Medical-legal partnerships — collaborative endeavors between health care clinicians and lawyers to more effectively address issues impacting health care — have proliferated over the past decade. The goal of this interdisciplinary approach is to improve the health outcomes and quality of life of patients and families, recognizing the many non-medical influences on health care and thus the value of an interdisciplinary team to enhance health. There are currently over 180 MLPs at over 200 hospitals and health centers in the United (...) States, with increasing federal interest and potential legislative support of this model.This article examines the unique, interrelated, and often similar ethical issues that confront the clinical and legal partners involved in MLPs. We contend that the ethical precepts of the clinical and legal professions should be seen as opportunities, not barriers, to further the interdisciplinary nature of MLPs. (shrink)

Genome Canada has funded a research project to evaluate the usefulness of different forms of ethical analysis for assessing the moral weight of public opinion in the governance of genomics. This paper will describe a role of public consultation for ethical analysis and a contribution of ethical analysis to public consultation and the governance of genomics/biotechnology. Public consultation increases the robustness of ethical analysis with a more diverse and rich accounts experiences. Consultation must be carefully and respectfully designed to generate (...) sufficiently diverse and rich accounts of moral experiences. Since dominant groupstend to define ethical or policy issues in a manner that excludes some interests or perspectives, it is important to identify the range of interests that diverse publics hold before defining the issue and scope of a consultation. Similarly, a heavy policy focus and pressures to commercialize products risk oversimplification of the discussion and the premature foreclosure of ethical dialogue. Consequently, a significant contribution of ethical dialogue strengthened by social analysis is to consider the context and non-policy use of power to govern genomics and to sustain social debate on enduring ethical issues. (shrink)

Problems posed by HIV/AIDS differ from those ofpast epidemics by virtue of unique propertiesof the causative agent, dramatic societalchanges of the late 20th century, and thetransition of medical practice from aprofessional ethic to a technology-dependentbusiness ethic. HIV/AIDS struck during thecoming-of-age of molecular biology and also ofbioethics, and the epidemic stimulated thegrowth of both disciplines. The number ofarticles published about AIDS and ethics (asidentified by a MEDLINE search) peaked in 1990,just before the peak incidence of AIDS in theUnited States. The character (...) of ethicaldialogue has now shifted from familiar moralquandaries such as civil liberty versus publicwelfare to concerns about vaccine trials andpublic policy toward the developing world.Physicians and other health care workers whowere involved from the onset endured somethingof an emotional roller coaster. Theircompassion-based work ethic was to a largeextent replaced by a competence-based workethic after the introduction in 1996 of highlyactive antiretroviral therapy. The abundantrecent literature on ``professionalism'' inmedicine makes scant mention of AIDS/HIV. Thedisruptive effect of AIDS/HIV on society wouldhave been substantially greater had relevanttechnology such as the ability to isolateretroviruses and potent therapy againsttuberculosis not been in place. This soberingconsideration, along with such recent events asthe use of bioterrorism against civilianpopulations, suggests new relevance forPotter's definition of ``bioethics'' as a scienceof survival in which the biology of ecosystemsmust be taken into account. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 51-53, September‐October 2021.

Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

Ce livre présente cinq entretiens avec des philosophes pionniers dans le champ de la bioéthique francophone, Anne Fagot-Largeault et Jean-Yves Goff i (France), Gilbert Hottois et Jean-Noël Missa (Belgique) et Marie-Hélène Parizeau (Québec), cinq personnalités de renom, connues pour leur trajectoire exceptionnelle. Les entretiens menés avec ces auteurs au sujet de leurs oeuvres, de leurs expériences dans des comités de bioéthique et des différents débats soulevés ces dernières années nous permettent de connaître leur travail, mais aussi de faire une incursion (...) dans le développement fulgurant de la bio-médecine et des biotechnologies des cinquante dernières années. Les conséquences de ces applications, les problèmes éthiques générés, les jugements favorables et défavorables à l'égard des changements sociaux qui se sont produits et le bouleversement d'idées qui s'en est suivi, sont autant d'aspects abordés dans ces entretiens. L'utilisation du langage courant exige un effort de synthèse important; aussi ces entretiens sous la forme d'une conversation, offrent-ils au lecteur une large vision panoramique, rigoureuse et concise de l'évolution de la bioéthique francophone. (shrink)

The article is dedicated to the application questions of a case study method known as casuistry. In its long tradition, it focuses on an influential variant of the early modern period and reconstructs its functionality. In the course of reading recent receptions, it is noted that some studies speak of a “casuistic revival” in moral case deliberation in health care. As a result of this revival, casuistry has been modified in such a way that it guides case discussions in practice (...) with the help of a tripartite methodology. However, as it turns out, casuistry, a case comparison method of ethical judgement based on reasoning logic, is less suitable for moral case deliberations in direct patient care. This stems from the fact that casuistry is a detailed procedure of ethical learning beneficial to institutionalized ethics committees or similar forms of ethics consultation in health care. (shrink)

This paper examines the historical rise of both cardiopulmonary resuscitation and the do-not-resuscitate order and the wisdom of their continuing status in U.S. hospital practice and policy. The practice of universal presumed consent to CPR and the resulting DNR policy are the products of a particular time and were responses to particular problems. In order to keep the excesses of technology in check, the DNR policies emerged as a response to the in-hospital universal presumed consent to CPR. We live with (...) this historical concretion, which seems to perpetuate a false culture that the patient's wishes must be followed. The authors are critical of the current U.S. climate, where CPR and DNR are viewed as two among a panoply of patient choices, and point to UK practice as an alternative. They conclude that physicians in the United States should radically rethink approaches to CPR and DNR. (shrink)

S. Matthew Liao's paper (2005) exemplifies what I characterize as the third stage in the lifecycle of bioethics, “bioethics as co-PI,” in which bioethics asserts a role in directing the biomedical...

Medical practitioners have traditionally seen themselves as part of an international community with shared and unifying scientific and ethical goals in the treatment of disease, the promotion of health, and the protection of life. This shared mission is underpinned by explicit acceptance of traditional concepts of medical morality, and by an implied link between individual human rights and the ethics of medical practice long enshrined in a range of World Medical Association (WMA) and other medical codes. These have been powerful (...) instruments exhorting individual practitioners to promote health and to defend universal principles in order to protect their patients and the physician-patient relationship even in the face of authoritarian state coercion and imposed national ideologies and policies. There has been widespread support for this approach and this should be intensified. (shrink)

In the first part of this article we survey the concept of human rights from a philosophical perspective and especially in relation to the “right to healthcare”. It is argued that regardless of meta-ethical debates on the nature of rights, the ethos and language of moral deliberation associated with human rights is indispensable to any ethics that places the victim and the sufferer in its centre. In the second part we discuss the rise of the “right to privacy”, particularly in (...) the USA, as an attempt to make the element of personal free will dominate over the element of basic human interest within the structure of rights and when different rights seem to conflict. We conclude by discussing the relationship of human rights with moral values beyond the realm of rights, mainly human dignity, free will, human rationality and response to basic human needs. (shrink)

When laypeople learned what decisions physicians were making about laypeople's health they were often appalled. … They discovered that physicians … were making controversial moral moves, choices th...

February is Black History Month and so healthcare practitioners will soon rummage history books for information about famous African Americans, like Onesimus, the African slave who...

The principle of respect for autonomy requires informing patients adequately and appropriately about diagnoses, treatments, and prognoses. However, some clinical cases may cause ethical dilemmas regarding telling the truth. Under the existence especially of certain cultural, social, and religious circumstances, disclosing all the relevant information to all pertinent parties might create harmful effects. Even though the virtue of telling the truth is unquestionable, sometimes de facto conditions compel physicians to act paternalistically to protect the patient/patients from imminent dangers. This article, (...) which aims to study the issue of whether a physician should always tell the truth, analyzes an interesting case that represents the detection of misattributed paternity during pre-transplant tests for a kidney transplant from the son to the father in Turkey, where social, cultural, and religious factors have considerable impact on marital infidelity. After analyzing the concept of telling the truth and its relationship with paternalism and two major ethical theories, consequentialism and deontology, it is concluded that the value of the integrity of life and survival overrides the value of telling the truth. For this reason, in the case of a high possibility of severe and imminent threats, withholding some information is ethically justifiable. (shrink)

(2003). The Ethics and Governance of Medical Research: What does regulation have to do with morality? New Review of Bioethics: Vol. 1, No. 1, pp. 41-58.

In his compelling novel Blindness, José Saramago tells us about victims stricken by a contagious form of blindness who were quarantined and came to see themselves as pigs, dogs, and “lame crabs.” Of course, they were all human beings - although unable to perceive themselves, or others, as members of the human community. The disciplines of bioethics, health law, and human rights are likewise all members of the broad human rights community, although at times none of them may be able (...) to see the homologies, even when responding to a specific health challenge.The boundaries between bioethics, health law, and human rights are permeable, and border crossings, including crossings by blind practitioners, are common. Two working hypotheses form the intellectual framework of this article: we can more effectively address the major health issues of our day if we harmonize all three disciplines; and American bioethics can be reborn as a global force by accepting its Nuremberg roots and actively engaging in a health and human rights agenda. (shrink)

In his compelling novel Blindness, José Saramago tells us about victims stricken by a contagious form of blindness who were quarantined and came to see themselves as pigs, dogs, and “lame crabs.” Of course, they were all human beings - although unable to perceive themselves, or others, as members of the human community. The disciplines of bioethics, health law, and human rights are likewise all members of the broad human rights community, although at times none of them may be able (...) to see the homologies, even when responding to a specific health challenge.The boundaries between bioethics, health law, and human rights are permeable, and border crossings, including crossings by blind practitioners, are common. Two working hypotheses form the intellectual framework of this article: we can more effectively address the major health issues of our day if we harmonize all three disciplines; and American bioethics can be reborn as a global force by accepting its Nuremberg roots and actively engaging in a health and human rights agenda. (shrink)

This article analyzes certain aspects of the structure of bioethics as a discipline. It begins by arguing that bioethics is an academic discipline of a pragmatic nature and then puts forward a classification of the main problems, issues, and concerns in bioethics, using this classification as a way to outline the limits and framework of the field. Pushing further, it contends that comprehensive treatment of any topic in bioethics requires that three normative dimensions be taken into account. It concludes that (...) the classification of the issues and analysis of each issue's normative dimensions can provide valuable contributions toward understanding the sui generis structure of bioethics as a pragmatic discipline. (shrink)

There is an assumption in virtue epistemology that epistemic virtues are the same in different times and places. In this paper, however, I examine this assumption in the practice of medicine as a paradigm example. I identify two different paradigms of medical practice, one before and the other after the rise of bioethics in 1960s. I discuss the socially defined role and function of physicians and the epistemic goals of medical practice in these two periods to see how these elements (...) affect the necessary epistemic virtues for physicians. I conclude that epistemic virtues of medical practice differ in these two periods according to the differing epistemic goals and the socially defined function of physicians. In the end, I respond to the possible objections to my thesis based on the distinction between skill and virtue. (shrink)

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) (...) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country. (shrink)

The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to American bioethics.

In this paper I argue that applied ethics is a phenomenon spontaneously emerged between the Sixties and the Seventies and resulting from interbreeding of theoretical discussion in ethics and public discourse of liberal-democratic societies. I contend that the phenomenon’s novelty is in a peculiar relationship it has helped in establishing between ethical theories and real-world issues, and besides that the true nature of applied ethics is that of deliberation, whose tool is the faculty of judgment, or casuistry, understood the Kantian (...) way. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim (...) of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

In this paper I argue that a narrow view of justice dominates the bioethics literature. I urge a broader view. As bioethicists, we often conceive of justice using a medical model. This model focuses attention at a particular point in time, namely, when someone who is already sick seeks access to scarce or expensive services. A medical model asks how we can fairly distribute those services. The broader view I endorse requires looking upstream, and asking how disease and suffering came (...) about. In contrast to a medical model, a social model of justice considers how social determinants affect the health of a population. For example, social factors such as access to clean drinking water, education, safe workplaces, and police protection, profoundly affect risk for disease and early death. I examine one important social determinant of health, health care coverage, to show the limits of a medical model and the merits of a broader view. (shrink)

Definition of the problem: In parallel with public and philosophical discussions, there is an ongoing debate about euthanasia in theological ethics. In this situation it is helpful to provide a systematic overview of the different arguments and judgements. Arguments: A short introduction is followed by a first part dealing with the definition of terms. The second and major part concerning normative arguments is subdivided into three steps: the level of principles, the more concrete level of actions and finally the level (...) of social consequences. The third part presents some reflections following the eudaimonistic ethical tradition (the ethics of a good life and death) focusing on the central question: how to find meaning in life when faced with suffering. Conclusion: It would be fruitful to intensify the ethical reflection both on the problems concerning the foundations of social life, especially the meaning of dignity, autonomy and inviolability of human life, and social consequences of a liberal practice of euthanasia. In this context ethicists are challenged to reflect on the different approaches to what is or can be a good life and a human death. (shrink)

It was in the course of one particular clinical encounter that I came to realize the power of narrative, especially for expressing clinically presented ethical matters. In Husserlian terms, the mode of evidence proper to the unique and the singular is the very indirection that is the genius of story-telling. Moreover, the clinical consultant is unavoidably changed by his or her clinical involvement. The individuals whose situation is at issue have their own stories that need telling. Clinical ethics is in (...) this sense a way of helping patients, families, and, yes, health providers to discover and give voice to those stories. In this way, clinical ethics is an evoking of meaning. Kierkegaard understood this well: Indirect communication is the language for the unique and the otherwise inexpressible. (shrink)

Considerations of ethical questions regarding pets should take into account the nature of human-pet relationships, in particular the uniquely combined features of mutual companionship, quasi-family-membership, proximity, direct contact, privacy, dependence, and partiality. The approaches to ethical questions about pets should overlap with those of animal ethics and family ethics, and so need not represent an isolated field of enquiry, but rather the intersection of those more established fields. This intersection, and the questions of how we treat our pets, present several (...) unique concerns and approaches for focused examination. (shrink)

Bioethicists have recently expressed concern over a lack of quality control within the field. This apprehension focuses on bioethics expanding in ways that obscure its distinctive ethical remit and the specialist reasoning skills it requires. This thesis about the quality and conduct of bioethics may have particular relevance for clinical ethics. As one of the youngest offshoots of bioethics, the field focuses on the ethical issues that arise specifically in a clinical context. However, non-ethics specialists are increasingly involved in this (...) field. This means that clinical ethics could be especially vulnerable to the quality control concerns articulated within bioethics. The growing public profile of clinical ethics means that concerns over quality in this area warrant specific attention by those concerned with declining standards in bioethics and those working in clinical ethics. (shrink)

Kevin Wm. Wildes, S.J.; Religion in Bioethics: A Rebirth, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 2, 1 January 2002, Pa.

Patient and citizen participation is now regarded as central to the promotion of sustainable health and health care. Involvement efforts create and encounter many diverse ethical challenges that have the potential to enhance or undermine their success. This article examines different expressions of patient and citizen participation and the support health ethics offers. It is contended that despite its prominence and the link between patient empowerment and autonomy, traditional bioethics is insufficient to guide participation efforts. In addition, the turn to (...) a “social paradigm” of ethics in examinations of biotechnologies and public health does not provide an account of values that is commensurable with the pervasive autonomy paradigm. This exacerbates rather than eases tensions for patients and citizens endeavoring to engage with health. Citizen and patient participation must have a significant influence on the way we do health ethics if its potential is to be fulfilled. (shrink)

“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day (...) if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field. (shrink)

In 1969, the field of human genetics was in its infancy. Amniocentesis was a new technique for prenatal diagnosis, and a newborn genetic screening program had been established in one state. There were also concerns about the potential hazards of genetic engineering. A research group at the Hastings Center and Paul Ramsey pioneered in the discussion of genetics and bioethics. Two principal techniques have emerged as being of enduring importance: human gene transfer research and genetic testing and screening. This essay (...) tracks the development and use of these techniques and considers the ethical issues that they raise. (shrink)