A considerable section of the population in India accesses the services of individual private medical practitioners (PMPs) for primary level care. In rural areas, these providers include MBBS doctors, practitioners of alternative systems of medicine, herbalists, indigenous and folk practitioners, compounders and others. This paper describes the profile, knowledge and some practices of the rural doctor in India and then discusses the reasons for lack of equity in health care access in rural areas and possible (...) solutions to the problem. (shrink)

Psychedelic or ecodelic medicines (e.g., psilocybin, ayahuasca, iboga) for the care and treatment of addiction, post‐traumatic stress disorder, cancer, cluster headaches, anxiety, and depression have surged to the forefront of discussions about mental health in the US, leading to the emergence of well‐capitalized biotech companies offering multimillion‐dollar IPOs. Venture capital website Pitchbook reports “continuing investor interest and growing acceptance of what until recently was seen as a fringe area of medicine.” As scholars, activists, and practitioners who have been healed (...) by these medicines and applaud the recent wave of decriminalization after a long, strange trip of mass incarceration and widespread dangerous misinformation, we look forward to a culture that makes these medicines available in a safe and affordable way that respects the lineages of the knowledges that are essentially and not accidentally bundled with these plants—Indigenous and counterculture wisdoms for whom these medicines were never “fringe,” but always foundational. In place of corporadelia's pursuit of standardization, we emphasize the care and wisdom of the Indigenous and countercultural teachings—traditions that have made psychedelics available to the emerging corporate/research partnership in the first place. These knowledge traditions offer foils to the ongoing translation of university peer‐reviewed research into market copy, technical articles, and IPOs, and the concomitant emergence of psychedelic pundits. In particular, we examine instances where prominent researchers have overstated the findings of existing clinical trials in public‐facing representations of the field. We argue that these corporate priorities and tactics are being aided by a new wave of psychedelic “thought leaders” who seek to delegitimize non‐hierarchical approaches to knowledge production and community support within a psychedelic commons. While prominent psychedelic psychiatrists and behaviorists are focused on rooting out and transforming individual habits of mind, we argue that there is another, latent potential for psychedelics to draw attention to—and transform—the invisible, hegemonic infrastructures and ideologies that subtly naturalize and perpetuate deeply unequal societies. (shrink)

Mixtecs and Zapotecs, originating from the Oaxaca area in Mexico, are among the largest indigenous groups of workers in California. Many adults in this community only access the health care system when sick and as a last resort. This article describes the development of a radionovela to inform the community about the importance of preventive health care. It was developed following the Sabido Method. The methodology to develop a radionovela may be of interest to other public health practitioners (...) who want to develop educational materials in an engaging format, especially for communities that rely on oral, not written information. (shrink)

Coercive medico-legal interventions are often employed to prevent people deemed to be unable to make competent decisions about their health, such as minors, people with mental illness, disability or problematic alcohol or other drug use, from harming themselves or others. These interventions can entail major curtailments of individuals' liberty and bodily integrity, and may cause significant harm and distress. The use of coercive medico-legal interventions can also serve competing social interests that raise profound ethical, legal and clinical questions. Examining the (...) ethical, social and legal issues involved in coerced care, this book brings together the views and insights of leading researchers from a range of disciplines, including criminology, law, ethics, psychology and public health, as well as legal and medical practitioners, social-service 'consumers' and government officials. Topics addressed in this volume include: compulsory treatment and involuntary detention orders in civil mental health and disability law; mandatory alcohol and drug treatment programs and drug courts; community treatment orders; the use of welfare cards with Indigenous populations; mandated treatment of seriously ill minors; as well as adult guardianship and substituted decision-making regimes. These contributions attempt to shed light on why we use coercive interventions, whether we should, whether they are effective in achieving the benefits that are offered to justify their use, and the impact that they have on some of society's most vulnerable citizens in the names of 'justice' and 'treatment'. This book is essential reading for clinicians, researchers and legal practitioners involved in the study and application of coerced care, as well as students and scholars in the fields of law, medicine, ethics and criminology. The collection asks important questions about the increasing use of coercive care that demand to be answered, and offers critical insights, guidance and recommendations for those working in the field. (shrink)

Within a given culture – whether industrialized or more tradition oriented – essentially the same fundamental medical theories, practices, and pharmacopoeia tend to be applied to human and non-human sickness and patients. In modern industrialized societies, however, healthcare services are sharply divided between human and veterinary medicine. There is likewise a sharp division between practitioners in these two health sectors: medical doctors and veterinarians. Yet in non-Western, traditional or indigenous medical systems, the same practitioners (...) often treat both humans and animals. There is a growing body of literature that attests to the efficacy of traditional health practices and herbal medicines for the prevention and treatment of both human and livestock ailments.The authors argue for an intersectoral approach to human and veterinary health services in poor countries, especially those targeted to rural people with LIMITED access to modern health services. Extension of conventional medical and veterinary services is particularly difficult and costly in Third World countries where the necessary infrastructure (roads, clinics, labs, cold chains, etc.) is poorly developed and where much of the populace and their livestock reside in remote, rural areas, or where people may be nomadic or transhumant. Consideration should therefore be given to the joint delivery of human and livestock healthcare and related services, as well as to linking informal, ethnoveterinary practices and practitioners with more formalized systems of veterinary AND medical practice. Several advantages of such an approach are identified and explored. (shrink)

The introduction of new medical technologies into a developing country is usually greeted with enthusiasm as the possible benefits become an object of great anticipation and provide new hope for therapy or relief. The prompt utilization of new discoveries and inventions by a medical practitioner serves as a positive indicator of high standing in the professional community. But the transfer of medical technology also involves a transfer of concomitant values. There is a danger that, in the process (...) of adopting a particular technology, the user takes for granted the general utility and desirability of the implements and procedures under consideration without recognizing the socio‐cultural peculiarities of the adopting country. A sensitivity to the social conditions and cultural traditions is important so that the emergence of new values can be examined critically and the transfer of necessary technology can be effected smoothly. In the Philippines, efforts to boost patronage of transplant technology appear to have overlooked this need for socio‐cultural sensitivity. Legislative fiat cannot be used to override deep‐seated values. There is a need to be more sensitive to the possible confrontation of values that the transfer of technology brings in order to avoid the erosion of indigenous socio‐cultural values and minimize the intrusiveness of beneficial medical technology. (shrink)

Medical migration appears to be an increasing global phenomenon, with complex contributing factors. Although it is acknowledged that such movements are inevitable, given the current globalized economy, the movement of health professionals from their country of training raises questions about equity of access and quality of care. Concerns arise if migration occurs from low- and middle-income countries to high-income countries. The actions of HICs receiving medical practitioners from LMICs are examined through the global justice theories of John (...) Rawls and Immanuel Kant. These theories were initially proposed by Pogge and Tan and, in this work, are extended to the issue of medical migration. Global justice theories propose that instead of looking at health needs and workforce issues within their national boundaries, HICs should be guided by principles of justice relevant to the needs of health systems on a global scale. Issues of individual justice are also considered within the framework of rights and social responsibilities of individual medical practitioners. Local and international policy changes are suggested based on both global justice theories and the ideals of individual justice. (shrink)

Recent reports in Australia have suggested that some medical practitioners are refusing to treat children who have not been vaccinated, a practice that has been observed in the USA and parts of Europe for some years. This behaviour, if it is indeed occurring in Australia, has not been supported by the Australian Medical Association, although there is broad support for medical practitioners in general having the right to conscientious objection. This paper examines the ethical underpinnings (...) of conscientious objection and whether the right to conscientious objection can be applied to the refusal to treat unvaccinated children. The implications of such a decision will also be discussed, to assess whether refusal to treat unvaccinated children is ethically justifiable. The best interests of both existing and new patients are crucially important in a doctor’s practice, and the tension between these two groups of patients are contemplated in the arguments below. It is argued that on balance, the refusal to treat unvaccinated children constitutes unjustified discrimination. (shrink)

The aim of this study was to determine the opinions of private medical practitioners in Bloemfontein, South Africa, regarding euthanasia of terminally ill patients. This descriptive study was performed amongst a simple random sample of 100 of 230 private medical practitioners in Bloemfontein. Information was obtained through anonymous self-administered questionnaires. Written informed consent was obtained. 68 of the doctors selected completed the questionnaire. Only three refused participation because they were opposed to euthanasia. Respondents were mainly male (...) (74.2%), married (91.9%) and Afrikaans-speaking (91.9%). More were specialists (53.2%) than general practitioners (46.8%). A smaller percentage (35.5%) would never consider euthanasia for themselves compared to for their patients (46.8%). The decision should be made by the patient (50%), the patient’s doctor with two colleagues (46.8%), close family (45.2%) or a special committee of specialists in ethics and medicine (37.1%). The majority (46.9%) indicated that euthanasia should be performed by an independent doctor trained in euthanasia, followed by the patient’s doctor (30.7%). Notification should mainly be given to a special committee (49.9%). Only 9.8% felt that no notification was necessary. There was strong opposition to prescribing of medication to let the patient die. Withdrawal of essential medical treatment to speed up death was the most acceptable method. Although the responding group was fairly homogeneous, responses varied widely, indicating the complexity of opinions. (shrink)

Fragen der Korruption von Vertragsärzten sind seit längerer Zeit höchst umstritten: Nach dem so genannten „Herzklappenskandal“ sind in den vergangenen Jahren wiederholt Pharma-Konzerne mit dem Vorwurf der Bestechung von Ärzten in die Schlagzeilen geraten. Das Thema wirft nicht nur juristische oder sozialpolitische, sondern auch ethische Fragen auf. Bislang gab es dazu in Deutschland jedoch nur wenig Reflexion. Bewertungen wurden von der Ärzteschaft vor allem Politikern und Juristen überlassen. Dabei bleibt die Frage der strafbaren Bestechlichkeit im Kern ein Problem, das Ärzteschaft (...) und Medizinethik betrifft. Im Alltag ist es oft schwer zu entscheiden, wann es sich bei Zuwendungen um mögliche Bestechung handelt. Die Übergänge zwischen dem unproblematischen Annehmen kleiner Geschenke und Korruption sind fließend. Es bleibt fast ausschließlich dem moralischen Empfinden der Ärzte überlassen, die Grenze zwischen Kooperation und Korruption im Umgang mit Pharmaunternehmen zu ziehen: Unausweichlich vorhandene Konflikte zwischen privaten und berufsethischen Interessen müssen von den Ärzten angesichts unzureichender allgemeingültiger Richtlinien für angemessenes Verhalten individuell gelöst werden. Das Bewusstsein für die sozialpolitische und berufsethische Bedeutung von Interessenkonflikten unter Ärzten und Studierenden sollte erhöht werden. Eine offensivere Auseinandersetzung mit der Frage der Bestechlichkeit in der Medizin ist wünschenswert und erforderlich. (shrink)

This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total (...) response rate of 68 per cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances. (shrink)

Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope (...) arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death. (shrink)

Because the number of organs available for transplantation does not meet the needs of potential recipients, some have proposed that a potentially effective way to increase registration is to offer a self‐benefit incentive that grants a 'preferred status' or some degree of prioritization to those who register as potential donors, in case they might need organs. This proposal has elicited an ethical debate on the appropriateness of such a benefit in the context of a life‐saving medical procedure. In this (...) paper we review arguments and ethical concerns raised by scholars, and studies of views of members of the public regarding the prioritization incentive system. We also report on our study of the views of those involved in organ transplant and of other medical professionals in Israel, as over half a decade ago Israel implemented a prioritization incentive system. Bioethicists propose that key stakeholders' views can provide additional arguments and perspectives on controversial issues. Proponents justify the prioritization incentive drawing mainly on arguments related to its potential effectiveness, reciprocity and fairness. Opponents point to the fact that registering is not binding and not an actual donation, and raise concerns regarding equity, autonomy and gaming the system. Ethical concerns raised by the practitioners in the study were examined in light of scholars' arguments and actual registration and donation data. Practitioners involved in transplantation raised ethical concerns corresponding to those raised by scholars as well as additional concerns. They also challenged proponents' assumptions regarding the utility of the incentive system from their own experience and argued that proponents obscure the meaning of reciprocity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Section on Psychedelics Research and TreatmentDominic SistiAgainst a backdrop of post-pandemic malaise, diseases of despair, and a fragmented mental health care system, psychedelics have enjoyed a resurgence of interest as powerful psychotherapeutic agents and as catalysts of personal growth. The true power of these substances—some of which are considered sacramental by Indigenous peoples—has been shrouded for half a century by cultural mythology, political propaganda, (...) and misuse. From about 1940 to 1970, psychedelics including psilocybin and LSD were studied and used by clinicians to treat a range of psychiatric disorders from alcoholism and depression in adults to "autistic schizophrenia" in children.In June 1971, the Nixon administration's racist and illiberal War on Drugs inaugurated what was essentially a total ban on psychedelics. Society was robbed of half a century of scientific progress, and one can only speculate how differently our society might now function, and how many people might have been spared the trauma of mental illness and incarceration. Thankfully, it appears the time has arrived for psychedelic medicines to be decriminalized and included again in the pharmacopeia.In June 2023, a group of psychedelic researchers, therapists, bioethicists, Indigenous scholars, and advocates met at the Banbury Conference Center at Cold Spring Harbor Laboratory. There, this interdisciplinary group discussed several pressing ethical issues in psychedelics research and treatment that continue to [End Page 114] challenge the field. The aim of this meeting was to develop a bioethical framework for the use of psychedelics in mainstream medical settings. That is, how should psychedelics be employed responsibly by everyday clinicians, including psychiatrists, psychologists, social workers, and other behavioral health-care providers? This special section offers a sampling of three topics in psychedelic bioethics raised by the Banbury group, several of whom appear as coauthors.In our first paper, Logan Neitzke-Spruill and colleagues offer an overview of explanatory models describing the therapeutic mechanisms of psychedelic substances and how each of these models generates unique ethical quandaries. Starting from molecular biology and moving to neural circuitry and networks, neurobiological models now propel contemporary scientific research into psychedelics. Knowing how these substances work on a molecular level may offer promising ways forward in the development of new molecules designed to treat serious mental illnesses and other neurologic conditions. Perhaps neuroplastic mechanisms will be harnessed to develop new therapies without necessitating a psychedelic trip—a controversial premise discussed in our third paper, by Katherine Cheung, Brian Earp, and David Yaden.Such "neuroreductionism" risks ignoring the subjective psychological and spiritual experiences of patients that appear to be pivotal in psychedelic-assisted therapy, often described as mystical and utterly transformative. At the psychological level, these substances engender a kind of vulnerability and suggestibility requiring clear ethical standards to ensure patients' psychological and physical safety. And so too, practitioners will need structural and cultural competency to recognize the spiritual or moral values that inspire patient reactions during and after their psychedelic experiences. Ethically informed psychedelic practitioners will have to navigate between disciplinary silos and explanatory models. One practical upshot is the open question of how best to train psychedelic practitioners who hold this broad set of competencies.To that end, well-trained practitioners will need to be able to disclose in some way the transformative properties of psychedelics to prepare patients for their experiences. But how does one describe the ineffable? This raises the question of how or if it is possible for patients to truly consent to the transformative experience elicited by psychedelics, often described as one of the most important experiences of a person's life. The experience might stimulate significant emotional healing, or it might be horrifying. This sounds like a problem uniquely attached to psychedelics: after all, most pharmaceuticals don't trigger changes in one's fundamental moral values, life choices, and commitments, nor are they intended to. Yet, Brent Kious, Andrew Peterson, and Amy McGuire challenge the view that the psychedelic experience is uniquely transformative and impervious to the disclosure requirements of informed consent, a bedrock of bioethics. Ultimately, the writers show how consent is possible even if the experiences are dramatically different from most medical interventions, endorsing a practical view of consent [End... (shrink)

My office is in a medical building in suburban Washington, D.C. —in Bethesda, named for the Biblical healing pool. All of the offices of my building are occupied by medical specialists, representing the most sophisticated training in the application of the scientific method. Downstairs and of service to all of us is a pharmacy, looking for all the world like a research laboratory with its gleaming surface, meticulous cleanliness, micro-balances, records, reference books, and cash register. It is neatly (...) stocked with modern, physiologically-defined preparations of active, predictable drugs. Among the enzymes, hormones, antibiotics, and chemo therapeutics for neoplasm, are a few newly hatched, unfledged remedies, but most are dependable and thoroughly assayed. The intently busy, white-coated, unsentimental pharmacists serve a hard-headed group of practitioners and a neighborhood of upper-class, well-educated patients. It is disconcerting, then, to see the undersurface of this sophistication, the irrational shadows beneath the science. On the front counter of the pharmacy are displayed attractive colored advertisements and pleasantly seductive inducements to self-improvement through diet cults and foods, tranquilizers, energizers, protein supplements, happiness promisers, preparations to enhance sexuality, vitamins artfully combined, and many packeted stuffs of no rational or pretended use whatsoever. “Why,” I ask the gimlet-eyed pharmacist, “do you have this large display of ‘Il Wah Genuine Chinese Ginseng, the Miraculous Herb of Life’? Doesn't it violate your university training? Your integrity as a modernist?” “Oh,” says he, “ginseng makes you feel better! You have more energy. You can do more! Lots of athletes use it, and people who work too hard and feel exhausted. It's only $3.45 a package. The prescriptions you give me once in a while yield no profit, but I sell a lot of ginseng. I use it myself!” Bemused, I walk back to my office, wondering about the easy abandonment of rationality, and pull down a box of medicinals collected the year before at an open-air pharmacy in the riverside markets of Brazil. The box gives forth deliciously rich forest smells. The packets within contain barks, roots, seeds, all of purported medical value. Other packets have amulets, charms, and protectives. The colorful labels on some of the patent medicines invoke ancient saints and healers, and promise happiness, health, prosperity and power. The essential rationale for their use in indigenous medicine was illusive to me despite many conversations with indigenous healers, and many times I have gone through the hundreds of items trying to find the key to what Brazilian and North American people fundamentally want from a pharmacy. In both cultures, where does magic stop and science begin? Do shops in both countries vend talismans in the search for the enhanced life, and fetishes against death? How much of all drug use is ritual and inchoate expectation? How can we reduce the mystification and incrementally increase the rationality of our pharmacopeia? (shrink)

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of (...) concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance (...) of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable health policy and practice remains a challenge. In particular, there is limited understanding of ways to respond to situations in which conventional practices mandated by the state and regulated by its legal (...) apparatus come into direct conflict with the values and autonomy of Indigenous individuals, communities, and nations. In this paper, we consider two cases of conflict between Indigenous and biomedical perspectives to clarify some of the competing values. We argue for the importance of person‐ and people‐centered approaches to health care. These value conflicts must be understood at multiple levels to clarify their personal, social, cultural, and political dimensions. Taking into account the divergence between epistemic cultures and communities allows us to understand the multiple narratives deployed in decision‐making processes in clinical, community, and juridical contexts. Recognizing the knowledge claims of Indigenous peoples in health care can help clinicians avoid reinforcing the divides created by the structural and institutional legacy of colonialism. This analysis also provides ways to adjudicate conflicts in health care decision‐making by disentangling cultural, political, medical, and pragmatic issues to allow for respectful dialogue. Insofar as the engagement with cultural pluralism in health care rights is conducted with reciprocal recognition, the medical community and Indigenous peoples can address together the difficult question of how to integrate different epistemic cultures in the health care system. (shrink)

It is well recognised that medicine manifests social and cultural values and that the institution of healthcare cannot be structurally disengaged from the sociopolitical processes that create such values. As with many other indigenous peoples, Aboriginal Australians have a lower heath status than the rest of the community and frequently experience the effects of prejudice and racism in many aspects of their lives. In this paper the authors highlight values and ethical convictions that may be held by Aboriginal peoples (...) in order to explore how health practitioners can engage Aboriginal patients in a manner that is more appropriate. In doing so the authors consider how the ethics, values, and beliefs of the dominant white Australian culture have framed the treatment and delivery of services that Aboriginal people receive, and whether sufficient effort has been made to understand or acknowledge the different ethical predispositions that form the traditions and identity of Aboriginal Australia. (shrink)

Chinese medicine (CM) is one ofseveral ancient systems of medical care basedupon a different worldview than the prevailingbiomedical model; it employs its own language,systems of logic, and criteria forunderstanding health and diagnosing illness.Medicinal herbs play a central role in the CMsystem of practice and knowledgeable CMpractitioners have extensive clinicalexperience using them. However, the establishedscientific and regulatory organizations thatrely upon biomedical understandings ofpathology do not accept the definitions formedicinal herb quality used by CMpractitioners. Furthermore, local medicinalherb growers within the upper (...) Midwest are in aposition to grow many herbs, but are unclearabout the demand for and desired qualities ofthe medicinal herbs they produce. Given thissituation, the Medicinal Herb Network wasfounded as a partnership effort of small-scalemedicinal herb growers and practitioners of CMto develop more appropriate standards ofmedicinal herb quality and to encourage locallygrown, high quality medicinal herbs consistentwith these standards. An overview of CM servesas grounding from which to articulate thedilemmas experienced by CM practitioners ofperceiving medicinal herb quality andintegrating knowledge across divergent medicalsystems. A Network initiative designed toovercome these dilemmas illustrates thepossibility of developing a lexicon of qualitydescriptors for medicinal herbs using Chinesemedical theory, while drawing from descriptivesensory analysis procedures currently practicedby a sub-group of food scientists. (shrink)

This book is intended as a practical introduction to the ethical problems which doctors and other health professionals can expect to encounter in their practice. It is divided into three parts: ethical foundations, clinical ethics, and medicine and society. The authors incorporate new chapters on topics such as theories of medical ethics, cultural aspects of medicine, genetic dilemmas, aging, dementia and mortality, research ethics, justice and health care (including an examination of resource allocation), and medicine, ethics and medical (...) law. Medical Ethics also covers issues having to do with the beginning and end of life, as well as ethical questions surrounding the human body and the use of human tissue, confidentiality and AIDS, care of the mentally ill, and the implications of genetic technology. Each chapter presents a range of ethical views, drawing both from traditional philosophy and the most recent contemporary trends. The theoretical discussion is extended and illustrated by case studies and examples. This book is a non-technical guide to ethics written with the needs of medical students and medical practitioners in mind. It will also appeal to students and practitioners of allied health professions, and for all users of health care services. (shrink)

Medical practitioners are duty-bound to tell their patients the truth about their medical conditions, along with the risks and benefits of proposed treatments. Some patients, however, would rather not receive medical information. A recent response to this tension has been to argue that that the disclosure of medical information is not optional. As such, patients do not have permission to refuse medical information. In this paper I argue that, depending on the context, the disclosure (...) of medical information can undermine the patient’s ability to exercise her autonomy or have therapeutically detrimental effects. In the light of these insights I go on to develop a context-sensitive approach to medical disclosure. The advantage of this account is that it addresses concerns on both sides of the debate; whilst it acknowledges that patients do not have an exercisable ‘right not to know,’ it allows that in some cases medical information ought to be withheld. (shrink)

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started (...) searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance. (shrink)

Medical practitioners have always been expected to abide by certain standards of conduct and uphold certain values, more or less throughout the world. In this book, besides discussing specific ethical issues, the author ponders questions such as the right to life and the integrity of the human person. Ethics in medicine takes account of the principles that underlie the best decisions, particularly in unusual circumstances – such as a pandemic. Many of these are enshrouded in the oaths most (...) doctors take – the Hippocratic Oath is perhaps the best known, and has influenced numerous others over the centuries. However, these principles and the resulting conduct have taken different directions at various moments in history and in different parts of the globe, though always primarily oriented to the protection of human health. The author compares some interesting similarities and differences, tracing the main social, legal and religious attitudes, in what has come to be known as "medical ethics", with all its benefits to Mankind. Alongside basic human dignity, four main values have been pivotal in medical ethics: Caring for sick people, putting their well-being at the center of concern, and doing good. Not causing harm: never making a patient take risks, and never prescribing a doubtful treatment. Fairness: treating all patients in accordance with their health needs, never favoring or neglecting anyone on the basis of background, occupation, etc. Self-determination: the patient can be informed about treatments and, when possible, should approve the prescriptions. The doctor must show empathy, respect for confidentiality, and responsibility. Briefly, this overview of the medical profession’s ethics focuses on experience, principles, aims, virtues and above all the basic rules which in various places through the centuries have governed the tortuous paths of Mankind. Written by an acclaimed expert in the field, this book is of value for all those working in healthcare, and people interested in its ethics. (shrink)

Despite theorisation and consistent Pracademic (academics who are also practitioners) contributions to the concepts of truth-telling and decolonising epistemologies in the fields of activist research, there remains ongoing need for articulating the everyday praxis and positionality of empirical work. This paper considers the practice of two intercultural Australian-based practitioners’ examination of the ethical practices towards decolonising praxis as a contributor to third-space youth development which considers the space between participants. First Nations terminology is drawn on to explore the (...) empirical nature of third space theory (Bhabha) acknowledging the social construct of hybrid identities within individuals and communities’ personhood. Through exploring Indigenous inquiry as a contributor to third-space youth development, this paper argues that co-creation of knowledge amongst young people and practitioners considers a third space which can allow for deeper understandings of intercultural work and power dynamics. This article provides the opportunity to further explore a critical analysis of the challenges and possibilities of practitioners/pracademics working towards a decolonising journey which has implications for the ethics of youth work practice globally. (shrink)

The issues of medical ethics, from moral quandaries of euthanasia and the morality of killing to political dilemmas like fair healthcare distribution, are rarely out of today's media. This area of ethics covers a wide range of issues, from mental health to reproductive medicine, as well as including management issues such as resource allocation, and has proven to hold enduring interest for the general public as well as the medical practitioner. This Very Short Introduction provides an invaluable tool (...) with which to think about the ethical values that lie at the heart of medicine. This new edition explores the ethical reasoning we can use to approach medical ethics, introducing the most important 'tools' of ethical reasoning, and discussing how argument, thought experiments, and intuition can be combined in the consideration of medical ethics. Considering its practical application, Tony Hope and Michael Dunn explore how medical ethics supports health professionals through the growing use of ethics expertise in clinical settings. They also contemplate the increasingly important place of medical ethics in the wider social context, particularly in this age of globalization, not only in healthcare practice, but also policy, discussions in the media, pressure group and activism settings, and in legal judgments. ABOUT THE SERIES: The Very Short Introductions series from Oxford University Press contains hundreds of titles in almost every subject area. These pocket-sized books are the perfect way to get ahead in a new subject quickly. Our expert authors combine facts, analysis, perspective, new ideas, and enthusiasm to make interesting and challenging topics highly readable. (shrink)

Physicians and other medical practitioners make untold numbers of judgments about patient care on a daily, weekly, and monthly basis. These judgments fall along a number of spectrums, from the mundane to the tragic, from the obvious to the challenging. Under the rubric of evidence-based medicine, these judgments will be informed by the robust conclusions of medical research. In the ideal circumstance, medical research makes the best decision obvious to the trained professional. Even when practice approximates (...) this ideal, it does so unevenly. Judgments in medical practice are always accompanied by uncertainty, and this uncertainty is a fickle companion—constant in its presence but inconstant in its expression. This feature of medical judgments gives rise to the moral responsibility of medical practitioners to be epistemically humble. This requires the recognition and communication of the uncertainty that accompanies their judgment as well as a commitment to avoiding intuitive innovations. (shrink)

This article sets out to explore the way in which Western science and technology was received in the Mbeere Mission of central Kenya since August 1912 when a medical missionary, Dr T.W.W. Crawford, visited the area. In his dalliance with ecclesiastical matters, Crawford, a highly trained Canadian medical doctor, was sent by the Church Missionary Society (CMS) at Kigari-Embu, in 1910, to pioneer the Anglican mission in the vast area that included Mbeereland, where Mbeere Mission is situated. Contending (...) with the African indigenous knowledge in medicine, environmental conservation, agriculture and other forms of indigenous science, the introduction of Western science and technology, 1912 to 1952, the article argues, did not erase the former; rather, it complimented it. Pockets of general resistance were evident, though Mbeereland, unlike its neighbouring Mutira Mission of 1912, did not offer elaborate opposition to the Western science and technology, partly because the locals could have learnt about it from their neighbours who had experienced it much earlier. Through a historico-narrative design, the research article endeavours to primarily review the coming of Western medicine in Mbeereland: Did it conflict with the African medicine? Methodologically, the data have been collected via archival sources, oral interviews and by reviewing applicable literature.Contribution: The input of this research article to the HTS Journal’s vision and scope is seen by appreciating its focus on the interface between African indigenous knowledge and the European science and technology. Although the main focus is. (shrink)

Aims To examine the understanding of the ethical dilemmas associated with Big Data and artificial intelligence (AI) among Jordanian medical students, physicians in training, and senior practitioners. Methods We implemented a literature-validated questionnaire to examine the knowledge, attitudes, and practices of the target population during the period between April and August 2023. Themes of ethical debate included privacy breaches, consent, ownership, augmented biases, epistemology, and accountability. Participants’ responses were showcased using descriptive statistics and compared between groups using t-test (...) or ANOVA. Results We included 466 participants. The greater majority of respondents were interns and residents (50.2%), followed by medical students (38.0%). Most participants were affiliated with university institutions (62.4%). In terms of privacy, participants acknowledged that Big Data and AI were susceptible to privacy breaches (39.3%); however, 59.0% found such breaches justifiable under certain conditions. For ethical debacles involving informed consent, 41.6% and 44.6% were aware that obtaining informed consent posed an ethical limitation in Big Data and AI applications and denounced the concept of “broad consent”, respectively. In terms of ownership, 49.6% acknowledged that data cannot be owned yet accepted that institutions could hold a quasi-control of such data (59.0%). Less than 50% of participants were aware of Big Data and AI’s abilities to augment or create new biases in healthcare. Furthermore, participants agreed that researchers, institutions, and legislative bodies were responsible for ensuring the ethical implementation of Big Data and AI. Finally, while demonstrating limited experience with using such technology, participants generally had positive views of the role of Big Data and AI in complementing healthcare. Conclusion Jordanian medical students, physicians in training and senior practitioners have limited awareness of the ethical risks associated with Big Data and AI. Institutions are responsible for raising awareness, especially with the upsurge of such technology. (shrink)

Objective To determine the knowledge and attitudes of healthcare personnel regarding the provision of non-beneficial futile care in the intensive care units at the major public hospitals in Trinidad and Tobago. Method Prospective data collection was done using a questionnaire administered to the medical and nursing staff of the intensive care units. The questionnaire was designed to capture the opinions regarding the futile care offered to terminally ill patients at the intensive care units. The responses were based on a (...) five-point Likert scale. The influence of factors such as age, gender, duration of work experience, religious belief, ethnicity, occupational category and educational status on the responses were analysed. Results A total of 274 completed responses were obtained from doctors and nurses. The frequency with which the respondents encountered ethical or legal problems in the intensive care unit varied widely from ‘daily’ to ‘yearly’. The majority felt that knowledge of ethics is important, and only 32% knew the legal issues pertaining to their work. Eighty percent of doctors and nurses had no knowledge of an existing Hospital Ethics Committee and its role in ethical dilemmas. Although 62% said their decisions regarding futile care will be influenced by their scientific knowledge, only 32% agreed to withdraw care. Eighty percent said that the government should pass appropriate laws regarding withdrawal of futile care. Conclusions Most healthcare providers in intensive care unit are not knowledgeable in the ethical and legal issues of non-beneficial futile care. There is a need to devise means to bring awareness and educate intensive care unit healthcare providers in this subject. (shrink)

Objectives: To investigate the extent to which family physicians in Lithuania inform their patients about possible side-effects when a common treatment is proposed. To examine the relation between physicians’ estimation of the severity and frequency of these side-effects and their willingness to inform patients. To identify the reasons for informing or not informing the patients.Methods: A questionnaire, presenting three hypothetical cases involving decisions about ordinary medical treatments and a series of general questions about information about side-effects, was distributed to (...) 500 Lithuanian GPs. The response rate was 42%.Results: The respondents differed considerably with regard to their willingness to inform patients about side-effects, but they informed their patients significantly more if the side effect was considered to be common and serious, than in cases when it was considered to be rare and trivial. The majority of the respondents informed their patients primarily to enable them to react appropriately to the side-effects in question. The major reason for not informing was that the side-effects were considered too rare to be relevant to the patient’s decision-making.Conclusion: Information, given to patients about side-effects by Lithuanian GPs, is not in accordance with the principle of respect for patients’ autonomy and requirements of Lithuanian legislation. (shrink)

Comparing the practice of nurse practitioners to medical practice began almost 50 years ago and continues to this day. This comparison is curious since the founders of this movement did not indicate that these advanced practice nurses were to be interchangeable with physicians. Nevertheless, substantial literature indicates that nurse practitioners perform equally or better when measured against physician practice standards. This paper compares the ontology and epistemology of both professions and concludes that the philosophical foundations are so (...) different that comparisons are illogical. (shrink)

Artificial Intelligence (AI) has an increasing role to play in medical education and has great potential to revolutionize health professional education systems overall. However, this is accompanied by substantial questions concerning technical and ethical risks which are of particular importance because the quality of medical education has a direct effect on physical and psychological health and wellbeing. This article establishes an overarching distinction of AI across two typological dimensions, functional and humanistic. As indispensable foundations, these are then related (...) to medical practice overall, and forms of implementation with examples are described in both general and medical education. Increasingly, the conditions for successful medical education will depend on an understanding of AI and the ethical issues surrounding its implementation, as well as the formulation of appropriate guidelines by regulatory and other authorities. Within that discussion, the limits of both narrow or Routine AI (RAI) and artificial general intelligence or Decision AI (DAI) are examined particularly in view of the ethical need for Trustworthy AI (TAI) as part of the humanistic dimension. All stakeholders, from patients to medical practitioners, managers, and institutions, need to be able to trust AI, and loss of confidence could be catastrophic in some cases. (shrink)

Indigenous understandings of consciousness represent an important inspiration for scientific discussions about the nature of consciousness. Despite the fact that Indigenous concepts are not outputs of a research driven by rigorous, scientific methods, they are of high significance, because they have been formed by hundreds of years of specific routes of cultural evolution. The evolution of Indigenous cultures proceeded in their native habitat. The meanings that emerged in this process represent adaptive solutions that were optimal in the (...) given environmental and social milieu. We argue that it would not be appropriate to handle these meanings as something that science considers to be wrong, or outdated relics of the human past. In contrast, Indigenous concepts and their meanings may be considered to be an important heritage of native human populations, but moreover, they are also an interesting material for analyses and inspiration for recent scientific debates. Furthermore, it is also necessary to mention another reason why the exploration of Indigenous concepts has been so topical recently. Thus far, much psychological theoretical development has been published in English as a result of research conducted in Western countries. The dominance of English and the superiority of research conducted by researchers from Western countries may be considered as a kind of barrier toward other ways of knowing. We argue that the traditional cultural knowledge coming from Indigenous societies may offer an interesting source of new thought for science. The weakening of the strong dependence of science on well-established academic circles dominated by Western theoretical perspectives may be beneficial for stimulating its further development (Sidik, 2022). Therefore, this special symposium of the Journal of Consciousness Studies aims to open the doors for other ways of knowing, For the knowing that emerged in native Indigenous cultures. We argue that the rich cultural heritage of these societies may stimulate the emergence of new analytical perspectives for scientific theorising about the nature of consciousness. For all these reasons, the Indigenous concepts of consciousness captured our interest, and we decided to start investigating them. In 2020 and 2021, we retrieved and analysed pieces of information from past ethnographical field evidence gathered in various Indigenous cultures. After removal of data about the cultures showing a high acceptance of influences from external religious traditions (e.g. Christianity, Islam or Buddhism), a comparative analysis of data from 55 Indigenous groups was conducted and published in the Journal of Consciousness Studies (Trnka and Lorencova, 2022). This primary project revealed many interesting results, but more importantly, it also showed many unexplored avenues that called for further exploration. This special symposium of the Journal of Consciousness Studies is a continuation and new development of research on the Indigenous understanding of consciousness. Past ethnographical evidence involved some valuable pieces of knowledge about Indigenous concepts of consciousness, but the relevant information was often fragmentary or even totally missing in some cases. Moreover, many authors of past ethnographic records applied a strong etic approach that clouded the understanding of native Indigenous thoughts. Therefore, the main goal of the recent symposium was to broaden the overall information basis for the analysis of Indigenous concepts of consciousness or closely related phenomena. In other words, the symposium aimed to bring more detailed knowledge of Indigenous concepts of consciousness, mind and body and their relations in various groups of Indigenous people. In 2022, we contacted potential contributors and were pleased by their positive reactions, which reflected the topicality of this research focus. The authors were asked to draft their papers with a special focus on (a) a cultural Indigenous understanding of the concept of consciousness, (b) a cultural Indigenous understanding of the mind-body differentiation (or consciousness-body differentiation) and (c) cultural metaphors and cultural beliefs related to consciousness, mind and body. Many of contributors were native members of Indigenous cultures that made the descriptions of Indigenous concepts more accurate and reliable. This enabled many truly emic, in-depth insights into the Indigenous concepts of consciousness and related phenomena to be gained. As a result, this issue of the Journal of Consciousness Studies introduces eight papers, each focused on a different geographical region/Indigenous groups: Nahua and Maya (Mexico), Guna (Panama), Mapuche (Chile), Maori (New Zealand), Telingit (Altai), Mongolian groups, Igbo (Nigeria) and Asabano (New Guinea). These papers are followed by one more general paper discussing magical consciousness on the case of an Aboriginal wise man (Australia). The symposium closes with our concluding editorial essay, which generalises the findings and introduces three theoretical models of understandings of consciousness inspired by the analysis of Indigenous concepts of consciousness. Aside from the importance for basic research, the exploration of Indigenous concepts of consciousness is also very important for informing practitioners from many applied spheres. Many current methods for treating addictions, traumatic life events, professional burnout and other mental health problems use features of Indigenous healing practices. A proper understanding of meanings related to mind, body and consciousness are quite important for Western psychotherapists to adapt the Indigenous practices to particular Western cultural milieus. Furthermore, a proper understanding of meanings related to mind, body, and consciousness is also important for treating ethnic, linguistic and culturally diverse populations (APA, 1990). For therapists, psychologists and physicians, understanding the meanings of these concepts may promote their own better care of their clients from various Indigenous ethnic groups. Last but not least, Indigenous concepts, meanings and languages are closely related to the continuation of the heritage of Indigenous people (United Nations, 2016). The world’s Indigenous languages have recently been under threat of disappearing; many Indigenous languages are endangered globally, and the rate of loss is high (United Nations, 2016). Importantly, recent research has also shown that the retention of Indigenous languages may be protective for the psychological and physical health of their speakers. All these areas represent fields for potential use of the findings presented in this symposium of the Journal of Consciousness Studies. As a concluding note, the editors of this symposium hope that this collection of papers will inspire academic scholars while also providing important information for practitioners from various spheres. (shrink)

Today the medical community faces a number of pressing issues. Molecular and high-tech medicine, despite their tremendous successes, also burden us with new ethical dilemmas: when and how to die, whose life to preserve, whether to modify genes and to create life, and how to pay for it all. Furthermore, alternative methods appear to work at least for certain disorders. They are popular and definitely cost less, while the spiraling costs of conventional medicine have led to the development of (...) managed care and health economy assessments with controversial consequences. An international symposium in Berlin, in September 1999, sought to address some of these issues by sparking an interdisciplinary discussion gathering leading experts in the field of genetics, robotic surgery, medical ethics, preventive health and health economics, history, and law. This book contains all the contributions and seeks to involve scholars and medical practitioners who are interested in shaping the future of medicine. (shrink)

Issues in medical ethics are rarely out of the media and it is an area of ethics that has particular interest for the general public as well as the medical practitioner. This short and accessible introduction provides an invaluable tool with which to think about the ethical values that lie at the heart of medicine. Tony Hope deals with thorny moral questions, such as euthanasia and the morality of killing, and also explores political questions such as: how should (...) health care resources be distributed fairly? (shrink)

Medical clinicians – doctors, nurses, nurse practitioners etc. – are charged to act for the good of their patients. But not all ways of acting for a patient's good are on par: some are paternalistic; others are not. What does it mean to act paternalistically, both in general and specifically in a medical context? And when, if ever, is it permissible for a clinician to act paternalistically? In Medical Paternalism Part 1, I answered the first question. (...) This paper answers the second. The place of paternalism in clinical medicine is best understood, I argue, in terms of the potential for conflict between the autonomy principle and the beneficence principle. The first enjoins clinicians to respect the decisions of patients with respect to their (the patients') own care. The second enjoins clinicians to act for the good of their patients. Clinicians act paternalistically, I argue, when they act on the beneficence principle to the exclusion of the autonomy principle. Understanding just what these principles amount to (particularly the autonomy principle) reveals that the autonomy principle defeasibly trumps the beneficence principle and that, as a result, acting paternalistically (at least when it comes to competent patients) is presumptively impermissible. (shrink)