Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted (...) to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. (shrink)

Background Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. Methods Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents’ sense of comfort (...) in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. Results Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. Conclusions Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training. (shrink)

Conservative ethical systems, particularly organized religions, are frequently at odds with the means, if not the goals of the new reproductive technologies. Among the most problematic measures adopted in recent years to allow childless women to raise genetically related offspring is surrogate motherhood. Traditional Jewish law, or Halakha, notwithstanding this reluctance, is, nevertheless, more likely than many others to find reasons to justify the practice, given its well-known stance viz procreation and its leniency regarding the new reproductive technologies. In the (...) following article, we ask whether Halakha, which allows abortion to save the life of a mother, would sanction the employment of a surrogacy arrangement in the case where pregnancy threats her life, in order to save the fetus as well. (shrink)

Friesen et al. (2023) describe barriers to research in patient populations that have been historically labeled as vulnerable and, as a result, are under-represented in research due to the Instituti...

Providing the most thorough coverage available in one volume, this comprehensive, broadly based collection offers a wide variety of selections in four major genres, and also includes a section on film. Each of the five sections contains a detailed critical introduction to each form, brief biographies of the authors, and a clear, concise editorial apparatus. Updated and revised throughout, the new Fourth Edition adds essays by Margaret Mead, Russell Baker, Joan Didion, Annie Dillard, and Alice Walker; fiction by Nathaniel Hawthorne, (...) Ursula K. LeGuin, Anton Chekov, James Joyce, Katherine Mansfield, F. Scott Fitzgerald, William Faulkner, Alice Walker, Louise Erdrich, Donald Barthelme, and James McPherson; poems by John Donne, Robert Browning, Walt Whitman, Edwin Arlington Robinson, e.e. cummings, Langston Hughes, W.H. Auden, Philip Levine, and Louise Gluck; and plays by August Wilson, Marsha Norman, Wendy Wasserstein, and Vaclav Havel. The chapter devoted to film examines the relation of film to literature and gives the complete screenplay for Citizen Kane plus close analysis of a scene from the film. With its innovative structure, comprehensive coverage, and insightful and stimulating presentation of all kinds of literature, this is an anthology readers will turn to again and again. (shrink)

De Interpretatione is among Aristotle's most influential and widely read writings; C. W. A. Whitaker presents the first systematic study of this work, and offers a radical new view of its aims, its structure, and its place in Aristotle's system. He shows that De Interpretatione is not a disjointed essay on ill-connected subjects, as traditionally thought, but a highly organized and systematic treatise on logic, argument, and dialectic.

The House of Lords debate of July last on the Death Penalty Abolition Bill 1 may prove to have been a landmark in British constitutional and legal history; certainly it was of the greatest interest as a specimen of current moral thinking and moral conflicts on the death penalty; and it is in this latter light that I shall discuss it here. Socialists and radicals might of course complain that a predominantly Conservative House of Lords could not be representative of (...) current thinking; and they might contrast the voting for the second reading of Mr. Silverman's Bill in the Lords—Contents 95, Non-contents 238—with the votes that had previously been recorded in the Commons. (shrink)

Objective To determine the attitudes of Egyptian patients regarding their participation in research and with the collection, storage and future use of blood samples for research purposes. Design Cross-sectional survey. Study population Adult Egyptian patients (n=600) at rural and urban hospitals and clinics. Results Less than half of the study population (44.3%) felt that informed consent forms should provide research participants the option to have their blood samples stored for future research. Of these participants, 39.9% thought that consent forms should (...) include the option that future research be restricted to the illness being studied. A slight majority (66.2%) would donate their samples for future genetic research. Respondents were more favourable towards having their blood samples exported to other Arab countries (62.0%) compared with countries in Europe (41.8%, p<0.001) and to the USA (37.2%, p<0.001). Conclusions This study shows that many individuals do not favour the donation of a blood sample for future research. Of those who do approve of such future research, many favour a consent model that includes an option restricting the future research to the illness being studied. Also, many Egyptians were hesitant to have their blood samples donated for genetic research or exported out of the Arab region to the USA and European countries. Further qualitative research should be performed to determine the underlying reasons for many of our results. (shrink)

This is a surprisingly good book. Published by Longmans in Great Britain as part of a series on "Education Today," it provides a very lucid and cogent first glimpse at the discipline of the philosophy of religion. The author's perspective is derivative of the analytic school, but what makes the book so valuable is that Goodall relates linguistic distinctions to Biblical categories. The author makes it obvious that he is a believer and authenticates the conviction that one can be a (...) believer and still sound like Flew or Ryle. The influence of Ian T. Ramsey comes through loud and clear. Goodall presents his proofs for the validity of religious statements with clarity and vigor. Worth the price of the book alone is Goodall's discussion of Lear's "The pobble who had no toes."--W. A. J. (shrink)

T he O bject of this paper is the development of a view of punishment which incorporates what is of importance in retributive and utilitarian justifications of the practice of punishment. This proposed theory was noted and referred to as the plene esse , but not fully worked out, in the course of a discussion paper in which my concern was to offer an alternative view, to that of Mr Anthony Quinton, by construing ‘the right to punishment’ as meaning that (...) ‘the offender has the right to be regarded as responsible for his actions’. (shrink)

The additional data, perspectives, questions, and criticisms contributed by the commentaries strengthen our view that local cortical processors coordinate their activity with the context in which it occurs using contextual fields and synchronized population codes. We therefore predict that whereas the specialization of function has been the keynote of this century the coordination of function will be the keynote of the next.