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....

The International Perspective

The other motto, Think globally act locally, recognizes that environmental problems have important global dimensions, particularly because carbon dioxide and other greenhouse gasses threaten to cause climate change. To some extent the international community has dealt successfully with environmental threats for example, the Montreal Protocol, an international accord signed in 1987, initiated controls on the production of chemicals that damage stratospheric ozone. And conventions aimed at...

Religious Conceptualizations of the Body

Perhaps the most vivid example from the domain of religion that the body is a cultural phenomenon subject to cultural transformations is given in the classic work on New Caledonia by Maurice Leenhardt, the anthropologist and missionary. Leenhardt recounts his discovery of the impact of Christianity on the cosmocentric world of the New Caledonian Canaques via a conversation with an aged indigenous philosopher. Leenhardt suggested that the Europeans had introduced the notion of spirit to the...

Sterilization

Sterilization is a particularly useful technique for men and women who are certain that they have fulfilled their reproductive agenda. For these individuals sterilization provides an uncomplicated and generally certain method of limiting fertility. Whereas sterilization done competently is 100 percent effective, cases have claimed damages for children conceived as the result of incomplete sterilizations. The key legal issues in sterilization involve the need to ensure that the choice is made by...

Buddhism

In order to understand Buddhist responses to cloning, it is important to note that Buddhist teaching generally emphasizes the centrality of individual judgment and discretion informed by reflection on Buddhist texts and the opinion of respected teachers. Thus, on cloning as on other issues, it is difficult to speak of a Buddhist position. Nevertheless, the tradition clearly emphasizes a number of values that are helpful in framing a Buddhist response to cloning. First, in Buddhism, human...

The Implications of Abortion

The liberalization of abortion law establishes rights for women who wish to terminate their pregnancies. The full implications of those rights are unclear for 1. the use and disposal of fertilized eggs, embryos, and fetal remains 2. the enforceability of surrogate mother and surrogate gestator contracts granting third parties a legal interest in a woman's pregnancy 3. the criminalization of pregnant women's conduct 4. the tort liability of healthcare providers for wrongful birth and wrongful...

The Course of Grief

There have been a number of approaches to understanding the process or course of acute grief. Earlier approaches tended to see grief as proceeding in stages or phases. Colin Murray Parkes (1972), for example, described four stages of grief shock, angry pining, depression and despair, and detachment. Recent approaches have emphasized that grief does not follow a predictable and linear course, stressing instead that it often proceeds in a roller-coaster-like pattern, full of ups and downs, times...

Anthropology and the Study of Biomedical Technology

A broad range of clinical issues and public health concerns have been addressed by anthropologists, including end-of-life decision making, definitions of death, human organ and tissue transplantation therapies, disclosure of medical information, informed consent for medical treatment, reproductive technologies, genetic testing and screening, human rights, and treatment of human subjects in biomedical research. Scholars working at the boundary of anthropology and the field of science and...

Caring for in Clinical Medical Ethics 19201982

In championing the fast-developing technical art of medicine, Richard C. Cabot acknowledged and seemed to acquiesce in the fact that doctors and nurses were not caring for the whole patient Their attention was too strongly concentrated on the difficult tasks of diagnosis and treatment, and there is not enough attention left to go round (Cabot, p. 16). He was certainly in favor of manifesting courtesy and patience with sick people but under some conditions, he said, it is not advisable for the...

Vegetative State

The vegetative state is characterized by the loss of all higher brain functions, with relative sparing of brainstem functions. Because brainstem functions are still present, the arousal mechanisms contained in the brainstem are relatively intact and the patient therefore is not in a coma. The patient has sleep wake cycles but at no time manifests any signs of consciousness, awareness, voluntary interaction with the environment, or purposeful movements. Thus, the patient can be awake but is...

Model of Permission

The model of permission became the pervasive one around the world in the final quarter of the twentieth century. Under the model of permission, abortion is legally available, but only with the approval of government officials or officially-designated decision makers, such as administrative boards, committees, physicians, or judges. In some permissionmodel jurisdictions, officials grant permission pro forma in nearly every case. In Norway, prior to 1975 reforms that liberalized abortion, as many...

Allocation Criteria

Before examining such approaches, this entry addresses the justifications and weaknesses of the major allocation criteria from which implemented or proposed approaches have been constructed. As one nationwide questionnaire study of microallocation criteria favored by selected medical directors has documented (Kilner, 1990 hereafter, U.S. Study), these criteria can be clustered into four major types social, sociomedical, medical, and personal criteria. SOCIAL CRITERIA. The characteristic feature...

Clinical Research Issues

Activists and the scope of the HIV epidemic forced society and scientists to reconsider fundamental questions about clinical trials of promising new therapies (Lo, 2000b). WHAT IS THE GOAL OF THE CLINICAL TRIAL To most scientists and to the U.S. Food and Drug Administration (FDA), the goal of clinical trials is to determine the safety and effectiveness of new drugs. Historically, clinical research has been considered dangerous for subjects. The HIV epidemic, however, caused many patients to...

Model of Privacy

Under the model of privacy, the law rarely compels abortion and permits all or virtually all abortions, as long as they are performed by medically qualified persons in clinics, hospitals, or other qualified facilities. Safety is a frequent goal of legal systems characterized by the model of privacy, although safety is not necessarily suggested by privacy nomenclature. The former Soviet Union adopted the model of privacy on safety and privacy grounds in 1920, more than a half century before the...

Mortality Transition Patterns

There are two interesting patterns in the epidemiologic transition of the United States. In 1900 the average life expectancy for women was 2.6 years greater than that of men. By 1990 this difference had increased to 6.8 years. Although the increasing gender gap in longevity is attributable to more rapid declines in death rates for women at every age and for most causes of death, it is unclear why the mortality transition of women has proceeded at a faster pace than that of men. The prevailing...

Contemporary Debates in Social and Political Theory

Current debate in social and political theory has focused on the question of whether to buttress or to challenge the liberal consensus that came to prevail in modern Western industrial societies. These broad, competing schools of thought are known as liberalism, civic republicanism, and communitari-anism. A social movement informed by one or more of these traditions will exhibit conflicting tendencies and posit incompatible claims. Liberalism comes in many different forms. Some liberal thinkers...

Antiaging Interventions Ethical And Social Issues

An estimated 2,500 physicians in the United States had established specialty practices devoted to longevity medicine by 2003, and the American Academy of Anti-Aging Medicine (A4M) boasted 11,000 members in that year. The goal of this clinical community is to extend the time their patients can live without the morbidities of the aging process namely memory loss, muscle loss, visual impairment, slowed gait and speech, wrinkling of the skin, hardening of the arteries, and all the other maladies we...

Key Issues in Managerial Ethics

Conflicts of interest arise when someone has two sets of duties or obligations and meeting one set makes it impossible to meet the other. They embody the biblical admonition against serving two masters. Whether a conflict of interest is present is fact-dependent, and accurate determination requires careful scrutiny. The potential for a conflict of interest does not necessarily mean that there is a conflict of interest. It is useful to distinguish differing interests that...

Dmpa

Food and Drug Administration (FDA) approved contraceptive labeling for depot-medroxyprogesterone (DMPA) commonly known by its trade name, Depo-Provera. This culminated a twenty-year effort to make a long-acting injectable contraceptive available to American women. Based upon the findings of extensive clinical research done outside the United States over a decade, the FDA determined that while some concerns remained, DMPA was considered to be as safe as other...

Barrier Methods

Barrier methods include mechanical barriers such as male and female condoms, the female diaphragm and cervical cap, and chemical barriers such as spermicidal products. Nonprescription barrier contraceptives are an important contraceptive option because of their wide availability, relative ease of use, and acceptably high efficacy when used correctly and consistently. While the contraceptive efficacies of the various barrier methods when used alone are comparable to each other (typically about...

The Roles of Medicine and Law in the Islamic Debate on Abortion

Islam's response to abortion during the fourteen centuries of its existence has been documented mostly in the jurispru-dential works of its doctors of law and the medical writings of its physicians. Islamic perspectives on abortion have been shaped directly by both its theology and its revealed law (Shari'a). Because of the centrality of the latter as a practical guide in the religious and spiritual life of Muslims, however, they depend heavily on the deliberations and ethico-legal decrees...

Karma and Eugenics

The concept of karma can be interpreted, or sometimes misinterpreted, so that it appears to oppose eugenics. Karma holds that misfortunes in this life are due to harmful actions in a former life (although there are also social sources of unfavorable karma). By this interpretation, if a child is born with a genetic disorder, then the misfortune is due to previous voluntary actions that harmed others and hence is deserved. Furthermore, this karma must be worked off the suffering must be endured...

Implications for Medicine

The primary health specialty of family medicine, or family practice, distinguishes itself by focusing on the healthcare needs of people from cradle to grave, and by explicitly acknowledging the ways in which illness or traumas that individuals confront resonate through the families of which they are a part. More than any other medical specialty, family practitioners have espoused the view that the patient is the family, and they are typically trained to understand various family systems...

Uses of Reproductive Cloning

What uses might there be, or what reasons might someone have, for producing a human being through cloning What follows is a survey of a number of possible uses of this procedure, some of which are obviously more problematic than others. The ethical issues that have been or might be raised regarding the possible uses of reproductive cloning will then be discussed. One of the probable primary uses, if cloning does become a reality, is for the treatment of fertility problems. For example, if the...

Bibliography

They Decide Who Lives, Who Dies. Life November 9, 1962. Dottes, Anita L. 1991. Should All Individuals with End-Stage Renal Disease Be Dialyzed Contemporary Dialysis and Nephrology 12 19-30. Fox, Ren e C. 1981. Exclusion from Dialysis A Sociologic and Legal Perspective. Kidney International 19(5) 739-751. Fox, Ren e C., and Swazey, Judith P. 1978. The Courage to Fail A Social View of Organ Transplants and Dialysis, 2nd edition rev. Chicago University of Chicago Press....

The Body as a Cultural Phenomenon

It has been suggested that in contemporary civilization the human body can no longer be considered a bounded entity, in part because of the destabilizing impact of consumer culture and its accompanying barrage of images. These images stimulate needs and desires, as well as the corresponding changes in the way the social space we inhabit is arranged with respect to physical objects and other people (Featherstone et al.). In this process, fixed life-cycle categories have become blurred into a...

Rollo May and Erik Erikson Psychological Developments

Rollo May (1909-1994), a pioneer of the humanistic school of psychology, introduced to U.S. psychology the views of European existentialists. He made Heidegger's views on care more accessible to the average reader by pointing to their psychological and moral implications. May's 1969 book Love and Will was written in a historical period in which, he argued, humans were experiencing a general malaise and depersonalization resulting in cynicism and apathy, which he regarded as the...

Normative Ethics and Practice

The raison d'etre for normative ethics, as we have seen, is to guide action, and the theories explored above have been developed with such guidance in mind. There is general disagreement, however, about exactly how these normative theories are to relate to the resolution of particular normative problems. It is not easy to demonstrate how the debate between consequentialists and deontologists is related to more concrete disagreements about physician-assisted suicide or recombinant DNA research....

Goals

Ambitious and diverse goals have been proposed for medical ethics education, including increased awareness of ethical issues a cultivation of basic ethical commitments more humane medical practice tolerance of conflicting views development of analytic skill in moral reasoning enhanced intellectual development in ethics and the humanities positive attitudes toward patients less paternalism in clinical practice higher professional conduct and improved clinical decision making (Callahan Miles et...

Conclusion Bioethics Culture and Globalization

The experiences of death are culturally constructed within particular social and historical moments. An anthropological account of death takes into account the network of human relationships within which behaviors and practices associated with death and mourning are situated. A cultural analysis of the rituals and symbols evoked by death and dying also suggest the powerful role of social and economic conditions that necessarily define and constrain death experiences, including the treatment of...

Nursing Ethics Education in the United States

Nursing ethics has been incorporated to some degree in nursing education since the early twentieth century. In the early 1900s ethics was taught as a science necessary to the education of the competent nurse who put patient safety and welfare first (Robb). Ethics teaching, reflecting religious and military influences, focused on the character and ethics of the nurse, the virtues required of nurses (e.g., loyalty and obedience), the duties and obligations nurses owed physicians and the hospitals...

Reasoned Suicide and Mental Health

The aim of the idealized ascetic to attain release and end the cycle of rebirth provided an acceptable rationale for suicide in highly selected circumstances. Sallekhand is a Jain practice sanctioned for elderly mendicants involving ritual fasting that ends in death its aim is for the individual to meet the final moment with utmost tranquillity (Settar). The Dharmasastra literature, which outlines Hindu codes of conduct, also refers to another form of religious suicide, the great journey,...

Arguments for and against IGM

There is not sufficient space in this entry for an in-depth discussion of the arguments for and against applying IGM procedures to human beings, and so the entry will provide only a quick summary of those arguments (for further discussion, see Resnik, Steinkraus, and Langer Walters and Palmer President' s Commission Holtug). ARGUMENTS FOR IGM. The following arguments have been made in favor of IGM. 1. IGM can benefit patients by preventing genetic diseases as well as the disability, pain, and...

Oppression of Women

Beginning in the 1980s, despite insistence by people within the culture about their good intentions, voices worldwide condemned the rites as brutal forms of oppression of women comparable to making men eunuchs (removal of the testes or external genitals). International organizations denounced the practices, including UNICEF, the International Federation of Gynecologists and Obstetricians, and WHO, along with the American Medical Association and many women's groups. They deny that this is just a...

Dialysis kidney

Two principal therapies exist for patients who develop irreversible kidney failure and require renal replacement therapy to survive kidney dialysis and kidney transplantation. The topic of kidney transplantation is addressed elsewhere in the Encyclopedia. This entry discusses kidney dialysis. The two main techniques for kidney dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, blood is pumped from a patient's body by a dialysis machine to a dialyzer a filter composed of...

The Epidemiological Transition

Lower death rates from diseases such as cholera, typhoid, and tuberculosis were only partially the consequence of bacteriologically inspired state preventive measures, and the disease burden from acute infectious disease began to decline rapidly. The provision of clean, properly filtered water supplies and effective sewage systems reflected growing municipal pride and the middle-class desire for cleanliness. It made epidemics such as the outbreak of cholera that killed over eight thousand...

Rights Conflicts and Abortion

Most opposition to abortion is grounded in two assumptions the first is the moral personhood and right to life of the fetus the second assumption is that, in a conflict of rights, the right to life must trump a woman's right to privacy, choice, and bodily autonomy. Many pro-choice arguments ignore the second assumption perhaps because it seems intuitively implausible that any other right could outweigh a right to life and focus solely on the first assumption, either offering support for the...

Alleged Benefits of Female Circumcision

The modern defense of female circumcision allows us to reconstruct the ancient rules that governed moral action or behavior in polygamous communities. The defense enumerates a wide range of health-related and social benefits alleged to result from the practice 5. prevention of stillbirths in women pregnant for the first time 7. increase of matrimonial opportunities 9. improvement of male sexual performance and pleasure and 10. promotion of social and political cohesion. Cleanliness is regarded...

Research Not Followed By Embryo Transfer

Research in this context may be proposed for a variety of reasons. The goal of the research may be to assess the safety and efficacy of clinical practices, for example, IVF or the use of contraceptive vaccines. Alternatively the goal may be epidemiological, for example, to estimate the frequency of chromosomal abnormalities in early human embryos. Another goal that has gained significant national and international attention is the use of embryos for the creation of stem cells (Thompson et al.)....

Major Beliefs in African Religion

As an all-embracing worldview, African religion has a number of beliefs held in common by the community. Individuals cannot reject a particular belief, since beliefs are part and parcel of the wider community. The term community is used here to refer to a grouping of persons in a particular area who lead a fairly similar cultural life, within a given people or in a town. BELIEF IN GOD. Belief in God is found among all African peoples. The Creator and Preserver of all things, God is invisible,...

Phenotypic Prevention

The dominant rhetoric of contemporary public health genetics stresses phenotypic forms of prevention as the primary goal of population genetic screening (Coughlin). This is not surprising. Phenotypic prevention is a straightforward medical pursuit that few would criticize it is designed to further the health interests of individual patients by allowing them to avoid foreseeable medical problems. Almost all public health efforts outside of population genetic screening employ this concept of...

Genotypic Prevention

Genotypic prevention is a pursuit that is much more controversial than phenotypic prevention. That is understandable, for several reasons First, it is often hard to know what ends genotypic preventive measures are intended to serve. Genotypic preventive measures are usually described as a way of furthering the procreative interests of prospective parents, by allowing them to avoid the birth of individuals with foreseeable health problems (like AID following adult carrier testing for cystic...

Mental Health And Human Behavior

Divided Loyalties in Mental Healthcare Electroconvulsive Therapy Freedom and Free Will Genetics and Human Behavior Grief and Bereavement Health and Disease Homicide Homosexuality Human Rights Impaired Professionals Informed Consent Issues of Consent in Mental Healthcare Insanity and the Insanity Defense Institutionalization and Deinstitutionalization Life, Quality of Literature and Healthcare Mental Health, Meaning of Mental Health Mental Health Services Mental Health Therapies Mental Illness...

Artificial Hearts And Cardiac Assist Devices

DEATH, DEFINITION AND DETERMINATION OF II. LEGAL ISSUES IN PRONOUNCING DEATH LAW AND BIOETHICS (1995) University of Florida, Gainesville PHARMACEUTICS, ISSUES IN PRESCRIBING (1995) Institute for the Medical Humanities. University of Texas MENTAL HEALTH SERVICES II. ETHICAL ISSUES University of Chicago HEALTHCARE INSTITUTIONS Cornell University Medical Center MEDICINE, ART OF (1995) PAIN AND SUFFERING (1995) George Washington University PSYCHOANALYSIS AND DYNAMIC THERAPIES Centers for Disease...

The Moral Status of the Early Embryo

In contrast to China and India, most Western countries are deeply divided over ethical issues related to embryo research. Does the embryo merit full protectability from the moment of fertilization, or does it gradually attain full protectability as it moves through a series of developmental stages If fertilization is not the point of greatest moral significance, is there some later developmental marker beyond which embryo research ought not be conducted FERTILIZATION. Fertilization of egg by...

Public versus Private Control

All governments have some degree of involvement in healthcare because essentially all countries have a centrally funded agency that is concerned with public health issues. The proportion of healthcare expenditures spent on public health tends to be higher in low-income countries, although the level of effort varies greatly from country to country. Government involvement usually includes surveillance of communicable diseases and interventions to prevent or curtail epidemics. Some countries have...

Ethical Issues in Grief

Ethical issues in grief may emerge from three sources. First are general issues for counselors. Grieving persons can be highly vulnerable. Counselors have to have personal integrity and follow the ethical standards of their profession, including maintaining confidentiality, preventing harm to the client or others, assuring competence, and upholding standards of professional behavior. Counselors should familiarize themselves with their respective codes of ethics. They may wish to review as well...

The Impact of Science on Life Expectancy

Population aging also has implications in the context of human evolution. Scientists in the field of evolution biology have hypothesized, in nonhuman species, a link between reproduction and the rate of senescence (Finch). Although it is unlikely that the physiological mechanisms regulating human reproduction will be altered intentionally to postpone senescence, it may eventually become possible to manipulate the genome to achieve the same effect. In fact, the mapping of the human genome may...

Conclusion

Dialysis was one of the earliest life-sustaining treatments. Since its inception, dialysis has raised many ethical issues to be analyzed and resolved. In the 1960s the attempt to make difficult yet socially acceptable ethical decisions about patient-selection criteria and the rationing of dialysis failed because of the use of social worth criteria. The dialysis community and others learned from this experience. In the 1990s, prompted by the dramatic expansion of the ESRD program and a belief by...

Death in Systematic Religious Thought

The classical doctrines and rituals of Judaism and Christianity are no less complicated and diverse than their biblical backgrounds. Neither the Judaic nor the Christian tradition is monolithic. Both faiths have been developed over extended periods of time in response to changing historical circumstances and cultural influences. But these theological complexities can be simplified for purposes of comparing and contrasting their respective views of death. Just as there are elements of continuity...

Healing and Cultural Reality

Healing, of course, is a much broader cultural phenomenon than that encompassed by Western scientific medicine. Admittedly, the success of Western medicine at curing has helped justify its claim to be the model for healing in the world today. Yet, as Eric Cassell notes, the success of medicine has created a strain the doctor sees his role as the curer of disease and 'forgets' his role as healer of the sick, and patients wander disabled but without a culturally acceptable mantle of disease with...

Hellenistic Schools Epicureanism and Stoicism

Where death had been a distinctly secondary concern for Socratic thinking, it soon became a primary one for Hellenistic philosophers. For Epicurus, Lucretius, and Zeno, then Seneca, Epictetus, and Marcus Aurelius, discovering how to live life and confront death were the central tasks of philosophy. Although Epicureans and Stoics differed on what they most valued in life, they equally valued attaining equanimity in the face of imminent death. Epicureans in particular saw no reason to fear death,...

Orthodox Public Health and Alternative Practices

No practice has been more orthodox since the nineteenth century than public-health medicine. When microscopic technologies aided in the discovery of bacterial causes of infectious diseases, public-health physicians began energetic application of laboratory science on behalf of societal health. Public-health physicians were laboratory science's strongest advocates. They insisted upon strict quantitive standards of proof for what they considered ethical medical practice. Only what could be shown...

Modern Protestant Views on Abortion

Specific comment on abortion is rare in most Reformation traditions until the twentieth century. Perhaps in deference to the lack of biblical discussion, most reformers considered matters regarding the morality of abortion, like matters governing all sexual and reproductive behavior, to be ordered by human rational discernment. They were issues of natural morality rather than of revealed truth. Despite emphasis on recovering the meaning of Christian biblical tradition, Lutherans, Calvinists,...

Consequentialism and Abortion

The abortion debate in the United States has almost exclusively focused on questions of rights, to the exclusion of all other considerations. A consequentialist approach that assesses the morality of abortion in light of its good and bad consequences has the potential to resolve the rights standoff, and a number of consequentialist considerations have bearing on the abortion debate. Abortion critics have long raised fears of a slippery slope, charging that permissiveness about abortion will...

Objections to an Ethic of Care

Since the publication of In a Different Voice, the proposal to develop a feminine ethic of care has met with a variety of concerns and objections. One set of concerns is that a feminine ethic of care may unwittingly undermine feminism. These concerns stem, in part, from a belief that the qualities in girls and women that feminine ethics esteems have developed within the context of a sexist culture. Thus, some suspect that women's competency at caring for and serving others is an outgrowth of...

Biomedical Engineering Medical Technology and Issues in Bioethics

One reason for the growing public interest in bioethics is the rapid change in healthcare practice that has resulted from biomedical innovation. The resulting technology has both desirable and undesirable effects as well as many effects that, although not clearly negative or positive, alter the responsibilities of professionals and laypersons in regard to birth and death, illness, and injury. As people confront new information and new possibilities, they are faced with difficult decisions that...

Other Moral Considerations

Those who believe that the human embryo is a fully protectable human being have no choice but to oppose embryo research that could not ethically be performed on infants or children. But those who maintain that the early embryo is not yet a full human being, still have to determine how that embryo ought to be treated. Some have proposed severely restrictive criteria for embryo research. Norman Ford, after providing painstaking arguments to support the conclusion that the embryo cannot be a human...

Focus The United States

The Constitution of the United States does not mention abortion by name. However, the Supreme Court has consistently held since Roe v. Wade (1973) and Doe v. Bolton (1973) that the due process clause of the Fourteenth Amendment guarantees American women a fundamental right to obtain medically safe abortions. States may not categorically ban abortion or unduly burden women's fundamental constitutional right to terminate pregnancy. The state of Connecticut passed the first American legislation...

Withholding and Withdrawing Dialysis

After cardiovascular diseases and infections, withdrawal from dialysis is the third most common cause of dialysis-patient death. In one large study, dialysis withdrawal accounted for 22 percent of deaths (Neu and Kjellstrand). Older patients and those with diabetes have been found to be most likely to stop dialysis. Over time, as the percentage of diabetic and older patients (those sixty-five or over) on dialysis increased, withdrawal from dialysis became more common. According to surveys of...

Schizophrenia

There is evidence that schizophrenia, one of the most devastating mental illnesses with a whole life prevalence rate of about 1 percent, is a developmental disorder, tracing its origin to abnormalities in brain development, which cause subtle and non-specific behavioral changes in childhood and later lead to full blown psychosis, usually in adolescence. Duration of untreated psychosis seems to be a significant predictor of poor outcome (Harrigan et al.), thus making early identification and...

Figure 1

Opening for menstrual and urine flow 1-3 Vulva after infibulation. source Author. Opening for menstrual and urine flow 1-3 Vulva after infibulation. source Author. Mons veneris Labia majora Labia minora Mons veneris Labia majora Labia minora Clitoral hood Clitoris Urethra Skene's gland Vaginal opening - Hymen Bartholin's gland 1-4 Normal vulva before circumcision. forbids men to marry uncircumcised girls hence, circumcision of girls ensures they will be marriageable. Certain traditional...

Sharing Genetic Information

When a test has been performed and a result has been obtained, other considerations come into play. Perhaps the most vexing is whether and when a person has a moral duty to share genetic information. Genetic test results for a specific individual also reveal information about that person's relatives. Parents and children share half their genes, as do siblings. If a woman learns that she carries a gene associated with breast cancer, does she have a responsibility to share that information with...

The Meaning of Alternative and Conventional

Alternative implies alternative to orthodox, regular, mainline, or conventional medicine. These latter adjectives refer to a medical theory, based on modern science, that began to emerge in the Renaissance with medical innovators such as Andreas Vesalius (1514-1564) and Paracelsus (1493-1541), and to scientifically validated medical therapies that blossomed in the twentieth century. If alternative medicine is characterized by an enormous variety of different medical theories and practices with...

Drug Triggers The Brain Learns

Drug use provides a quick and powerful means of changing one's moods and sensations. In a cost-benefit analysis, the user seeks the immediately gratifying effects as a benefit that outweighs the long-term cost of drug use. Other users may be influenced by physical or psychological states such as depression, pain, or stress that may be temporarily relieved by drug consumption. Drug use is such a powerful rein-forcer and shaper of behavior that drug paraphernalia and virtually all of the events...

Hinduism

In no small measure, Vedic (Brahmanical) religion (1500-600 b.c.e.), its sequel now called Hinduism, and other Indian religions (Jainism and Buddhism) inherited views of death from the Indo-Europeans who came to India, probably from eastern Anatolia. Because life expectancy in the prehistoric world was about thirty years, on account of disease, natural calamities, and warfare, people turned to religion for help, performing rituals for health, physical security,...

The Body in Medicine and Philosophy

It should of course be recognized that, given the uniqueness of each embodiment, individuals experience their bodies (and, correlatively, the surrounding world) in different ways, depending on initial biological endowments, native and cultivated abilities, activities that are available and or encouraged, and others. Thus, a boy who from birth has been unable to walk experiences I can in quite different ways from a boy who has that ability. If the latter has an accident that renders him unable...

The Model of Prohibition

The model of prohibition governs official abortion policy in many African, Latin American, South Asian, and Middle Eastern countries. For example, Brazil and Sri Lanka permit abortion only to save the life of the woman. Most jurisdictions in Europe and North America reject the model of prohibition, permitting abortion on request, where pregnancy results from rape or incest, or where the continuation of pregnancy threatens the physical, mental or social well-being of the woman or her fetus....

Hazards of Alcohol

The potential social and economic costs of alcohol use to society can be staggering. In the United States alone, it is estimated that abuse of alcohol cost 136.3 billion in 1990 for alcohol-related diseases, accidents, lost productivity, and rehabilitation (Harwood et al.). Three aspects of alcohol use may present problems drinking itself, acute intoxication, and chronic heavy drinking, commonly referred to as alcoholism. Ethanol is a simple yet highly toxic molecule that is rapidly absorbed...

Bioterrorism

The issues associated with bioterrorism are as broad in their scope and as challenging in their complexity as any in bioethics. These issues engage the resources of basic sciences, history, political philosophy, sociology, healthcare administration, and public health, as well as clinical medicine. In some instances they present unique concerns, in others they are variations on more familiar bioethical problems. In providing a sound bioethical account of these problems this entry will presuppose...

Clinical Applications in Neuromodulation

The modern era of neuromodulation began in 1987 when the French neurosurgeon Alim Benabid noted improvements of parkinsonian tremor following stimulation of the thalamus (Speelman and Bosch). While engaged in mapping with electrodes prior to ablative surgery for Parkinson's disease, Benabid discovered that electrical stimulation of specific targets could modulate motor symptoms and tremor a technique that came to be known as neuromodulation. These observations inspired him to develop the modern...

Environmental Research and the Envirome

It is clear from epidemiological studies that more than half the variance of typical behavioral traits, as well as half of the liability for psychiatric disorders (including schizophrenia), is environmental. This has fueled major searches for various environmental causes. In schizophrenia, this work has been reviewed by Ming Tsuang and his colleagues, who note that the major environmental risk factors in schizophrenia are due to the nonshared environment. These include problems in pregnancy...

Nineteenth Century Alternative Medicine

One of the first challenges to the orthodoxy of regular physicians occurred in the early 1800s. Samuel Thomson (1769-1843) was a poor New Hampshire farmer whose mother and wife had suffered from the bleedings and mercurial drugs forced upon them by regular physicians. Thomson believed that better treatments must be available, and he began studying the therapeutic value of herbs. He soon developed his own system of botanical medicine predicated upon the assumption that...

Conflicts of Interest

A conflict of interest occurs when there is a clash between a physician's personal financial gain and the welfare of his or her patients. While a conflict of interest generally exists for all physicians who practice fee-for-service medicine, there is a potentially greater conflict of interest for physicians who share in the ownership of for-profit dialysis units in which they treat patients. Physicians who receive a share of the profits are financially rewarded for reducing costs. Although...

The Psychological and Social Context of Domestic Abuse

The changes that occur in a battered woman's sense of self-esteem and competence are often more lasting and more damaging to the woman than the actual physical abuse. Battered women learn to pay attention to their partner's needs instead of their own in hopes of reducing the violence. They begin to distrust their own judgment and their own abilities to provide for themselves and their children (if they have children). They may eventually come to believe that they deserve the abuse they receive....

Therapy versus Enhancement

Many of the writers, clinicians, and scientists who defended genetic therapy also had moral qualms about genetic enhancement. In genetic enhancement the goal of the intervention is not to treat or prevent a disease but to achieve another result, such as increased height, intelligence, disease resistance, or musical ability. Thus, according to many authors, there is a moral distinction between genetic therapy, which is morally acceptable, and genetic enhancement, which is morally unacceptable or...

Competence To Refuse Psychotropic Medication

In contrast to admission to a medical-surgical hospital, admission to a psychiatric hospital may be accomplished by voluntary or involuntary means. In either facility, however, there may be uncertainty about the patient's ability to consent to voluntary hospitalization. Patients who are demented or seriously depressed or psychotic often have difficulty understanding that they are ill, need treatment, or should be hospitalized. They may have difficulty comprehending the risks and benefits of...

Paradigm Applications

In the Roman Catholic bioethics literature, the PDE has long been invoked to deal with cases of maternal-fetal conflict to distinguish between permissible interventions that may result in the death of the fetus and abortion, which is absolutely forbidden (Barry). Consider the following set of maternal-fetal conflict paradigm cases. Paradigm 1 Therapeutic Hysterectomy. A thirty-three year old pregnant woman is diagnosed with a highly aggressive form of uterine cancer ten weeks into her...

Alcoholism

What are the benefits and problems that attend the use of alcoholic beverages In what ways may drinking cause harm Is the use of alcohol hazardous for all individuals or only for some Who is at risk Should an intoxicated person be held accountable for his or her actions while under the influence How is excessive drinking like or unlike other self-injurious appetitive behaviors such as overeating, smoking, or other substance abuse Should society limit or control the use of alcohol, and should it...

Religious Traditions A Jewish Perspectives

The Jewish discussion of abortion is a multi-vocal one that crosses several centuries of text and tradition. However, for a tradition in which much is in contention, the legal and ethical norms surrounding abortion are relatively less controversial. The tradition, in general, takes a clear middle path allowing some abortions, in certain circumstances, for specific rational moral appeals. For Jews who are not close followers of Talmudic law, the cultural and economic realities of modernity...

Religious Practices and the Body

The cultural-historical transformation of the body is highlighted by comparison of fasting as a technique of the body in the medieval somatic spirituality with the phenomenon of anorexia nervosa in the late twentieth century. In a study of 261 holy women in Italy since the year 1200, Rudolf Bell distinguishes between contemporary anorexia nervosa and what he calls holy anorexia. While the former is regarded as a syndrome of clinical pathology, in the latter, the suppression of physical...

The Control of Drugs and Alcohol

The control of drugs and alcohol involves both practical and philosophical considerations. Practically, a nation or locality has a limited array of controls, and those controls usually depend on the compliance of the public. EFFECT OF LICENSING AND TAXATION. During the English gin epidemic, Parliament was limited to using a variety of license fees and taxes, which were not always easily enforced, to curb the production of gin. Success in the campaign did not begin to be acknowledged by...

Cancer and the Oncologists Ethical Duties Some General Considerations

An oncologist's ethical responsibilities typically begin with a positive diagnosis of cancer, an event that triggers shock and anxiety in patients and their families. Cancer is associated by many people with disfigurement, dying, and death therefore, the first ethical duty of an oncologist and his or her team is to convey the diagnosis in a way that balances the reality of the disease and its implications with the overall need to maintain optimism and hope. Whereas the obligation to be honest...

Gender Assignment of Newborns and Children

The sex of a newborn child is of keen interest to the parents, but some children are born with ambiguous genitalia, having both testicular and ovarian tissue, or genetic syndromes that confound a simple designation as male or female. The term gender assignment refers to practices that are used to discern and impose a gender identity on a newborn child. Suzanne J. Kessler has described how cultural ideals of sex influence the practice of gender assignment. She showed that some physicians have...

Health Disease and Morality

Ayurveda, despite its emphasis on the humoral basis of health and disease, also recognized external (agantu) causes that provided a better account than endogenous (nija) causes that is, humoral imbalance to explain some medical conditions. Karma referred to the impact of misdeeds in a previous life. Irreverent, unethical behavior and other violations of codes of conduct (prajna-aparadha) in one's current life were not limited to effects on that individual they could also affect offspring...

The Bacteriological Revolution

Cholera was only the most dramatic of a number of infectious diseases that took advantage of urbanization, poor hygiene, overcrowding, and improved communications in the nineteenth century (Bardet et al.). Typhus, typhoid, diphtheria, yellow fever, tuberculosis, malaria, and syphilis continued to have a major impact, and even smallpox returned on a large scale during the Franco-Prussian War of 1870-1871. Treatment continued to be ineffective. But the rapid development of microscope technology...