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

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

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

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

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

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

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

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

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust (...) at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. (shrink)

The paper begins with a defence of a new definition of privacy as the absence of undocumented personal knowledge. In the middle section, I criticise alternative accounts of privacy. Finally, I show how my definition can be worked into contemporary American Law.

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable (...) of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow (...) biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health. (shrink)

Several decades of behavioral research have established that variations in socioeconomic status are related to differences in cognitive performance. Neuroimaging and psychophysiological techniques have recently emerged as a method of choice to better understand the neurobiological processes underlying this phenomenon. Here we present a systematic review of a particular sub-domain of this field. Specifically, we used the PICOS approach to review studies investigating potential relationships between SES and scalp event-related brain potentials. This review found evidence that SES is related to (...) amplitude variations in a diverse range of ERPs: P1, N1, N2, Error-Related Negativities, N400, auditory evoked potentials, negative difference waves, P3 and slow waves. These ERPs include early, mid-latency and late potentials that reflect a broad range of cognitive processes. In this review, all SES effects on ERPs appeared to reflect an impairment or a less efficient form of task-related neural activity for low-SES compared to high-SES individuals. Overall, these results confirm that a wide variety of distinct neural processes with different functional meanings are sensitive to SES differences. The findings of this review also suggest that the relationship between SES and some ERP components may depend on the developmental stage of study participants. Results are further discussed in terms of the current limitations of this field and future avenues of research. (shrink)

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has for decades been a locus of dispute between ardent defenders of its scientific validity and vociferous critics who charge that it covertly cloaks disputed moral and political judgments in scientific language. This essay explores Alasdair MacIntyre's tripartite typology of moral reasoning—"encyclopedia," "genealogy," and "tradition"—as an analytic lens for appreciation and critique of these debates. The DSM opens itself to corrosive neo-Nietzschean "genealogical" critique, such an analysis holds, only (...) insofar as it is interpreted as a presumptively objective and context-independent encyclopedia free of the contingencies of its originating communities. A MacIntyrean tradition-constituted understanding of the DSM, on the other hand, helpfully allows psychiatric nosology to be understood both as "scientific" and, simultaneously, as inextricable from the political and moral interests—and therefore the moral successes and moral failures—of the psychiatric guild from which it arises. (shrink)

The principles of equality and equity, respectively in the Bill of Rights and the white paper on health, provide the moral and legal foundations for future health care for children in South Africa. However, given extreme health care need and scarce resources, the government faces formidable obstacles if it hopes to achieve a just allocation of public health care resources, especially among children in need of highly specialised health care. In this regard, there is a dearth of moral analysis which (...) is practically useful in the South African situation. We offer a set of moral considerations to guide the macro-allocation of highly specialised public health care services among South Africa's children. We also mention moral considerations which should inform micro-allocation. (shrink)