioethics, Life Choices provides a comprehensive introduction to the field. Instructors who have used the first edition as a text will welcome this new, updated edition. Scholars and health care practitioners will find it useful as a valuable reference on a wide range of bioethical issues.
Embryo adoptions, stem cells capable of transforming into any cell in the human body, intra- and inter-species organ transplantation—these and other biomedical advances have unsettled ideas of what it means to be human, of when life begins and ends. In the first study to consider the cultural impact of the medical transformation of the entire human life span, Susan Merrill Squier argues that fiction—particularly science fiction—serves as a space where worries about ethically and socially charged scientific procedures are worked through. Indeed, she demonstrates that in many instances fiction has anticipated and paved the way for far-reaching biomedical changes. Squier uses the anthropological concept of liminality—the state of being on the threshold of change, no longer one thing yet not quite another—to explore how, from the early twentieth century forward, fiction and science together have altered not only the concept of the human being but the contours of human life.
Drawing on archival materials of twentieth-century biology; little-known works of fiction and science fiction; and twentieth- and twenty-first century U.S. and U.K. government reports by the National Institutes of Health, the Parliamentary Advisory Group on the Ethics of Xenotransplantation, and the President’s Council on Bioethics, she examines a number of biomedical changes as each was portrayed by scientists, social scientists, and authors of fiction and poetry. Among the scientific developments she considers are the cultured cell, the hybrid embryo, the engineered intrauterine fetus, the child treated with human growth hormone, the process of organ transplantation, and the elderly person rejuvenated by hormone replacement therapy or other artificial means. Squier shows that in the midst of new phenomena such as these, literature helps us imagine new ways of living. It allows us to reflect on the possibilities and perils of our liminal lives.
Listening to the Whispers gives voice to scholars in philosophy, medical anthropology, physical therapy, and nursing, helping readers re-think ethics across the disciplines in the context of today's healthcare system. Diverse voices, often unheard, challenge readers to enlarge the circle of their ethical concerns and look for hidden pathways toward new understandings of ethics. Essays range from a focus on the context of corporatization and managed care environments to a call for questioning the fundamental values of society as these values silently affect many others in healthcare. Each chapter is followed by a brief essay that highlights issues useful for scholarly research and classroom discussion. The conversations of interpretive research in healthcare contained in this volume encourage readers to re-think ethics in ways that will help to create an ethical healthcare system with a future of new possibilities.
For over thirty years, David F. Kelly has worked with medical practitioners, students, families, and the sick and dying to confront the difficult and often painful issues that concern medical treatment at the end of life. In this short and practical book, Kelly shares his vast experience, providing a rich resource for thinking about life's most painful decisions.
Kelly outlines eight major issues regarding end-of-life care as seen through the lens of the Catholic medical ethics tradition. He looks at the distinction between ordinary and extraordinary means; the difference between killing and allowing to die; criteria of patient competence; what to do in the case of incompetent patients; the meaning and use of advance directives; the morality of hydration and nutrition; physician-assisted suicide and euthanasia; and medical futility. Kelly's analysis is sprinkled with significant legal decisions and, throughout, elaborations on how the Catholic medical ethics tradition—as well as teachings of bishops and popes—understands each issue. He provides a helpful glossary to supplement his introduction to the terminology used by philosophical health care ethics. Included in Kelly's discussion is his lucid description of why the Catholic tradition supports the discontinuation of medical care in the Terry Schiavo case. He also explores John Paul II's controversial papal allocution concerning hydration and nutrition for unconscious patients, arguing that the Catholic tradition does not require feeding the permanently unconscious.
Medical Care at the End of Life addresses the major issues that inform this last stage of caregiving. It offers a critical guide to understanding the medical ethics and relevant legal cases needed for clear thinking when individuals are faced with those crucial decisions.
In a single convenient resource, this revised and updated edition of a classic text organizes and presents clearly the documents of the Catholic Church pertaining to medical ethics. Introductory chapters provide the context for interpreting the Church's teachings and theological values, guiding the reader in how to apply the teachings to particular ethical dilemmas and helping the reader to understand the role of conscience within the Catholic tradition.
The teaching of the Church in regard to health care ethics is pertinent not only for health care professionals and students, but for all who are concerned about the common good of society. Medical Ethics examines specific teachings of the Church on over seventy issues in clinical and research ethics, including abortion, AIDS, artificial insemination, assisted suicide, cloning, contraception, euthanasia, gene therapy, health care reform, organ donation and transplantation, organizational ethics, stem cells, surrogate motherhood, and withholding and withdrawing life support.
O'Rourke and Boyle bring this fourth edition up to the present day by incorporating recent papal documents regarding the social aspects of health care, assent to Church teaching, and the 2008 papal instruction Dignitas personae, an extremely influential document that illuminates such controversial dilemmas as prenatal adoption, frozen embryos, and genetic diagnosis.
In a single convenient resource, this book organizes and presents clearly the documents of the Catholic church pertaining to medical ethics. Introductory chapters provide the context for interpreting the Church's teachings and guide the reader in applying the teachings to particular ethical quandaries.
This third edition has been updated to incorporate the statements issued since the preparation of the second edition. The authors have revised the introductory chapters to include ideas from the papal encyclical Splendor Veritatis and "Instruction of the Ecclesial Vocation of the Theologian," published by the Vatican Congregation for the Doctrine of the Faith, concerning the various levels of the teachings of the Church. Other new statements included in this edition are relevant topics from the papal encyclical Evangelium Vitae (abortion, euthanasia, amniocentesis, suicide and withdrawing life support); the Vatican Congregation of Doctrine and Faith on uterine isolation; the U.S. bishops on the care of anencephalic infants, genetic testing, and cloning; and the Pennsylvania Catholic Conference on the treatment for rape in Catholic hospitals.
Medicine, Health Care, and Ethics adds to this rich tradition with a collection of contemporary essays that represent the very best efforts of current Catholic scholarship in the field of health care and medical ethics.
Methods in Medical Ethics
Jeremy Sugarman Georgetown University Press, 2001 Library of Congress R724.M43 2001 | Dewey Decimal 174.2
Medical ethics draws upon methods from a wide array of disciplines, including anthropology, economics, epidemiology, health services research, history, law, medicine, nursing, philosophy, psychology, sociology, and theology.
In this first book to systematically examine, critique, and challenge some of these disciplines and their methods in light of their influence on medical ethics, leading scholars present particular methods that have played significant roles in the field. The methods addressed include philosophy, religion and theology, professional codes, law, casuistry, history, qualitative research, ethnography, quantitative surveys, experimental methods, and economics and decision science. Reviewing each, they provide descriptions of techniques, critiques, and notes on resources and training. Physician-assisted suicide and euthanasia are used as an illustration of the richness of multidisciplinary work applied to individual issues. Similarly, genetic testing is used as an example of how multiple descriptive methods may privilege certain findings.
Methods in Medical Ethics is a valuable resource for scholars, teachers, editors, and students in any of the disciplines that have contributed to the field. As a textbook and reference for graduate students and scholars in medical ethics, it offers a rich understanding of the complexities of both moral questions and their answers.
Medical ethics draws upon methods from a wide array of disciplines, including anthropology, economics, epidemiology, health services research, history, law, medicine, nursing, philosophy, psychology, sociology, and theology.
In this influential book, outstanding scholars in medical ethics bring these many methods together in one place to be systematically described, critiqued, and challenged. Newly revised and updated chapters in this second edition include philosophy, religion and theology, virtue and professionalism, casuistry and clinical ethics, law, history, qualitative research, ethnography, quantitative surveys, experimental methods, and economics and decision science. This second edition also includes new chapters on literature and sociology, as well as a second chapter on philosophy which expands the range of philosophical methods discussed to include gender ethics, communitarianism, and discourse ethics. In each of these chapters, contributors provide descriptions of the methods, critiques, and notes on resources and training.
Methods in Medical Ethics is a valuable resource for scholars, teachers, editors, and students in any of the disciplines that have contributed to the field. As a textbook and reference for graduate students and scholars in medical ethics, it offers a rich understanding of the complexities involved in the rigorous investigation of moral questions in medical practice and research.
Most of us want and expect medicine’s miracles to extend our lives. In today’s aging society, however, the line between life-giving therapies and too much treatment is hard to see—it’s being obscured by a perfect storm created by the pharmaceutical and biomedical industries, along with insurance companies. In Ordinary Medicine Sharon R. Kaufman investigates what drives that storm’s “more is better” approach to medicine: a nearly invisible chain of social, economic, and bureaucratic forces that has made once-extraordinary treatments seem ordinary, necessary, and desirable. Since 2002 Kaufman has listened to hundreds of older patients, their physicians and family members express their hopes, fears, and reasoning as they faced the line between enough and too much intervention. Their stories anchor Ordinary Medicine. Today’s medicine, Kaufman contends, shapes nearly every American’s experience of growing older, and ultimately medicine is undermining its own ability to function as a social good. Kaufman’s careful mapping of the sources of our health care dilemmas should make it far easier to rethink and renew medicine’s goals.
The Origins of Bioethics argues that what we remember from the history of medicine and how we remember it are consequential for the identities of doctors, researchers, and patients in the present day. Remembering when medicine went wrong calls people to account for the injustices inflicted on vulnerable communities across the twentieth century in the name of medicine, but the very groups empowered to create memorials to these events often have a vested interest in minimizing their culpability for them. Sometimes these groups bury this past and forget events when medical research harmed those it was supposed to help. The call to bioethical memory then conflicts with a desire for “minimal remembrance” on the part of institutions and governments. The Origins of Bioethics charts this tension between bioethical memory and minimal remembrance across three cases—the Tuskegee Syphilis Study, the Willowbrook Hepatitis Study, and the Cincinnati Whole Body Radiation Study—that highlight the shift from robust bioethical memory to minimal remembrance to forgetting.
Sir William Osler (1849–1919) had a long and distinguished career as a physician and professor at McGill University, the University of Pennsylvania, the Johns Hopkins University, and finally, as the Regius Chair in Medicine at Oxford University. Over the course of his professional life, Osler gave many addresses—mostly to medical students—on medical ethics, medicine and the humanities, the relationship between the medical practitioner and the patient, and, as the titular essay makes clear, on the “way of life” he advocated for the ethical physician. He remains an inspiration to many contemporary medical practitioners; there are active Osler Societies throughout the world. While Osler’s talks were frequently published during his lifetime and they have been published individually and in different compilations since his death, none contain the over 1500 annotations that appear here, notes that serve to explain the many philosophical, biblical, historical, and literary allusions contained in Osler’s writings. This thoroughly explicated selection of Sir William Osler’s writings will be cherished by physicians, medical students, nurses, philosophers, theologians, and ethicists in this—and future—generations.
For nearly fifteen years Practical Decision Making in Health Care Ethics has offered scholars and students a highly accessible and teachable alternative to the dominant principle-based theories in the field. Devettere’s approach is not based on an ethics of abstract obligations and duties, but, following Aristotle, on how to live a fulfilled and happy life—in short, an ethics of personal well-being grounded in prudence, the virtue of ethical decision making.
This third edition is revised and updated and includes discussions of several landmark cases, including the tragic stories of Terri Schiavo and Jesse Gelsinger (the first death caused by genetic research). Devettere addresses new topics such as partial-birth abortion law, embryonic stem cell research, infant euthanasia in The Netherlands, recent Vatican statements on feeding tubes, organ donation after cardiac death, new developments in artificial hearts, clinical trials developed by pharmaceutical companies to market new drugs, ghostwritten scientific articles published in major medical journals, and controversial HIV/AIDS research in Africa. This edition also includes a new chapter on the latest social and political issues in American health care.
Devettere’s engaging text relies on commonsense moral concepts and avoids academic jargon. It includes a glossary of legal, medical, and ethical terms; an index of cases; and thoroughly updated bibliographic essays at the end of each chapter that offer resources for further reading. It is a true classic, brilliantly conceived and executed, and is now even more valuable to undergraduates and graduate students, medical students, health care professionals, hospital ethics committees and institutional review boards, and general readers interested in philosophy, medicine, and the rapidly changing field of health care ethics.
For more than twenty years Practical Decision Making in Health Care Ethics has offered scholars and students a highly accessible and teachable alternative to the dominant principle-based theories in the field. Raymond J. Devettere's approach is not based on an ethics of abstract obligations and duties but, following Aristotle, on how to live a fulfilled and happy life—in short, an ethics of personal well-being grounded in prudence, the virtue of ethical decision making.
New sections added in this revised fourth edition include sequencing whole genomes, even those of newborns; the new developments in genetic testing now provided by online commercial companies such as 23andMe; the genetic testing of fetuses by capturing their DNA circulating in the pregnant woman's blood; the Stanford Prison experiment and its relevance to the abuses at the Abu Graib prison; recent breakthroughs in the diagnosis of consciousness disorders such as PVS; the ongoing controversy generated by the NIH study of premature babies at many NICUs throughout the county, a study known as SUPPORT that the OHRP (Office of Human Research Protections, an office within the department of HHS) deemed unethical.
Devettere updates most chapters. New cases include Marlise Munoz (dead pregnant woman's body kept on life support by a Texas hospital), Jahi McMath (teenager pronounced dead in California but treated as alive in New Jersey), Margot Bentley (nursing home feeding a woman dying of end stage Alzheimer’s despite her advance directive that said no nourishment or liquids if she was dying with dementia), Brittany Maynard (dying 29-year-old California woman who moved to Oregon to commit suicide with a physician's help), and Samantha Burton (woman with two children who suffered rupture of membranes at 25 weeks and whose physician obtained a court order to keep her at the hospital to make sure she stayed on bed rest). Thoughtfully updated and renewed for a new generation of readers, this classic textbook will be required reading for students and scholars of philosophy and medical ethics.
From Harry and Louise through the McCaughey septuplets, this book explains stories and issues in health care ethics that have appeared in the news media. Written for the general reader in a pluralistic society, it outlines and applies principles of justice from the Catholic tradition to contemporary problems that increasingly affect us all.
This second edition contains extensive new material and new topics, including physician-assisted suicide, managed care, organ donation, genetic testing, cloning, and the question of futility. Aimed at a wide audience, this book will also be useful for introductory ethics courses in colleges and high schools.
In Private Bodies, Public Texts, Karla FC Holloway examines instances where medical issues and information that would usually be seen as intimate, private matters are forced into the public sphere. As she demonstrates, the resulting social dramas often play out on the bodies of women and African Americans. Holloway discusses the spectacle of the Terri Schiavo right-to-die case and the injustice of medical researchers’ use of Henrietta Lacks’s cell line without her or her family’s knowledge or permission. She offers a provocative reading of the Tuskegee syphilis study and a haunting account of the ethical dilemmas that confronted physicians, patients, and families when a hospital became a space for dying rather than healing during Hurricane Katrina; even at that dire moment, race mattered. Private Bodies, Public Texts is a compelling call for a cultural bioethics that attends to the historical and social factors that render some populations more vulnerable than others in medical and legal contexts. Holloway proposes literature as a conceptual anchor for discussions of race, gender, bioethics, and the right to privacy. Literary narratives can accommodate thick description, multiple subjectivities, contradiction, and complexity.
This volume moves beyond ethics as problem-solving or ethics as etiquette to offer a look at ethics in primary care—as opposed to life-or-death—medical care. Professional Ethics and Primary Care Medicine deals with the ethics of routine, day-to-day encounters between doctors and patients. It probes beneath the hard decisions to look at the moral frameworks, habits of thought, and customs of practice that underlie choices. Harmon Smith and Larry Churchill argue that primary care, far from being merely a setting for the rendering of care, provides a new understanding of both physician and patient, and thereby offers a fresh basis for medical ethics.
Drawing on the controversial case of “Ashley X,” a girl with severe developmental disabilities who received interventionist medical treatment to limit her growth and keep her body forever small—a procedure now known as the “Ashley Treatment”—Reconsidering Intellectual Disability explores important questions at the intersection of disability theory, Christian moral theology, and bioethics.
What are the biomedical boundaries of acceptable treatment for those not able to give informed consent? Who gets to decide when a patient cannot communicate their desires and needs? Should we accept the dominance of a form of medicine that identifies those with intellectual impairments as pathological objects in need of the normalizing bodily manipulations of technological medicine?
In a critical exploration of contemporary disability theory, Jason Reimer Greig contends that L'Arche, a federation of faith communities made up of people with and without intellectual disabilities, provides an alternative response to the predominant bioethical worldview that sees disability as a problem to be solved. Reconsidering Intellectual Disability shows how a focus on Christian theological tradition’s moral thinking and practice of friendship with God offers a way to free not only people with intellectual disabilities but all people from the objectifying gaze of modern medicine. L'Arche draws inspiration from Jesus's solidarity with the "least of these" and a commitment to Christian friendship that sees people with profound cognitive disabilities not as anomalous objects of pity but as fellow friends of God. This vital act of social recognition opens the way to understanding the disabled not as objects to be fixed but as teachers whose lives can transform others and open a new way of being human.
The Sanctity of Human Life
David Novak Georgetown University Press, 2007 Library of Congress R725.57.N68 2007 | Dewey Decimal 174.2
Heated debates are not unusual when confronting tough medical issues where it seems that moral and religious perspectives often erupt in conflict with philosophical or political positions. In The Sanctity of Human Life, Jewish theologian David Novak acknowledges that it is impossible not to take into account the theological view of human life, but the challenge is how to present the religious perspective to nonreligious people. In doing so, he shows that the two positions—the theological and the philosophical—aren't as far apart as they may seem.
Novak digs deep into Jewish scripture and tradition to find guidance for assessing three contemporary controversies in medicine and public policy: the use of embryos to derive stem cells for research, socialized medicine, and physician-assisted suicide. Beginning with thinkers like Plato, Aristotle, Kant, and Nietsche, and drawing on great Jewish figures in history—Maimonides, Rashi, and various commentators on the Torah (written law) and the Mishnah (oral law)—Novak speaks brilliantly to these modern moral dilemmas.
The Sanctity of Human Life weaves a rich and sophisticated tapestry of evidence to conclude that the Jewish understanding of the human being as sacred, as the image of God, is in fact compatible with philosophical claims about the rights of the human person—especially the right to life—and can be made intelligible to secular culture. Thus, according to Novak, the use of stem cells from embryos is morally unacceptable; the sanctity of the human person, and not capitalist or socialist approaches, should drive our understanding of national health care; and physician-assisted suicide violates humankind's fundamental responsibility for caring for one another.
Novak's erudite argument and rigorous scholarship will appeal to all scholars and students engaged in the work of theology and bioethics.
Carl Djerassi is one of “the fathers of the Pill”—he was awarded the National Medal of Science for the first synthesis of a steroid oral contraceptive—and has had a prolific additional career as a writer of fiction, plays, and dialogues about science. In these two plays, ICSI and Taboos, he dramatizes the social transformations and contested viewpoints created by advances in reproductive science and technology.
Two of the most startling developments in contemporary science have radically disrupted the historical connection between sex and reproduction: in vitro fertilization and intracytoplasmic sperm injection (ICSI)—an assisted reproductive technique that directly injects a single sperm into an egg. The word play ICSI—designed for classroom readings—presents, in the format of a contentious talk-show dialogue, the science of direct-injection fertilization and the ethical issues connected with it. A DVD included in the book provides video of the ICSI injection process as viewed through a microscope, to be used in performances of the ICSI one-act dialogue. Taboos, a full-length play,turns the screws on characters that reflect a polarized America. Two couples—lesbian partners and a conservative husband and wife struggling with infertility—must make choices in a drama that examines the disjunction of sexual reproduction and the physical act of sex.
Slow Cures and Bad Philosophers uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine.
Contributors. Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy
Seven in ten Americans over the age of age of sixty who require medical decisions in the final days of their life lack the capacity to make them. For many of us, our biggest, life-and-death decisions—literally—will therefore be made by someone else. They will decide whether we live or die; between long life and quality of life; whether we receive heroic interventions in our final hours; and whether we die in a hospital or at home. They will determine whether our wishes are honored and choose between fidelity to our interests and what is best for themselves or others. Yet despite their critical role, we know remarkably little about how our loved ones decide for us.
Speaking for the Dying tells their story, drawing on daily observations over more than two years in two intensive care units in a diverse urban hospital. From bedsides, hallways, and conference rooms, you will hear, in their own words, how physicians really talk to families and how they respond. You will see how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result.
Research has consistently found that choosing life or death for another is one of the most difficult decisions anyone can face, sometimes haunting families for decades. This book shines a bright light on a role few of us will escape and offers steps that patients and loved ones, health care providers, lawyers, and policymakers could undertake before it is too late.
A pioneer in the theory of pluralistic casuistry, the idea that there are almost as many facets to moral choices as there are cases that call for choices, Baruch Brody takes issue with conventional bioethical wisdom and challenges the rigid principalism of contemporary bioethics. His views have been seen as controversial, but they are firmly held, and convincingly argued—all of which have led him to be one of the most widely discussed and highly admired bioethicists of our time. He argues for the fundamental distinction between active and passive euthanasia, for a need to reconceptualize approaches to brain death, and for the right of providers to unilaterally discontinue life support. He shows support for the waiving of the requirement of informed consent for some research, for the widespread use of animals in research, and for the use of placebos in many international clinical trials.
When it comes to morality as it is practiced in medicine, Brody makes clear that the ethical issues are never as simple as black and white—that there are myriad factors and fine nuances that can and should challenge decision making as it is commonly practiced in difficult medical cases. In this collection, delving thoughtfully and systematically into methodology, research ethics, clinical ethics, and Jewish medical ethics, he tackles thorny life-and-death questions head-on and fearlessly. He casts a light into all the corners of end-of-life decisions—a field in which he has exemplary credentials—while illuminating a new understanding of morality and ethics.
The introduction outlines Brody's approach, defines the terminology used, and contrasts his ethical positions with much of the competing literature. Taking Issue will be invaluable to students and scholars in medical ethics, bioethics, and philosophy of medicine.
The field of bioethics was deeply influenced by religious thinkers as it emerged in the 1960s and early 1970s. Since that time, however, a seemingly neutral political liberalism has pervaded the public sphere, resulting in a deep suspicion of those bringing religious values to bear on questions of bioethics and public policy.
As a theological ethicist and progressive Catholic, Lisa Sowle Cahill does not want to cede the "religious perspective" to fundamentalists and the pro-life movement, nor does she want to submit to the gospel of a political liberalism that champions individual autonomy as holy writ. In Theological Bioethics, Cahill calls for progressive religious thinkers and believers to join in the effort to reclaim the best of their traditions through jointly engaging political forces at both community and national levels.
In Cahill's eyes, just access to health care must be the number one priority for this type of "participatory bioethics." She describes a new understanding of theological bioethics that must go beyond decrying injustice, beyond opposing social practices that commercialize human beings, beyond painting a vision of a more egalitarian future. Such a participatory bioethics, she argues, must also take account of and take part in a global social network of mobilization for change; it must seek out those in solidarity, those involved in a common calling to create a more just social, political, and economic system.
During the past two decades Cahill has made profound contributions to theological ethics and bioethics. This is a magisterial and programmatic statement that will alter how the religiously inclined understand their role in the great bioethics debates of today and tomorrow that yearn for clear thinking and prophetic wisdom.
Setting out the implications of the postmodern condition for medical ethics, Troubled Bodies challenges the contemporary paradigms of medical ethics and reconceptualizes the nature of the field. Drawing on recent developments in philosophy, philosophy of science, and feminist theory, this volume seeks to expand familiar ethical reflections on medicine to incorporate new ways of thinking about the body and the dilemmas raised by recent developments in medical techniques. These essays examine the ways in which the consideration of ethical questions is shaped by the structures of knowledge and communication at work in clinical practice, by current assumptions regarding the concept of the body, and by the social and political implications of both. Representing various perspectives including medicine, nursing, philosophy, and sociology, these essays look anew at issues of abortion, reproductive technologies, the doctor-patient relationship, the social construction of illness, the cultural assumptions and consequences of medicine, and the theoretical presuppositions underlying modern psychiatry. Diverging from the tenets of mainstream bioethics, Troubled Bodies suggests that, rather than searching for the correct "coherent perspective" from which to draw ethical principles, we must apprehend the complexity and diversity of the discursive systems within which we dwell.