Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not (...) been inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

ArgumentThe border in turn-of-the-century Argentina was a place of heightened anxiety. State officials ignored the nation's vast land borders and focused on the port, located in the capital city of Buenos Aires, which attracted nearly six million European immigrants in the decades after 1870. Federal authorities were seeking to attract new immigrants and yet they were terrified that opening their gates would allow entry among the potential citizenry a new category of “toxins” dangerous to the national body. The authorities (...) hired physicians as gatekeepers to identify desirable and undesirable traits that went beyond the definition of communicable disease. Science and medicine appeared to provide a means of legitimating a variety of attempts by the state to control the makeup of the population; in reality, the state's power to inspect immigrants for disease, racial toxins, social upheaval, and political instability was minimized by realistic decisions to open borders and by a weak and limited ability to control the influx of people. Alongside calls for immigrant selection there coexisted a strong trend in political discourse that sought to build a unified, homogenous national culture by accepting and assimilating the foreign masses. Both approaches, however, had similar goals – the material progress of the nation, the advancement of Argentina's “civilization,” and the erasure of traces of “foreignness” among the new population. (shrink)

During the last decades, in different places and under different circumstances, some physicians and other health professionals have supported state violence. The Holocaust is a prime example for how doctors can cooperate with the state to plan, give ideological support to and implement violent policies. As a consequence of the Industrial Revolution, people gained access to health promotion and health protection, not as an achievement of the welfare state, but as a tool necessary to maintain healthy and (...) more productive workers. Gradually, all social strata, employees and their relatives gained access to health coverage. Physicians as a group increased in number and changed the structure of their profession by establishing a symbiotic relationship with the state. Between the state and the medical class, different models of cooperation can be distinguished. In general, we can affirm that with the implementation of a public health system, greater interdependence among the state and the medical class was established. In the case of authoritarian or totalitarian regimes, the support of the medical class for violent policies depends on the degree of previous cooperation. National Socialist Germany and the Soviet Union are two striking examples of totalitarian states in which strong public health systems and subsequent close cooperation between the medical class and the state can be observed. In both countries, violent state policies were quickly accepted and integrated into medical practice. Practices such as forced sterilization, murder of patients or experimentation with prisoners were prevalent under National Socialism. The abuse of psychiatry as tool for exerting power was common in the Soviet Union. South American dictatorships constitute examples of totalitarian states with weak previous cooperation between the medical class and the state, as they did not have strong public health systems. In those countries, support for state violence can be found, such as participation of health care professionals in torture or abduction of babies, but cooperation was not as strong as in Nazi Germany or the Soviet Union. In other cases in which no strong previous relationship existed between medicine and the state, authoritarian regimes were not accompanied by medical support for violence, such as in the case of the Rwandan genocide or in Cambodia, where doctors were persecuted and murdered based on their membership of the bourgeois class. (shrink)

This superb account of the development of scientific research in the state of Baden places the growth of science in nineteenth century Germany within a broad social and economic context. The book analyses the progress of scientific research and its institutionalization in the state university system. Focusing on the experimental sciences, the book explores the introduction of the research ethic into the university medical curriculum, and the process by which laboratory science came to be an essential pedagogical tool (...) in the education of future citizens of the state. The social and economic changes that ultimately transformed Germany into a modern industrial state are also considered. It was within this setting that laboratory training, once considered inappropriate for university studies, grew in status, and that dissatisfaction with the overly theoretical education traditionally offered by the universities began to increase. Thus, much like computers today, the scientific method in the nineteenth century came to represent an instrument for teaching not only specific skills but also a particular way of approaching, analyzing, and solving the problems of an industrializing economy. This compelling volume will be of interest to historians of science, medicine, and European studies. (shrink)

This essay considers the creation of a gender identity clinic at Rikshospitalet, the National Hospital of Norway, in the early 2000s and its implications for the production of medical knowledge during that era. In the preceding decades, medical transition was overseen by an informal, self-organized, multidisciplinary team of medical experts, but this situation changed when a centralized gender identity clinic was established under psychiatric control. The essay argues that shifting institutional, societal, economic, legal, and bureaucratic circumstances redistributed expertise and authority (...) on trans medicine. Economic framing, institutional frictions, patient activism, and media attention restricted the doctors’ room for maneuver and created a scientific crisis of legitimacy in trans medicine. These processes changed medical knowledge regarding medical transition; eventually, “sex change” and, therefore, all that is denoted by “sex” became intertwined with and inseparable from the politico-bureaucratic processes of reforming a modern public health-care system and welfare state. By anchoring the analysis in the history of science and expertise, this inquiry offers a new focus on the role of bureaucratic practices in the production, structuring, and circulation of medical knowledge in the welfare state. (shrink)

One of the common characteristics of science, technology, and medicine is their ambition to epistemologically and organizationally move beyond the confines of nation states. In practice, however, they develop differently in countries or regions. Scientists, engineers, and physicians are constrained as well as enabled by national boundaries and specific cultures. The cultural status of such practices in reverse is influenced by a country's history, politics, and the view of the role of science, technology, and medicine in society. It (...) is the relation between a specific region, Scandinavia, and the history of science, technology, and medicine within this region that this issue of Science in Context sets out to explore. But what is this “Scandinavia”? To many, Scandinavia besides being a specific geographical region of three countries (Denmark, Sweden, and Norway) with entwined histories and closely related languages is a way of denoting a specific style or movement. “Scandinavian design” is renowned for three interrelated features; minimalism or simplicity, functionalism, and “design to the people” i.e. functional products for the average citizen (Beer 1975; Glambek 1997; Fallan 2012). -/- . (shrink)

Mit Beitragen von: Wolfgang U. Eckart, Christian Bonah, Wolfgang U. Eckart / Andreas Reuland, Alexander Neumann, Peter Steinkamp, Volker Roelcke, Anne ...

Background Against a background of on the one hand, a declining demography and a conservative family register system that emphasizes the importance of the blood line, and on the other hand, an increase in the number of people undergoing fertility treatment, the absence of a legal regulatory framework concerning ART matters is likely to result in an increasing number of contradictory situations. It is against this background that the paper sets out to examine the judgements of court cases related to (...) ART, with a particular focus on the legal determination of parental status, and to link these to aspects of the legal and socio-ethical environment within which the courts make their judgements. Methods The methods used were thorough investigation of all the court cases concerning ART in the public domain in Japan, including the arguments of the concerned parties and the judgements so far delivered. With the court cases as a central focal point, trends in Japan, including deliberations by government and academic societies, are reviewed, and the findings of surveys on the degree of understanding and attitudes among the people toward ART are summarized. Results In terms of the judgements to date, the central criteria used by the courts in determining parental status were the act of parturition and the consent of the husband of the concerned couple. The government and academic societies have displayed a cautious attitude toward ART, but the findings of attitude surveys among the people at large show a generally positive attitude toward ART. Attitudes toward the overwhelming importance hitherto attached to the bloodline are also seen to be changing. Conclusion The main conclusion is that in the absence of a legal regulatory framework for ART, there is likely to be an increase in the contradictions between the use of outdated legal precedents and the technical development of ART. Since much of the specialist discussion necessary for the formulation of a legal framework has already been carried out, the speedy enactment of comprehensive and at the same time flexible legislation would be highly desirable, but further wide-ranging discussion involving the general public is likely to be needed first. (shrink)

This article introduces to a wider public a hitherto unknown report written by the “Romantic” natural philosopher and mineralogist Henrik Steffens (1773–1845). In the 1811 report Ideas on Medical Meteorology, commissioned by the Prussian Ministry of the Interior via the physician Johann Christian Reil (1759–1813), Steffens argued for a new, “organic” perspective on meteorology focusing on interrelations between the atmosphere and diseases among humans and animals. This new outlook, he argued, was to be realized via a series of observations directed (...) by the state administration. Excerpts from the report are translated and commented upon in order to illuminate their context. These show the report to be part of a significantly older European tradition of inquiry into the connection between changes in the atmosphere and health. A speculative variation of this tradition, for which the general term “Organic Meteorology” is introduced here, was ignited in German-speaking regions through Schelling’s natural philosophy. The report and its context show that the Prussian state was willing to engage with “Romantic” natural philosophy, that Steffens gladly provided expertise for this purpose, and that this was part of a more general effort to professionalize medicine. (shrink)

The use of complementary and alternative medicine (CAM) by US consumers has grown in recent years. CAM therapies often utilize medicinal herbs as part of the treatment process; however, research on US practitioner preferences for medicinal herbs is limited, despite growing concern surrounding the sustainability of wild-harvested medicinal herbs. In order better to understand consumer preferences for this emerging market, a mail survey of US practitioners (licensed acupuncturists) was conducted to examine the importance of five herb attributes in practitioners’ (...) herb selection decisions: (1) country of origin, (2) freshness, (3) production method (organic versus conventional), (4) price, and (5) traceability. The significance of these five traits is investigated using discrete choice analysis, and the implications for US medicinal herb growers are discussed. (shrink)

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances of intentional wrongdoing, by males in nonacademic medical settings, with oversight problems and a selfish motive such as financial gain or sex. More than half of cases involved a wrongdoer (...) with a suspected personality disorder or substance use disorder. Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

Sometimes, we operate as though we live in the center of our brains at the top of the tower that is our bodies. We are aware of our bodies as instrumental to accomplishing various pragmatic tasks, but we are unaware or forgetful about how the body constitutes our conscious experience of self and world. The deeper nature and significance of our lived bodily experience is hidden, and it is challenging to discover and describe adequately. Nonetheless, during periods of sickness and (...) injury, we are forced into dramatic confrontations with our bodies and must address our lived bodily experience in often vivid and visceral detail. Fortunately, we are not without resources in the effort to... (shrink)

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in (...) which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)

The heart of the matter -- The evolution of the French medicine -- Coping with physicians' conflicts of interest in France -- The rise of a protected medical market : the United States before 1950 -- The commercial transformation : the United States, 1950-1980 -- The logic of medical markets : the United States, 1980 to the present -- Coping with physicians' conflicts of interest in the United States -- The evolution of Japanese medicine -- Coping with physicians' (...) conflicts of interest in Japan -- Reforms -- Professionalism reconsidered. (shrink)

My aims has been to approach the debate about health service priorities from the perspective of political philosophy, but to keep the discussion firmly anchored in comtemporary problems of health care provision. The chapters are designed to provide the groundwork for anyone interested in the ethical problems in modern health care. I have used examples of health care delivery in Britain, the USA, the USSR, and the People's Republic of China to illustrate different aspects of the problem of priorities. The (...) issues can be summarised under three broad headings: Distribution, effectiveness, and authority to make decisions. (shrink)

This article explores the social frameworks guiding expert and nonexpert perspectives on medicines safety in the U.K. Scientific experts from the Committee on the Safety of Medicines and the Medicines Commission were interviewed, and three nonexpertgroups, including patients and health professionals, were studied by the administration of questionnaires and focused group discussions. The research examined to what extent these groups subscribed to technocratic or democratic approaches to medicines regula tion and how this might be related to values toward technological risk. (...) The results reveal that there is substantial divergence between expert and nonexpert perspectives on medicines regulation, and that this derives as much from value differences as from any informational deficits. However, there seems to be some scope for shared values between some experts and some nonexperts, especially as regards state secrecy. The article concludes by discussing how those values could be used to foster a new "social contract of expertise" in which scientists are more democratically accountable and patients take more responsibility in governing medical risks. (shrink)

Cardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in (...) which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter. (shrink)

This paper reassesses Robert Koch’s work on tropical infections of humans and cattle as being inspired by an underlying interest in epidemiology. Such an interest was developed from the early 1890s when it became clear that an exclusive focus on pathogens was insufficient as an approach to explain the genesis and dynamics of epidemics. Koch, who had failed to do so before, now highlighted differences between infection and disease and described the role of various sub-clinical states of disease in the (...) propagation and—consequently—in the control of epidemics. Studying pathologies of men and cattle in tropical countries eventually facilitated the application of such measures in Europe through the screening of healthy carriers of typhoid, which was carried out in 1902. The concept of the carrier state can be understood as a spin-off from tropical medicine into the study and control of infectious disease in Europe. With it travelled assumptions that were typical for colonial and veterinary medicine where the health of indigenous individuals or cattle would be a secondary objective compared to the control of diseases in populations. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

Books have their origins in conversations and seek to extend and expand those conversations over time and with different audiences. The conversations that have culminated in this book were initially stimulated through a research project at The Hastings Center on the role of religious voices in the professional fields of bioethical inquiry. Those professional conversations have continued throughout my academic career as a member of various institutional ethics committees, organizational ethics task forces, and in local, state, and national public (...) policy settings. The professional context of bioethics conversations can sometimes miss the richness of conversations that occur in the classroom and with various communities, including family members, friends, and religious and civic communities. These conversations provide an experiential depth, a groundedness in the lives and stories of persons, which augments and corrects the professionalized perspectives. I have been particularly fortunate and appreciative of opportunities to bridge the academic and professional with the personalized and communal through conversations about the ethical commitments and moral culture cultivated by The Church of Jesus Christ of Latter-day Saints (LDS or Mormon). I was invited to develop an overview essay on "Bioethics in Mormonism" for the professional reference work, Encyclopedia of Bioethics (3rd ed., 2004), and some years later received my first invitation to make a presentation on "LDS Ethics" in an academic setting at the University of Virginia. This book is the outgrowth of these many conversations and seeks to advance my communal bridging. My aim in this book is to begin bridging these various intersections between the LDS religious community and its moral culture, the professional fields of bioethics, and practical decision-making. This work seeks to be a catalyst for expanding discourse within the interdisciplinary field of Mormon studies to include ethics and bioethics. Ethics has not been a well-developed area in Mormon studies, in contrast to studies in LDS history, theology, or literature. To remedy this oversight, I present a substantive interpretation of the sources, theological background, and moral principles of LDS ethics. The historical narratives and conceptual intertwining I offer of both bioethics and of LDS moral culture is intended to complement and expand the realm of Mormon studies. A further objective is to create opportunities for reciprocal dialogues between the bioethics community and LDS scholarship. This conversation has yet to occur within academic disciplines, professional communities, or in public policy deliberations. My exposition, analysis, and critiques will intertwine and contextualize LDS moral values and health care practices within the ethical inquiry undertaken in the broader professional scholarship of bioethics. My arguments will disclose some points of common ground as well as areas of divergence towards the end of establishing the LDS faith tradition as a community of moral discourse for the bioethics field and the healing professions (medicine, nursing, pharmacy, etc.) it informs. My claim is that given its emerging cultural prominence, LDS ethical scholarship should engage in bioethical literacy and bioethics should be LDS-literate. I am also engaged in an effort to initiate more reflective dialogues regarding LDS ethics and moral culture among LDS scholars, LDS health care professionals, and the interested general LDS reader. The focus of the book on the interrelationship of religion, ethics, medicine, and health care should present for these various audiences new opportunities for mindful reflection and creative scholarship on the ethical implications of faith commitments, the responsibilities of the healing professions, and religious dimensions of public policy and public bioethics. A religious community that is formed through narratives and practices of covenantal commitments of love of neighbor needs to have a robust discourse about its ethical character. I have understood my scholarship in biomedical ethics and in religious ethics through a linking metaphor of my moral culture, of medicine, and the law, of bearing witness. The witness offers moral realities, moral truths about the way things are, vocalizes and embodies moral experience, and prophetically critiques the hypocrisies of the powerful and their oppression of the vulnerable by offering a new story, a re-storying, of tradition and conventional practice. (shrink)

Ethics boards have become obligatory passage points in today's medical science, and we forget how novel they really are. The use of humans in experiments is an age-old practice that records show goes back to at least the third century BC and, since the early modern period, as a practice it has become increasingly popular. Yet, in most countries around the world, hardly any formal checks and balances existed to govern the communal oversight of experiments involving human subjects until at (...) least the 1960s. Ethics by Committee traces the rise of ethics boards for human experimentation in the second half of the twentieth century. Using the Netherlands as a case-study, Noortje Jacobs shows how the authority of physicians to make decisions about clinical research gave way in most developed nations to formal mechanisms of communal decision-making that served to regiment the behavior of individual researchers. This historically unprecedented change in scientific governance came out of a growing international wariness of medical research in the decades after World War II. Research ethics committees were originally intended not only to make human experimentation more ethical but also to raise its epistemic quality. By examining complex negotiations over the appropriate governance of human subjects research, Ethics by Committee advances our understanding not only of the history of research ethics and the randomized controlled trial but also, more broadly, of how liberal democracies in the late twentieth century have sought to resolve public concerns over charged issues in medicine and science. (shrink)

In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assisted suicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal economic loss. (...) Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)

The role of government in assuring population access to affordable and appropriate health care represents a central question for any nation. Of particular concern is access to prescription drug coverage, not only because of the vital role played by drugs in modern medicine, but also because of their high costs. This article examines the sharply contrasting prescription drug coverage and payment policies found in Australia and the U.S. – strong political allies and international trading partners – and describes how (...) key U.S. interests have sought, through an aggressive trade agenda, to expand markets for U.S. goods and services, even when market expansions clash with other nations’ contrasting emphasis on social equity and fairness. Indeed, the nation’s bilateral free trade negotiations have brought the contours of this policy schism into sharp relief. (shrink)

In this original and compelling book, Jeffrey P. Bishop, a philosopher, ethicist, and physician, argues that something has gone sadly amiss in the care of the dying by contemporary medicine and in our social and political views of death, as shaped by our scientific successes and ongoing debates about euthanasia and the "right to die"--or to live. __The Anticipatory Corpse: Medicine, Power, and the Care of the Dying__, informed by Foucault's genealogy of medicine and power as well (...) as by a thorough grasp of current medical practices and medical ethics, argues that a view of people as machines in motion--people as, in effect, temporarily animated corpses with interchangeable parts--has become epistemologically normative for medicine. The dead body is subtly anticipated in our practices of exercising control over the suffering person, whether through technological mastery in the intensive care unit or through the impersonal, quasi-scientific assessments of psychological and spiritual "medicine." The result is a kind of nihilistic attitude toward the dying, and troubling contradictions and absurdities in our practices. Wide-ranging in its examples, from organ donation rules in the United States, to ICU medicine, to "spiritual surveys," to presidential bioethics commissions attempting to define death, and to high-profile cases such as Terri Schiavo's, __The Anticipatory Corpse__ explores the historical, political, and philosophical underpinnings of our care of the dying and, finally, the possibilities of change. A ground-breaking work in bioethics, this book will provoke thought and argument for all those engaged in medicine, philosophy, theology, and health policy. "With extraordinary philosophical sophistication as well as knowledge of modern medicine, Bishop argues that the body that shapes the work of modern medicine is a dead body. He defends this claim decisively with with urgency. I know of no book that is at once more challenging and informative as __The Anticipatory Corpse. __To say this book is the most important one written in the philosophy of medicine in the last twenty-five years would not do it justice. This book is destined to change the way we think and, hopefully, practice medicine." --_Stanley Hauerwas, Duke Divinity School _ "Jeffrey Bishop carefully builds a detailed, scholarly case that medicine is shaped by its attitudes toward death. Clinicians, ethicists, medical educators, policy makers, and administrators need to understand the fraught relationship between clinical practices and death, and __The Anticipatory Corpse __is an essential text. Bishop's use of the writings of Michel Foucault is especially provocative and significant. This book is the closest we have to a genealogy of death." --_Arthur W. Frank, University of Calgary _ "Jeffrey Bishop has produced a masterful study of how the living body has been placed within medicine's metaphysics of efficient causality and within its commitment to a totalizing control of life and death, which control has only been strengthened by medicine's taking on the mantle of a bio-psycho-socio-spiritual model. This volume's treatment of medicine's care of the dying will surely be recognized as a cardinal text in the philosophy of medicine." --_H. Tristram Engelhardt, Jr., Rice University, Baylor College of Medicine_. (shrink)

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in (...) which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)

The reflections put forward in this text concern the clinical and practical difficulties posed by the existence of patients in PVS, and the essential ethical issues raised, combining these ethical questions with practical and theoretical experience.Section 1 presents the methodology of the ethical reflection as we see it.Section 2 describes the clinical condition of patients in PVS. Section 3 develops the ethical difficulties relative to PVS from the French point of view. Section 4 illustrates the relevance of debating the ethical (...) significance of such problematic situations, whilst defending a practical position based on a philosophical conviction. Section 5 points out the limits of ethical reflection in a biomedical context, and calls for reflection closer to the source of the problems described. For a comprehensive appraisal of biomedical rationality, the final section suggests combining the bioethical debates with traditional philosophical ethical reflection so as to get a clearer understanding of the real, if limited, relevance of these debates. (shrink)

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the (...) perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on—and simultaneously affects—access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects. (shrink)