Ethical Considerations

Deep brain stimulation raises special concerns because neuromodulation techniques deal with the direct stimulation of the brain. No other organ is so closely involved with concepts of mind or self, self-determination and consent. POTENTIAL ALTERATION OF THE SELF. Interventions involving brain structure or function may result in alterations in cognition, memory, or emotions that may have a bearing on personhood. The potential of DBS to alter brain function may lead some to argue categorically...

Rhetoric and the Holocaust

The term holocaust is derived from the Greek holokauston, meaning burnt whole, which was a derivation of the Greek translation of the Hebrew olah, a biblical term for a burnt sacrifice. Historically, the term was used to denote great destruction of human life, especially through conflagration. For that reason it was employed often by journalists in World War II to refer not only to the destruction perpetrated by the Nazis on Jews and others but also to Allied acts such as the bombing firestorms...

Epidemics of the Late Twentieth Century

In the West, epidemic infectious disease was regarded by the second half of the twentieth century as indicating an uncivilized state of mind, and was ascribed above all to nonwhite populations in parts of the world outside Europe and North America. This reflected structural inequalities in the world economy, as the great infections became increasingly concentrated in the poor countries of the Third World. By the middle of the twentieth century, however, rapidly increasing life expectancy was...

Nonprofit Status Of Health Insurance Pioneers

Because the pioneers in U.S. health insurance were nonprofit, charitable organizations, they were developed to provide a social function beyond creating a profit for shareholders or syndicate owners. However, the social objective was not always to benefit consumers. Blue Cross was first organized to provide for the financial survival of the American voluntary, nonprofit hospital system during the period of the Great Depression. Although organized medicine initially opposed the new insurance...

Clinical Use of Advance Directives

Rarely do advance directives clearly dictate the care that should be given to a patient who lacks decision-making capacity. Generally, some interpretation of the document is required, a responsibility left to the named surrogate decision maker, other family members, and the healthcare team. When a patient who has an advance directive lacks decision-making capacity and is seriously ill, the healthcare providers should discuss the situation with the named surrogate and other appropriate loved...

Competence and Mental Healthcare

The presence of a mental disorder does not automatically negate the presumption of a person's competence. Although some severely mental ill persons are indeed incapacitated in many areas of their functioning, most mentally ill persons have only some discrete areas of decision-making incapacity, often confined to episodes of their illness. A paranoid delusional patient who denies that he is mentally ill, for example, may be unable to rationally decide whether or not to consent to antipsychotic...

Norplant

Norplant is a sustained-release contraceptive system that acts continuously for five years. It consists of six silicone rubber capsules, each the length and diameter of a matchstick, which are surgically implanted under the skin of the upper arm. The synthetic progestin Levonorgestrel, a hormone found in many oral contraceptives, is slowly released into the bloodstream, resulting in a constant hormone level. The contraceptive effect of Norplant is due primarily to inhibition of ovulation,...

Healthcare Issues

Fear and social stigma may be barriers to seeking HIV testing or care. In the United States, special procedures, protections, and programs have been developed to encourage testing and to provide care. TRANSMISSION AND PREVENTION. HIV is transmitted by direct contact with bodily fluids that contain the virus. The major modes of transmission are sexual contact and injection drug use (through sharing needles and drug paraphernalia). HIV can also be transmitted from mother to infant during...

The Holocaust in Bioethical Discourse

In bioethical contexts the Holocaust often is invoked as a form of moral approbation. The development of the Nuremberg Code in the wake of the Holocaust was the clear precursor to the emergence of modern protection measures for human subjects and therefore often is referenced legitimately (Caplan). However, the Holocaust-Nazi analogy also is invoked regularly to condemn a wide range of practices (e.g., abortion, physician-assisted suicide), healthcare strategies (e.g., managed care, age...

The Concept of Cancer An Overview

Although the biological, epidemiological, and genetic origins and indicators of cancer are vitally important they are the frontiers on which the disease is being battled cancer is more than the sum of its physical parts. It is also a socially imagined disease that is collectively thought about, embellished, and reacted to in ways that mesh with a people's established social and cultural norms. In some African countries, for example, perceptions of cancer as a stealthy, insidious disease mesh...

Historical Development

Although Catholic claims about abortion are not narrowly religious, certain biblical and early Christian characterizations of life in the womb no doubt have contributed to an ethos in which abortion is viewed negatively. The Hebrew Scriptures (Old Testament) did not treat the killing of a fetus as the killing of an infant (Exod. 21 22), although the Greek Septuagint translation of the Hebrew (early third century b.c.e.) adds a distinction between the formed and the unformed fetus, and presents...

Integrating Genetic and Environmental Information in Clinical Research

The risks posed by exposure to chemical and environmental agents are related to the level of exposure, the intrinsic potency of the agent, and the susceptibility of the person exposed. In general, the highest exposures are in patients receiving potent drugs or radiation as medical treatments and in workers manufacturing or cleaning up chemicals in various operations. Therefore, it is logical and efficient to investigate potential risks to human health in patients and in workers with known...

Theories And Conclusions Drawn From The Data

Emphasis upon traditional disciplinary approaches that are quantitative and maintain the distance between observer and experimental subject supposedly removes the bias of the researcher. Ironically, to the extent that these objective approaches are synonymous with a particular approach to scientific phenomena, they may introduce bias. As a corrective to such bias to a science that is too narrow, Sandra Harding proposes the notion of strong objectivity which recognizes the cultural, social, and...

Limits

If beneficent duties are more than supererogatory, or optional, a persistent issue is how to discern their proper scope. Where do obligations to benefit others end Are we morally required to give away all our surplus income and, beyond that, to chasten ourselves to more modest patterns of consumption Are physicians obligated never to say no to patients so long as any thread of hope for improvement exists Would beneficence require acceptance of higher taxes to fund universal health coverage, or...

Ethical And Legal Issues

Alternative medicine covers a dizzyingly heterogeneous group of medical theories and practices. Alternatives range from the different forms of faith healing, Christian Science, and folk medicine to allegedly scientific systems like homeopathy, chiropractic, and visualization therapy. Also included under the term are acupuncture herbalism iridology the traditional medicines of India, China, Japan, the Philippines, and indigenous peoples holistic medicine naturopathy (treatment using agents or...

Cancer and Endof Life Care

In the past oncologists typically greeted with foreboding and mistrust the prospect of relinquishing treatment in favor of palliative, end-of-life support such as hospice care. That open opposition has been replaced in most cases with careful circumspection. Many oncologists recognize a threshold beyond which continued treatment does more harm than good even though they may struggle to unite that recognition with the Hippocratic imperative to heal. This threshold, however, may not always...

Cancer Care and the Future

Future developments in cancer care will be affected by advances in the clinical control and prevention of the disease. Ongoing genetic and molecular research promises not just more effective treatments for cancer but also less invasive procedures for patients, greater patient autonomy, and improved quality of life. Potential problems may include a compounding of concerns about informed consent for cancer clinical trials and genetic susceptibility testing, as well as more macro issues such as...

The Limits of Medicine

Interestingly, one sector of medicine that is strongly wed to a naturalist ideology is biomedicine. Human health is usually understood by biomedicine not merely as the absence of diagnosable disease, but as functioning within a range that is typical for human beings of one's age and gender (Boorse). For functionalists in biomedicine, the statistically normal is morally normative that is, it represents the state of health that is supposed to be the goal of research and the priority of practice....

Extending Life Expectancy

The prospect for increasing life expectancy further is a subject of intense scientific debate. Projections of life expectancy can have a significant influence on anticipated changes in social programs, such as Social Security and Medicare, that are influenced by the future size and health status of the older population. Some scientists have argued that life expectancy at birth for humans cannot practically exceed about eighty-five years (Olshansky et al., 1990). This conclusion is based on the...

Effects of Extended Life Expectancy on General Population

Observing historical trends in mortality, and anticipating future improvements, raises the question of how the overall health of the population is influenced by these trends. From a historical perspective, there is little doubt that the thirty-year increase in life expectancy in the twentieth century was a result of trading one set of diseases and causes of death for another. The epidemiologic transition allowed much larger proportions of each birth cohort to survive to older ages, something...

The Ultimate Explanation Evolutionary Considerations

Nothing in biology makes sense except in the light of evolution. This statement by the well-known geneticist Theodosius Dobzhansky has been verified by the study of aging. The operation of natural selection means that some genetic variants of any population will be more successful (i.e., leave more copies of their genes in the next generation) than will other variants, and the first variant will be favored. Most known populations are structured by age that is, the population is composed of...

Pharmaceutical Interventions into the Aging Process

The genetic manipulations used in the laboratory are not likely to be well received as therapeutic tools. Once the longevity extension mechanisms described above were identified, many scientists independently tried to develop pharmaceutical interventions by feeding various drugs suspected of regulating those two processes to their laboratory animals. Five of those experiments have shown signs of success. Although those independent experiments used different intervention strategies and...

Laboratory Interventions into the Aging Process

An obvious limitation of the laboratory record is that there are few human data One cannot experiment on humans for both ethical and practical reasons. There are four species of multicellular animals that account for most of the recent research into longevity extension. Two of those model systems, the mouse and the rat, are mammals commonly used in biomedical research. The other two are invertebrates beloved of geneticists the fruit fly and the worm. Also, some laboratories focus on the use of...

Life Expectancy And Life Span

In the United States in 1900, the average life expectancy (also referred to as longevity) of a newborn baby was 47.7 years 46.4 for males and 49.0 for females. By 1990 the average life expectancy increased to 75.4 years 78.8 for females and 72.0 for males. Why did life expectancy increase so rapidly in the twentieth century, and what are the prospects for increasing it further Perhaps more important, has the overall health of the population improved or worsened during this transition, and what...

Healthcare of Older People

The nature of illness in older people greatly influences the ethical issues in their healthcare. Older people have a higher burden of illness than younger people. On average, they are likely to have several chronic medical conditions, be on multiple medications, and have frequent encounters with the healthcare system, including more hospitalizations. Because older people are closer to the end of their life expectancy, they have a greater chance of being involved in situations where difficult...

Theoretical Considerations

Early attempts to understand the nature of elder abuse were influenced by the child-abuse model. Victims were viewed as very dependent older women mistreated by well-meaning but overburdened adult daughters. Later findings suggested that spouse abuse might be a more useful framework for study, since the individuals involved were legally independent adults. To some health researchers, however, using the family violence paradigm, with its emphasis on harm, intentionality, and responsibility, was...

Ethical And Societal Perspectives

People who are physically or mentally disabled have many disadvantages. They may have an impairment, such as paralysis, blindness, or a psychiatric disorder, that reduces their ability to do things that nondisabled people do and may interfere with their fulfillment of socially valued roles. Also, disabled people often are subjected to various degrees of exclusion from the social and economic life of their communities. Political movements by disabled people to remove barriers and overcome...

Should Scientists Attempt to Control Aging

The fundamental philosophical and cultural challenge of anti-aging research is the blow that it could deal to aging's historical role as a constant in human affairs. If it is not necessary to assume the universality of aging in the ordering of society, new choices present themselves. From the point of view of the public good, is aging, as it is now known, a human experience to be encouraged or discouraged Both biomedicine and American culture reinforce the inclination to interpret the...

Health Risks and Benefits of GM Food

Critics of GM food present three kinds of arguments to suggest that it may not be good to eat (Thompson, p. 76). First, GM foods may produce allergic reactions because known or unknown allergens could be introduced into products people believe are safe. The food industry should and does take this problem seriously the liability issues alone are sobering. For example, because many people are allergic to peanuts, it would be risky to introduce into other crops genes that code for a protein unique...

The Effects of Individual Reproductive Choices on Society

In addition to advantageous or deleterious effects on individual women and couples, concerns exist about the effects of prenatal testing on society. THE DISABILITY CRITIQUE. The most forceful critique of prenatal testing is that made by disability theorists (Parens and Asch). Their most straightforward claim is that prenatal testing represents search and destroy missions against those who would be born with disability and is, simply, a eugenic program. A more subtle disability critique states...

Medical and Ethical Issues

The basic ethical question regarding circumcision is whether it is justified to perform a surgical procedure on a healthy, unconsenting child to prevent the possibility of future disease. The primary ethical task is to balance the pain and potential complications with the potential benefits. In addition, there is a strong tradition of respecting parental wishes when their decisions are not clearly contrary to the welfare of the child. Although the full details of the risks and benefits are...

Christian Orientations toward Death

Because the dominant religious influence in this history of the Western world has been that of Christianity, it is appropriate to outline the main Christian patterns of orientation toward death. There is no doubt of the predominance of a duality of levels in the Christian paradigm of the human condition, the levels of the spiritual and the material, the eternal and the temporal. On the one hand, there is the material-temporal world, of which one religious symbol is the dust to which humankind...

Harmful Effects of Female Circumcision or Female Genital Mutilation

The medical consequences of female genital mutilation are quite grave (El Dareer Koso-Thomas). In Africa an estimated ninety million females are affected (Hosken). Three levels of health problems are associated with the practice. Immediate problems include pain, shock, hemorrhage, acute urinary retention, urinary infection, septicemia, blood poisoning, fever, tetanus, and death. Occasionally, force is applied to position candidates for the operation, and as a result, fractures of the clavicle,...

Christianity

As with other religious traditions, Christian responses to cloning have been mixed. As early as the mid-1960s, Christian ethicists split sharply over whether cloning was playing God. Supporting new biotechnologies, Joseph Fletcher famously claimed let's play God (p. 126). Paul Ramsey's equally famous and oft-quoted response cautioned against advancing reproductive technologies Men ought not to play God before they learn to be men, and after they have learned to be men they will not play God (p....

Attitudes toward Other Drugs

The image of alcohol did not wax and wane in isolation from the public's perception of drugs such as morphine, heroin, and cocaine, although the peaks of their favorable and unfavorable public images did not coincide precisely with those of alcohol. The use of cocaine rose rapidly after its introduction into the United States in the mid-1880s. Not until the Harrison Act of 1914 did the federal government prohibit the sale of cocaine without a prescription. A similar restriction on alcohol,...

Contemporary Philosophy

The problem of death has not often been seen by contemporary philosophers as a choice between devising consolations for our finitude and demonstrations of our eternalness. For many, perhaps most philosophers early in the twenty-first century, the death of God is more than a century past, the grieving finished more than half a century ago. The problem of death, understood as the struggle to make life meaningful in an increasingly secular age plagued by the temptations of nihilism, continues. The...

Religious Perspectives

Even for those who are not actively religious, nascent human life evokes awe and a sense of being in the presence of primal powers of creation. In the procreation of all species, from plants to domestic pets, religious consciousness often senses the divine at play in the natural. In human procreation in particular, human beings not only observe but also participate in that power, and by conceiving and giving birth humans play a small but profoundly personal role in creation. There is little...

Search and Reunion

One of the effects of the civil-rights movement of the 1960s was the emergence of an adoption-reform movement led by adult adoptees. Its rallying cry was that the civil rights of the adopted had been violated when their original birth records were sealed, denying them access to information available to nonadopted people. Adoption support groups have been established across the United States to provide emotional support, lobby for open records, and facilitate the search for birth parents. Some...

Is Addiction a Real Disease

In addition to genetics, addiction as a disease is supported by the common signs and symptoms among the homeless and physician drug addicts. The target for drugs of abuse is the brain and changes in the neuroanatomy of the brain occur in all addicts and underlie the disease of addiction. Recent research in neuroscience has identified a specific area of the brain described as the reward center. This area of the brain makes essential survival behaviors such as eating, drinking and sex...

From Creation to Procreation

As an arena of divine presence, nascent life must be held in respect, for if it is God's work, its development must not be thwarted nor its condition questioned. According to the prophet Isaiah, God declares Woe to you who strive with your Maker, Does the clay say to the one who fashions it, What are you making or Your work has no handles Woe to anyone who says to a father, What are you begetting Or to a woman, With what are you in labor (Isa. 45 9-10) Because procreation is the work of God, it...

Complicated Grief

While models of complicated grief vary (Rando Worden), complicated grief reactions generally involve intensifications and exaggerations of the earlier described responses to grief that effectively impair the individual's ability to function. Complicated grief can also be evident in masked reactions that is, the grief is masked by another problem such as substance abuse. One factor that can complicate grief is disenfranchise-ment. The term disenfranchised grief refers to a grief that results...

Ethical Aspects

Since some followers of Islam in Africa, the Far East, and the Middle East endorse circumcision, it has been widely identified as an Islamic rite. However, female genital mutilation is not practiced in Saudi Arabia, Algeria, Iran, Iraq, Libya, Morocco, or Tunisia. Many Islamic and Christian religious leaders have categorically denied that female circumcision or female genital mutilation is an injunction in the Qur'an or a commandment in the Bible. Since the foundations of the practice lie...

The Social Force of Diagnosis

Concepts of disease have been used to impose political judgments. For example, in the United States prior to the Civil War it was proposed that the flight of a slave to the North and the absence of a wholesome inclination to do effective plantation work were diseases for which explanatory accounts and treatments could be provided (Cartwright). Masturbation was once viewed as a serious disease for which castration, excision of the clitoris, and other invasive therapies were employed. Individuals...

Orientations to the Body

The history of medical anthropology is to a large extent a history of scrutinizing and challenging Western assumptions about sickness, beginning with the distinction between biomedicine and traditional medicine. (Most medical anthropologists prefer the term biomedicine to the alternative terminology scientific, modern, and Western medicine. For an explanation see Leslie.) At first glance the distinction appears to be a commonsense way to classify different kinds of medical systems in practice...

Help and Grief

Persons experiencing acute grief can help themselves in a number of ways. Because grief is a form of stress, lifestyle management including adequate sleep and diet, as well as other techniques for stress reduction, can be helpful. Bibliotherapy or the use of self-help books can often validate or normalize grief reactions, suggest ways of adaptation, and offer hope. Self-help and support groups can offer similar assistance as well as social support from others who have experienced loss. Others...

The Distinction between Conventional Breeding and Genetic Engineering

For thousands of years human beings have altered the genomes of all major crops radically and constantly to change growth and ripening characteristics, speed maturity, eliminate grain shattering, improve taste and reduce toxins, increase size, and even get rid of seeds, as in grapes and bananas. Pictures comparing the wild and cultivated types of any crop invite incredulity because the differences are so sweeping. Crops that are very different from each other, such as Brussels sprouts, cabbage,...

Difficulties with the WHO Definitions

There are two main deficiencies in the definitions given above that should be remedied. First, they contain no account of what is normal or abnormal for human beings either in structure and function (as in the definition of impairment) or in the manner and range of performing an activity (as in the definition of disability). Second, only the definition of a handicap makes reference to disadvantage, yet intuitively, disadvantage, or at least inconvenience, is part of the concept of disability....

Cognitive Abilities and Intelligence

Though there are more data about the inheritance of intelligence than about any other complex behavioral characteristic of humans, the word intelligence is viewed even by the proponents of IQ testing as misleading because it has too many different meanings. IQ researchers seem to prefer to use the expression general cognitive ability, represented by the letter g (Jensen Plomin, DeFries, et al., 2001). The notion of substantial genetic influences on individual variation in g or intelligence...

The History of Circumcision

The walls of Egyptian tombs depict male circumcision, so the practice is known to be at least 5,000 years old. The Jewish and Muslim traditions of circumcision have their origin in the Old Testament. Jews accept the practice as a sign of the covenant between God and Abraham. In Genesis 17 12, God instructs Abraham He that is eight days old shall be circumcised among you, every male throughout your generations. As a Jew, Jesus was circumcised, and the early Christian church debated the need for...

Feminist Bioethics

In Canada and the United States, the bioethics movement and second wave feminism both began in the late 1960s, but the two discourses had little to say to one another for the better part of two decades. It was not until 1989 that the U.S. journal of feminist philosophy, Hypatia, published two special issues devoted to feminism and medical ethics. The few essays by feminists published up to that time in the premier U.S. journal in bioethics, the Hastings Center Report, dealt solely with ethical...

Addiction as a Modern Governing Image

The concept of addiction as an affliction of habituated drug users first arose in its modern form for alcohol as heavy drinking lost its banalized status in the United States and some other countries under the influence of the temperance movement of the nineteenth century (Levine Valverde). Habitual drunkenness had been viewed since the Middle Ages as a subclass of gluttony now abstinence from alcohol was singled out as a separate virtue and an important sign of the key virtue in a democracy of...

Gender identity

The term gender has a long history, with Greek roots signifying birth, race, and family and Latin roots signifying birth, race, and kind. The psychologist John Money was among the first to use the term to refer to a person's felt identity as male or female, as distinguished from that person's biological sex traits (Money). The term also is used to refer to a person's nature or identity as male or female and to social aspects of sex such as the cultural roles of men and women. Various biological...

Gender Identity Disorders

Some people assert a gender identity that is at odds with their anatomy and genetic traits. The American Psychiatric Association (APA) treats some of those people as suffering from gender identity disorder (GID). GID sometimes is called gender dysphoria, and it occurs in children, adolescents, and adults. According to the APA, people with this disorder are characterized by a strong and persistent cross-gender indentification (American Psychiatric Association, 2000, p. 581). This preoccupation...

Addiction and dependence

While addiction has been called a victimless crime, nothing could be further from the truth. Research consistently demonstrates that acts of violence against self and others, accidents, decreased productivity, health problems, and a number of other social ills have links to alcohol and drug abuse and addiction. Every day we read about, hear about, or know someone who is a victim of a crime caused by those who use or seek drugs. For some, it is tempting to ignore the ravages of addiction by...

Risk Factors and Characteristics

Although early studies were useful in documenting the existence of the problem and promoting state elder abuse policies, they were generally based on data collected from agency files, used small, unrepresentative samples, and lumped together the various types of abuse. Karl Pillemer (1986) sought to overcome some of these methodological weaknesses by interviewing victims directly, adding a nonabused comparison group, and limiting the investigation to physical abuse. His results showed that the...

Is Alcoholism a Disease

Beliefs about the cause or causes of alcoholism and the nature of drinking problems exert an important influence on public perceptions, institutional responses, and treatment and prevention, and shape the framework that guides ethical inquiry and response. The disease concept of alcoholism, first articulated by Elvin M. Jellinek in the 1940s, was actively promoted by a loose coalition of reformers, service providers, and recovering alcoholics. Since then, it has become the official view of the...

Islam

The idea of eugenics is not well developed in the Islamic world. Both Islamic law and tradition generally condemn abortion, which is permitted only if the mother's life is endangered, so there is no genetic counseling that would lead to abortion. Both religious law and tradition do include references to a man's choosing an appropriate wife, but these concerns have been interpreted as moral and social, rather than eugenic. Islamic religious-moral law, the Shari'a, deals with questions concerning...

Managing Incompetence

Because functional or decision-making capacities occur on a continuum and because a person's capacities can be expected to fluctuate over time, in most cases a clinician need not be resigned to accept a patient as permanently incapacitated. The clinician frequently has opportunities to enhance the person's functional or decision-making capacity. Hearing aids, eyeglasses, psychotropic medication, counseling and psychotherapy, and specific behavioral training in the area of incapacity are...

Findings about Morbidity and Mortality

In the 1980s some African clinician-activists from countries that practice those rites documented and brought to the world's attention the accompanying morbidity and mortality. Those pioneering medical studies include the ones conducted in the Sudan by Asma El Dareer (1982), in Sierra Leone by Olayinka Koso-Thomas (1987), and in Somalia by Raquiya Haji Dualeh Abdalla (1982). The death, infection, and disabilities associated with the rites are well established, challenging local beliefs that the...

Choice And Definition Of Problems To Be Studied

Many diseases that occur in both sexes have been studied in males only and or used a male-as-norm approach. Cardiovascular diseases serve as a case in point. Research protocols for large scale studies (MRFIT Grobbee et al. Steering Committee of the Physicians' Health Study Group) of cardiovascular diseases failed to assess gender differences. Women were excluded from clinical trials of drugs, they said, because of the desire to protect women or fetuses (and fear of litigation) from possible...

The Monetary Value of Life

CBA, in contrast to CEA, demands the assignment of monetary value to the benefits of a program or procedure. The health benefit whose monetarization has received the most explicit attention in the literature of CBA is life itself. Economic evaluation of life itself, as superficial and distorting as it may sound, is in one sense now an ordinary phenomenon. Now that a great number of effective but often costly means of preserving life are available, we inevitably and repeatedly pass up potential...

Normative Ethical Theories

The concept of normative ethics was invented early in the twentieth century to stand in contrast to the concept of metaethics. In ethical theories prior to the twentieth century, it is impossible to discern any sharp distinction between what have come to be called metaethics and normative ethics. In the first half of the twentieth century, however, this distinction began to structure ethics as an intellectual discipline and it continues to be influential at the end of the twentieth century even...

Casuistic Writings

Through the fourteenth and fifteenth centuries, many books of cases of conscience were published. The Summa Angelica (1480) and the Summa Sylvestrina (1516) were the most famous. However, these works were staid, unimaginative, and formalistic many authors simply plagiarized from more celebrated authors. But casuistry properly speaking came into its own in the mid-sixteenth century. In 1556 a Spanish canonist, Martin Azpilcueta, published A Handbook for Confessors and Penitents, which...

Dementia

The syndrome of dementia is an irreversible decline in cognitive abilities that causes significant dysfunction. Like most syndromes, dementia can be caused by a number of diseases. In the nineteenth century, for example, a main cause of dementia was syphilis. As a result of dramatic increases in average human life expectancy, dementia is caused primarily by a number of neurological diseases associated with old age. Dementia is distinguished from pseudo-dementia because the latter is reversible...

Confidentiality and the Control of Genetic Information

Medical genetics is more concerned with the family than almost any other medical subspecialty. As part of the evaluation of a clinically significant genetic disorder, the genetic counselor is required to collect detailed family data and record it in the form of a pedigree. This enables the counselor and the medical geneticist to determine whether there is a pattern of occurrence in the family consistent with control by a single gene of major effect (often referred to as a Mendelian gene). The...

The Argument from Cruelty

The language of this argument is sometimes taken from the Eighth Amendment of the U.S. Constitution (Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted) or from human-rights declarations that outlaw cruel, inhuman or degrading treatment or punishment. Thus, a brochure titled When the State Kills, issued by the British Section of Amnesty International (1990), contains the following passage under the heading Cruel, Inhuman and Degrading...

Law And Bioethics

Abortion Contemporary Ethical and Legal Aspects Abuse, Interpersonal Advance Directives and Advance Care Planning Animal Research Law and Policy Children Rights of Children Conflict of Interest Death, Definition and Determination of Legal Issues in Pronouncing Death Death Penalty Disability Legal Issues DNA Identification Environmental Policy and Law Epidemics Expert Testimony Fertility Control Legal and Regulatory Issues Genetic Discrimination Health Insurance Human Rights Impaired...

Mahayana Buddhist Thought and Practice

Even a brief survey of Mahayana Buddhism, which arose less than 500 years after the historical Buddha's lifetime, strongly suggests that Buddhist bioethics cannot be approached in singular terms. Mahayana refashions Theravada perspectives through the concept of sunyata (emptiness), while adding a new soteriological possibility based on faith birth in a Buddhist paradise as the goal of religious praxis. Thus, Mahayana Buddhism incorporates the ideal of enlightenment achieved through individual...

Internet Resources

Congregation for the Doctrine of the Faith. 1974. Declaration on Procured Abortion. Vatican. Available from < www.vatican. Congregation for the Doctrine of the Faith. 1987. Respect for Human Life (Donum vitae), Vatican. Available from < www.cin. org vatcong donumvit.html> . Dorff, Elliot N. 2002. Embryonic Stem Cell Research The Jewish Perspective, In United Synagogue Review Available from Pontifical Academy For Life. 2000. Declaration on the Production and the Scientific and Therapeutic...

Bibliography

Islam and Biological Futures Ethics, Gender, and Technology. London Mansell. Augustine. 1955. Enchiridion. In Confessions and Enchiridion, tr. and ed. Albert C. Outler. Library of Christian Classics, vol. 7. Chap. 23 84-85. Philadelphia Westminster Press. Breck, John. 2000. The Sacred Gift of Life Orthodox Christianity and Bioethics. Crestwood, NY St. Vladimir's Seminary Press. Bush, Lester E. 1985. Ethical Issues in Reproductive Medicine A Mormon Perspective, Dialogue A...

Criticisms of Autoexperimentation

Critics of autoexperimentation object to the practice on both methodological and ethical grounds. METHODOLOGICAL ISSUES. The worth of an experiment depends upon its scientific merit, upon its permissibility from ethical and legal perspectives, and upon its advisability on other grounds. Before any experiment is carried out, each of these elements must be assessed. Autoexperimentation suffers from three major methodological problems. First, there is an inherent difficulty in observing oneself...

Theories Of Aging And Life Extension

Theory without fact is fantasy, but fact without theory is chaos. C. O. Whitman (1894) An old adage says that nothing is certain except death and taxes. That is true, but it does not say anything about four score being the absolute measure of a person's years. That is good because knowledge about the biology of aging is changing, and with it people's expectations of what they can do about it. This new knowledge and the likely uses people will make of it will challenge perceptions of what...

Modern Behavioral Psychology

The Nobel Prize winning research of Ivan Pavlov (1849 1936) addressed gastric physiology and the chemistry of digestion. But in the process of studying the formation and secretion of digestive enzymes, Pavlov discovered that initially automatic or innate reflex mechanisms could be controlled externally by associating them with specific events in the environment. His theories of classical conditioning were grounded in neurophysiology and were intended to replace the mentalistic approach of...

The Existing Tradition

One of the reasons it is easy to slip between the phenotypic and genotypic senses of prevention in discussing genetic medicine's goals is that the desire to bear children free from specific genetic diseases can and often does provide a rationale for prospective parents' interest in the specialty's services. But that does not pose a professional ethical problem for clinical geneticists whether the intervention is genetic counseling, adult carrier screening, intrauterine diagnosis,...

International Population Control

The highly politicized nature of family planning in the United States has had major implications for the developing world. In response to pressures by conservatives, the emphasis of U.S. population programs abroad shifted heavily to programs promoting natural family planning rather than the more reliable methods of artificial contraception. Most notably, the Mexico City policy adopted by the Reagan administration in 1984 stipulated that no U.S. aid would go to any international organizations...

The Modern

With the coming of the modern era at the time of the Renaissance, which began in the fourteenth century, an emphasis on this world, nature, and the individual replaced the medieval focus on the hereafter. The secularization of paradise or the hope of realizing beauty, youth, and health in an earthly life has influenced human thought and action and the course of medicine up to the present. Empirical observation, causal explanation, and rational therapy became the ideals of education, research,...

Methods

Given the diverse objectives of ethics education, it is no surprise that a variety of methods have been developed to help students develop the knowledge, attitudes, and skills needed to become proficient in dealing with ethical issues in clinical practice. Teaching methods have ranged from large group lectures providing conceptual and historical overviews of issues in medical ethics, to seminar room discussions of paper cases, to participation in discussions of actual cases encountered during...

Criticisms of Autonomy

Some authors (Clements and Sider Callahan Thomasma) have criticized the centrality of autonomy in medical decision making. Their argument states that the primary obligation of healthcare providers is to maintain and restore health. There are two aspects to this claim. First, if patient autonomy is given primacy over the obligations of health professionals, physicians and other providers may violate their obligation to maintain and restore the health of patients for example, a patient may refuse...

Conclusion Ethical Implications

The history of epidemics suggests that society's responses have usually included scapegoating marginal and already stigmatized groups and the restriction of their civil rights. From the Jews massacred during the Black Death in medieval Europe, through the beggars and vagrants blamed for the spread of cholera in the nineteenth century, to the prostitutes arrested for allegedly infecting troops with syphilis during World War I, and the minorities whose life-styles were widely regarded as...

Hinduism And Buddhism

Because reproduction is one of the most important concerns of human life, most religions concern themselves with the regulation of sexual activity, marriage, and production of children. Hinduism and Buddhism also guide their followers in these matters, but in ways very different both from each other and from Western religions. Eugenics might be defined as controlling human reproduction to modify or benefit the species. Prior to the present innovation of genetic engineering, eugenics meant...

The Middle Ages

The Christian Middle Ages (500-1300) interpreted health and sickness in a theological perspective. Cosmological (or natural) and anthropological (or human) approaches were subordinated to, without being supplanted by, the supernatural notion of transcendence. Christian beliefs and natural causes for health and disease were not mutually exclusive. Sicknesses could be described simultaneously as physical entities and as acts of God's intervention. The Christian, Arabic, and Jewish traditions all...

The Growth of Medical Ethics Education

A series of empirical studies in the 1970s and 1980s documented the rapid growth of teaching programs. In a 1974 survey, 97 of 107 responding medical schools reported teaching medical ethics (Veatch and Solitto). Only six of these schools, however, reported a required exposure to medical ethics. In 1982 a majority of physicians reported that they had never received formal education in clinical ethics, and many felt inadequately prepared for common ethical problems in medicine (Pellegrino et...

Historical Background

An understanding of the emergence of bioethics will help to capture the panoramic breadth and complexity of the field. The 1960s is a pertinent point of departure, even though there were portents of the new field and issues in earlier decades. That decade brought into confluence two important developments, one scientific and the other cultural. In biomedicine, the 1960s was an era of extraordinary technological progress. It saw the advent of kidney dialysis, organ transplantation, medically...

Health and Wholeness

Healing is an action whose goal is the restoration of health. The English word health literally means wholeness and to heal means to make whole. Ancient Greek had two words generally translated as health hygieia, meaning a well way of living, and euexia, meaning good habit of body. Leon Kass (1985) notes that the English and both Greek words for health are totally unrelated to all the words for disease, illness, and sickness. This is also true for German, Latin, and Hebrew. In addition, the...

Two Key Distinctions and Four Basic Categories

While the public debate continued, scientists, clinicians, and scholars began to envision potential medical uses of HGE as they developed a framework for justifying the application of gene transfer technologies to human beings. Two key distinctions defined this framework the somatic versus germline distinction and the therapy versus enhancement distinction (Walters Anderson, 1985, 1989). Those distinctions implied four types of HGE Anderson (1989) and others argued that SGT could be justified...

Resource Allocation

Many children do not receive basic healthcare or social services. In some cases, countries that can afford to provide those services allocate insufficient funds for them. For example, the main health problems of children in the United States arise from failure to provide such basic care for children's allergies, asthma, dental pathology, hearing loss, vision impairment, and chronic disorders (Starfield Newachecket et al.). Basic healthcare and social services promote children's well-being,...

Research on Unimplanted Embryos and Fetuses Beyond the Fourteenth Day of Development

The developing human organism is technically called an embryo during the first eight weeks following fertilization. It is called a fetus for the remainder of its development. In this section, prolonged in vitro culture of embryos and fetuses will be evaluated. Prolonged embryo culture has been undertaken in several species of nonhuman mammals, especially rats and mice. In the early years of research, embryos at various stages of development were removed (or explanted) from the uteri of pregnant...

Improving Well Being and Health

In the United States and many other medical healthcare systems, a fee for service operating basis, or fee for time, results primarily in action from duty and obligation. However, there is leeway even within this operating system that provides opportunity to go the extra mile for the patient, or engage in compassionate caring for the sick person. Initial research has shown that empathy, valuing the patient, and giving the patient a sense that he or she is understood can be powerful factors in...

Disease and Illness

Illness makes one aware of the precariousness of the world. To capture the profound dislocations caused by illness, it is useful first to distinguish between illness and disease (Cassell, 1985 Engelhardt, 1982). Modern medicine has been largely concerned with understanding and treating specific diseases. Yet to diagnose an individual as having a disease means looking beyond that particular individual one notes a cluster of signs and symptoms that have repeatedly presented in a range of cases....

Types of Freedom

Diverse freedoms contrast with different types of restrictions, limitations, or restraints that negate them. Some freedom-inhibiting conditions are internal to persons, some external, some negative, some positive. Joel Feinberg (1980) developed a useful four-way typology of constraints external positive, external negative, internal positive, and internal negative. Examples of these, respectively, are lack of money, being handcuffed, fear, and weakness. In the free will controversy, freedom of...

Social Policy Considerations

Despite the initial hopes of early enthusiasts like English scientist Francis Galton (1822-1911), large collections of ordinary fingerprints have never been useful for much else besides individual identification. (Rabinow) The informational potential of the human genome, however, does require the designers of iDNAfication systems to consider in advance the range of uses they should accommodate. Even when a DNA profile collection is committed exclusively to use for personal identification...

Allocation Approaches

Allocation criteria, the building blocks of microallocation, must be prioritized and arranged into some sort of basic approach if microallocation decisions are to be ethically consistent. This approach can then serve as a framework for designing specific allocation procedures tailored to particular resources and settings. Approaches tend to be justified ethically by appeals to norms such as productivity, equality, and freedom, but relatively little grounding is typically provided for these...

Biotechnology and the Developing World

From a global perspective, increased production of food, however efficient, will not relieve the principal causes of famine and hunger, for these forces involve powerlessness, destitution, civil war, and oppression. The road to food security lies in making governments less corrupt, reducing ethnic and racial rivalries and hatreds, ending civil wars, improving education, providing employment, and halting gender discrimination. Food security is a function of social justice. With or without the...

Bioethics Perspective III Informed Consent and Racism in Research

Informed consent in research is an ethical principle that has particular relevance to African Americans and similarly vulnerable populations. Throughout the history of this country, medical research has supported racist social institutions. The Tuskegee Syphilis Experiment (TSS) is the most egregious violation of informed consent against a specific group of people, but it certainly is not an isolated example. Enslaved women were used to conduct painful research on urine leaks into the vagina...

Ethics of Medical Practice

The activities of the physician (vaidya) were closely linked with the doctrine of the three aims of Hindu life (Caraka, i. 30. 29 Vagbhafa, i. 2. 29). Viewed as complementary, rather than contradictory, they guide appropriate behavior. By relieving suffering and adding to the sum of human happiness, a physician (assumed in the texts to be a man) fulfills the first aim, carrying out his religious duty from the generous fees of his wealthy patients he achieves the second aim, riches while the...

Cost Effectiveness Cost Benefit and Risk Benefit Analysis

Efficiency involves the basic economic concept of opportunity cost the value sacrificed by not pursuing alternatives that might have been pursued with the same resources. When the value of any alternative use is less than the value of the current service, the current one is efficient when the value of some alternative is greater, the current service is inefficient. In thinking of the possible alternative uses, our sights can be set either narrowly or broadly. If we focus just on other options...

Patterns of Resort

The idea that in any community an individual's medical behavior is congruent with a unitary set of meanings concerning sickness and its causes, diagnosis, and treatment is an obstacle to translating medical realities between cultures. Anthropologists make a series of distinctions between medical traditions, sectors, and systems so that they compare cultural norms of medical behavior 1. A medical tradition is a set of practices and technologies organized around historically situated ideas about...

The Power of the Healer

Although he recognizes the limitations of traditional medical theory, Cassell does not intend to belittle or dismiss the role that the scientific explanation of disease has in Western culture or the promise it holds for the world. He wishes, in fact, to acknowledge its power The therapeutic power of the doctor-patient relationship grows in importance as the technology of cure becomes more powerful (1991, p. 69). Yet, unfortunately, even as the importance of the relationship between doctor and...

The Formation of Gay Identity

Research suggests that individuals develop their sexual identity in stages. However, the specific process by which people develop sexual identity is not well understood and is subject to great variation across individuals. Troiden (1989), who has written extensively about the process of identity formation among homosexuals, has posited that identity formation proceeds through four phases sensi-tization, identity confusion, identity assumption, and commitment. Troiden observed that children may...

Veracity and Truthtelling in Genetic Counseling

A major part of the genetic counseling process is the exchange of information about the medical and family history provided by the counselee and comprehensive genetic and medical information about the disease in question provided by the counselor (Fraser, 1974 Hsia). The counselee needs accurate information, including the correct diagnosis, in order to choose a beneficial course of action. Truth-telling is an essential ingredient of the relationship between genetic counselors and counselees....