This book is designed primarily to provide readings for a consideration of the moral issues in medicine from a philosophical point of view. There are two basic alternatives in structuring a philosophical course in medical ethics. One is to divide the course according to medically conceived topics such as organ transplantation, genetic engineering, euthanasie, etc. Such an approach is wholly viable, but we have preferred no to adopt it here. Rather, we have organized the book primarily on the basis of (...) more philosophically inspired categories. Thus, our headings invoke such notions of paternalism, truth, social justice, etc. (shrink)

Doctor's Dilemmas, a fascinating study of the moral dilemmas confronting health professionals and patients alike, examines areas of health care where ethical conflicts often arise. Gorovitz illuminates these conflicts by clearly explaining and applying a broad range of philosophical concepts. He lays the groundwork for informed ethical decision-making and provides the general reader with a lucid overview of the complexities of medical practice. Written in accessible, conversational style and making extensive use of anecdotes, examples, and references to literature, Doctor's (...) Dilemmas offers profound insights into medical ethics for all those involved with the health professions--be they doctors, nurses, administrators, or patients. (shrink)

Covid‐19 confronts us with tragic choices, in which every option is unacceptable. On the New York State Task Force on Life and the Law, I worked on guidelines for such situations. We did not envision the scale or character of Covid‐19. To minimize fear that the decisions made in these situations might be unfair, we all must know what guidelines or mandates inform them. Only with transparency about how decisions will be made, by whom, and according to what requirements can (...) we have confidence that fairness prevails. We now face many related questions about process, goals, leadership, and trust. For example, how might ethical guidelines evolve as scientific understanding advances? Should guidelines vary with different venues? And if, as I have argued, judgment is necessary even with the best of guidelines, how can we prepare clinicians to make good judgments? Are there implications for better training of personnel in nonemergency times for what they might face in the worst of times? (shrink)

Concern about the employment prospects of Ph.D.’s in the sciences and engineering has prompted overdue interest in the ethical aspects of graduate education. It is not possible to isolate an ethical inquiry that focuses solely on job-related issues. The ethical problems in graduate education are each related to employment, but none is related to employment only. We can illuminate potential ethical problems by considering conflicts of interest at each point from the decision to offer a graduate program through the treatment (...) of its alumni. Such consideration prompts reassessment of program content, relations with students, and the objectives of graduate programs. (shrink)

The attitudes and behaviours that constitute caring affect both the quality of the patient's experience and the outcomes of medical care. They can be identified and can be nurtured or discouraged by the structures of organisation and financing within which health care is provided. They have costs, so their viability is threatened as pressures increase to make health care more economically efficient. Yet the value of caring behaviour may justify what is necessary to sustain it. This issue deserves prompt and (...) extensive debate as health care systems undergo revision throughout the world. (shrink)

Book reviewed in this article: Follies and Fallacies in Medicine. By Petr Skrabanek and James McCormick.

Academic writing, even in prestigious journals, is frequently ugly and arduous. The writing in academic philosophy is no exception, especially given philosophers’ tendency to overlook prose and to focus exclusively on philosophical content. This paper argues that good prose matters for moral, prudential, and philosophical reasons. After glossing these reasons, the authors offer advice, born of experience, to academic writers who want to achieve clear, effective prose. Their advice includes how to improve sentence structure (e.g. eliminate undue repetition and forms (...) of “to be,” be careful with comma use, evaluate sentences by reading them aloud), global considerations (e.g. use technical notation cautiously, avoid prose in footnotes, read and report opponents’ views with charity), how to practice reiterating the same point in different words (e.g. play language games likes crossword puzzles, read non-academic prose, aim to communicate one’s point succinctly), and the suggestion to take prose seriously in the evaluation of student work. (shrink)

New prospects for technologically aided human reproduction require the development of a public policy concerning the setting of limits to reproductive autonomy and to research on human embryos. Previous American efforts to clarify policy on such matters have been ignored by the executive branch; there is a need for Congressional action to initiate the requisite processes of debate and policy formation. Keywords: human reproduction, public policy, persons, in vitro fertilization, embryo transfer, reproductive autonomy CiteULike Connotea Del.icio.us What's this?

Book reviewed in this article: Follies and Fallacies in Medicine. By Petr Skrabanek and James McCormick.

Records the papers and commentaries, with an edited discussion, presented at an international consultation convened by the Council for International Organizations of Medical Sciences (CIOMS) to guide revision of the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects. The Guidelines, first issued in 1982 and then revised in 1993, are being updated and expanded to address a number of new and especially challenging ethical issues. These include issues raised by international collaborative trials of drugs in developing countries, especially (...) expensive drugs, and the use of placebo controls in randomized clinical trials. Others arise from the complexity of research in human genetics, including stem-cell research, and in reproductive biology. Throughout, particular attention is given to the difficult questions that arose during the heated debate over trials in developing countries, of short-duration zidovudine (AZT) therapy to reduce perinatal transmission of HIV. The International Ethical Guidelines for Biomedical Research Involving Human Subjects set out a code of research ethics that is widely used by ethical review committees and other bodies responsible for reviewing and overseeing the ethical design of studies and conduct of research. The revision of the Guidelines is being coordinated by CIOMS, in collaboration with WHO. The consultation centered on seven specially commissioned papers, authored by international experts that explore some of the more difficult issues in depth. Each is followed by an invited commentary, often expressing opposing views, and a summary of the issues or conclusions that emerged during the subsequent debate. The first paper, on justice in international research, deals with the question of whether proposals for research to be conducted in a developing country should make provision for future access of the population involved to the interventions under investigation. Also considered are questions that arise when research uses populations in developing countries to investigate interventions that will be of exclusive benefit to the industrialized world. Case studies of recent drug trials and their research protocols are discussed to illustrate circumstances in which use of populations in developing countries is justified or constitutes exploitation. Ethical challenges of the randomized controlled trial are considered in the second paper, which includes a discussion on the equitable distribution of benefits and risks, the use of placebo for controls, and the obligation to ensure that the participation of controls does not compromise their medical care or endanger their health. A paper on informed consent in international health research considers how cultural factors influence communication and language in the informed-consent process and respect for privacy and confidentiality in the research. Subsequent papers address issues in genetics research and reproductive biology, including the moral status of fetuses and the use of embryos in research, and examine the contribution which international human rights instruments can make in the application of the general principles of ethics to research involving human subjects. The final paper gives an overview of capacity building and the role of communities in international biomedical research. (shrink)

Book reviewed in this article: Drawing the Line: Life, Death, and Ethical Choices in an American Hospital. By Samuel Gorovitz.