As our knowledge of the genetic constitution of human beings expands, testing to determine an individual's disposition toward a given disease will also increase. Since genes are a family affair, to know that an individual is genetically disposed toward a specific disease is an indicator that members of this individual's family may also be so disposed.

The Principle of Double Effect has been with us since the Middle Ages and has sanctified actions that might otherwise be viewed as morally wrong. What I wish to show in this brief perspective is that an overlooked element in the discussions of this principle raises a serious question about its applicability.

Over the past several decades, conflicts between physicians and patients or patient surrogates concerning continued treatment or the withdrawal of treatment have received public and legal attention. In more recent years, there have been several prominent Instances in which physicians have refused to provide treatment requested by patient surrogates because such treatment was judged to be futile. The claim that a treatment is futile has far reaching consequences. It serves to justify the withholding or withdrawal of treatment and thus, perhaps, (...) to also justify the rationing of healthcare. It limits the autonomy of the patient or patient surrogate by reducing their participation in the decision making process. (shrink)

Unlike the compassionate conservatism of George Bush, Compassionate Utilitarianism is not a confusing concept. Nor is it a newly minted version of Utilitarianism given that it is embedded in the writings of Jeremy Bentham, writings that have come to light only with the Oxford University Press publication of his Deontology in 1983 as edited by me. Bentham's An Introduction to the Principles of Morals and Legislation expresses the standard interpretation of Hedonistic Utilitarianism. What he said in Deontology serves as the (...) basis of Compassionate Utilitarianism. (shrink)

Disease and illness are terms that are often used interchangeably by physicians and the lay public. But not all usage permits this. For instance, diseases are referred to in terms of entities with etiologies; illnesses are not. We also speak of illness as being the effect or symptom of a disease, but not the converse. In what follows, disease and illness will be treated as distinct concepts. a.

Because of the emphasis on individualism and self-governance, medical interventions and medical research in Western nations are preceded by attempts to obtain informed consent from the individual patient or potential research subject. Individual autonomy expresses our belief that persons are ends in themselves and not merely instrumentalities to achieve the goals of others. By respecting the patient or potential research subject in the context of medical decisionmaking, we acknowledge that these individuals are moral agents. Thus, individual autonomy is an important (...) feature of morality as it is practiced in the West. However, there are at least two circumstances in which individual autonomy appears to be threatened. One is embodied in nonwestern societies that favor collective decisionmaking over that of the individual. The other is related to the need for family histories and family testing to determine the susceptibility of family members to some genetically based disease. In both cases, individual judgment appears to be made subordinate to collective judgment. (shrink)

When Jean-Paul Sartre, the French existentialist philosopher, declared some four decades ago that man makes himself, this assertion was based on Sartre's belief that human beings do not possess an essential human nature. Man's self creation had to do with his freedom to choose the roles that he played or could play, and their attendant effects on his attitudes and responsibilities. It said nothing about his freedom to alter his biological nature.

More than three decades after its introduction as a legal requirement for medical treatment in the clinical setting, informed consent continues to be viewed with skepticism as to its need or effectiveness. Some maintain that it is not required because the ordinary individual believes that doctors can be trusted to behave In the best interests of their patients. This issue will be discussed in a later portion of this article. Others are persuaded that informed consent is an unattainable ideal given (...) the limited capacity of the ordinary individual to understand the relevant information. This view is supported by studies intended to show that satisfactory understanding on the part of patients cannot be achieved. In rebuttal, Apple-baum, Lidz, and Meisel observed that:Such statements are easily refuted by reference to studies of situations in which reasonable comprehension actually has been achieved. A sounder interpretation of all these studies might be that patients and subjects can attain a good level of understanding in many cases, but that several factors — including the manner in which disclosure is made as well as patients' limitations — may get in the way. (shrink)

There is large, imposing-looking box in a wing of University College, London, that contains the lifelike remains of the English philosopher, Jeremy Bentham. Bentham requested that upon his death, which occurred in 1832, his body should first be used for purposes of a medical lecture and then be place on display. His request was entirely utilitarian in character. For as a famous individual, Bentham could argue that it made less sense to be buried and then have a statue constructed of (...) his likeness than to eliminate the burial by having himself made into a statue. He called the latter an auto-icon. (shrink)

This article is a thoughtful and well written examination of some of the complex issues that have emerged as a result of recent improvements in the treatment of extremely low birth weight (ELBW) infants, including those who weigh 500 to 600 grams or who are believed to be 23 to 24 weeks gestation. The authors argue that the 23 to 24 week gestation period is filled with ambiguity and flexibility in practice relative to active resuscitation. However, such ambiguity and flexibility (...) is likely to prevail whatever the boundary conditions of viability happen to be. Thus moral guidelines that inform the rescue of an infant believed to be 500 to 600 grams or 23 or 24 weeks gestation are likely to be relevant whatever the boundary conditions are. (shrink)

Informed consent began as a way of protecting physicians against legal liability. It did so by requiring physicians to provide their patients with sufficient information so that the patients could assent to or withhold consent from a proffered medical treatment. It was also intended to be an accurate expression of the patient's wishes. As such, it established the conditions by which a patient could be held responsible for his decisions concerning medical treatment.

I am inclined to agree with Arthur Caplan that a less invasive means than was employed in the case of Ashley X would have been preferable. But, such means do not, as yet, exist. Given these circumstances, what are the issues that the bioethics committee needs to consider prior to making a recommendation to the surgeon?

In 1985, after a long university career teaching philosophy and humanities, in which my only serious worries over the years were centered on such things as getting promoted, course preparations, and faculty affairs, I found myself confronted, as a medical ethics committee member, with a life and death issue. It concerned the care of an infant suffering from posthemorrhagic hydrocephalus, for which there appeared to be no permanently effective treatment. The parents refused to consider the discontinuing of aggressive care even (...) though this prolonged the suffering of their child. This standoff continued for 5 months, until the parents decided that it was God’s wish that aggressive treatment cease. (shrink)

At 41 weeks, the patient had been delivered by Cesarean section for failure to progress at Hospital A in the same city. Three days after birth she suffered a respiratory arrest. Resuscitation and ventilator support were initiated promptly but the child did poorly, and shortly after this first arrest, the parents were told by the child's physician that she had no chance of recovery. Nevertheless, the mother continued to insist that the child be kept on a respirator and aggressive support (...) be maintained. (shrink)