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)

SINCE the publication in 1952 of Douglas McKie's Antoine Lavoisier, the standard biography which is of great value to all students of eighteenth-century science, there has been a steady increase in knowledge of most aspects of Lavoisier's life and work. This survey will be concerned ,mainly with monographs and papers in scientific and historical journals, but several important books may first be noted.

In 1768 H. B. de Saussure studied chemistry with Baumé in Paris, and subsequently, using precise quantitative methods, he analysed minerals collected during his alpine journeys. He began to use the blowpipe in 1784, and later adapted it so that with a microscope and micrometer he could examine the effects of high temperatures on minute specimens of minerals. Analyses of air carried out with a portable eudiometer convinced him that air from alpine valleys contained more oxygen, and was therefore healthier, (...) than air from either mountain tops or plains. In 1788 he accepted the antiphlogistic theory after reading the annotated French translation of Kirwan's Essay on Phlogiston; he announced his conversion in a letter to the translator, Madame Lavoisier, whose reply is discussed and published here for the first time. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 535 second English volume), Ratzinger's Behold the Prerced One (pp. 1345 ), and W. Kasper's Theology and Church (pp. 94-108; Kasper says simply, "Rahner's characterization of neo-Chalcedonianism is historicaly inaccurate," p. 214, note 18). As it is, Ols's treatment reminds us that Rahner's own writings, which overlooked the later Councils of Constantinople, presume that Chalcedon had been the end of a development in Christology; this inaccurate presumption (...) has dominated too much of the writing which has followed Rahner's essay. Ols returns to this problem of " latent monophysitism " in some classical christologies in the final chapters of his work (VIII-XI). With a careful examination of the christology of Aquinas, the author skillfully demonstrates the rich development of Christ's true humanity that is possible within the classical approach; he deals specifically with the topics of Christ's knowledge, his sinlessness, and the concept of person. (It is interesting to note that, like Rahner and others before and after, Ols thinks that the word "person" is not particularly felicitous and would prefer simply the word hypostasis or subsistence [p. 187]. His wish is likely to have no more success than previous suggestions in this regard.) Although limited in its intent, this hook is rich in many ways. Ols's knowledge of St. Thomas is deep, and he uses that knowledge well. His critique of Rahner and Schilleheeckx may he forceful in its negative assertions, hut I believe it is accurate in pointing out the philosophical idealism that underlies much of their christological writings. This idealism is too often overlooked and needs the corrective of what we might call "Mediterranean realism." Although his criticism may he incisive, it is never unfair or strident, and he is aware of the positive insights that these men have contributed to our continuing reflections on the Lord. By intent, Ols's work is essentially one of evaluation and criticism. Nevertheless, the chapters that reflect on (and develop) Aquinas's teaching and give a positive presentation of the real human· ity of the Lord lead one to hope that the author will follow this study with a fully elaborated christology. St. Joseph's Seminary, Dunwoodie Yonkers, New York JAMES T. O'CONNOR Kant's System of Rights. By LESLIE A. MULHOLLAND. New York: Columbia University Press, 1990. Pp. xvii + 434. $49.00. Several good hooks on Kant's political philosophy have appeared in the past decade, hut the literature on Kant's political philosophy is still both slimmer and weaker than on any other aspect of his thought. 536 BOOK REVIEWS Though we still await a definitive study of the topic, this book goes a long way toward filling some important gaps. Even the best books on Kant's political philosophy tend to treat only the broad outlines of Kant's position, shying away from detailed exposition of Kant's theories of individual right and external possession and of the political theory based on them. Mulholland's is not only the most detailed but also the most persuasive account of these matters which has yet been presented in English. The book's first four chapters attempt to lay the foundations for Kant's political philosophy through a general discussion of his ethical theory. The main function of these (somewhat overlong) introductory chapters is to argue for a tension between the law of nature formula (which Mulholland prefers as a guide to Kant's theory of right) and the formula of humanity as end in itself. According to Mulholland, the law of nature formula leads to a theory of rights and political obliga· tion which places Kant in the natural law tradition, whereas the formula of humanity commits him to what Mulholland calls the " deed principle ": that acquired rights can come about only through a deed on the part of those having the duties corresponding to the rights through which these duties have been assumed. Mulholland argues that if we take the deed principle strictly, then we must base political obligation on consent and thus on a social contract. The burden of Mulholland's argument throughout the book is that Kant cannot sustain the deed principle, and it is... (shrink)

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)

Summary The model underlying the hippocratic humoral theory, as well as the corresponding part of hippocratic aetiology is reconstructed in precise, structuralist terms. Stress is laid on the presentation of the model, historical and philological derivations are suppressed. The global net structure of humoral theory in which the different diseases are described as specializations of the basic model is worked out, and the particular metatheoretical features of ‘therapeutical’ theories, as contrasted to ‘descriptive’ theories, are exemplified and stated in general.

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 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)

This book has been considered by academicians and scholars of great significance and value to literature. This forms a part of the knowledge base for future generations. We have represented this book in the same form as it was first published. Hence any marks seen are left intentionally to preserve its true nature.

This work, a reworked doctoral thesis written for Roland Bainton at the Yale Divinity School, begins with an announcement of a specific scholarly purpose: "To clarify the relationship between the clergy and the magistracy which grew out of Zwingli's reforming work at Zurich... the main focus of the study is upon the early stages of Zwingli's career at Zurich.... The ensuing study accepts the assumption that Zwingli believed in a Christian society ruled by two God-ordained officers, the magistrate and the (...) pastor, and asks 'What place did Zwingli assign to the magistrate and the clergy in order to realize the rule of God?'" Using as his model the German habilitations schrift, the author exhausts every possible aspect of Zwingli's theological and political thought. All of Zwinglian scholarship is summarized here, and problems in Zwingli's thought are dealt with emphasizing its development and its contradictions. Basically Walton argues that most of the scholarship about Zwingli is wrong because it assumes that Zwingli advocated domination of the government by the clergy. Zwingli was a defender of a theory of government which envisaged a co-operation between the spiritual and secular authority in a Christian society in order to realize the will of God. Walton finds that Zwingli's success in reforming Zurich was based upon the fact that his formulation of a Church-State detente conformed to pre-existing conditions in that city. Zurich was dominated by a corporate form of government which had already permitted the magistracy to take on a semi-sacral character. Zwingli, Walton argues, fit his theory of government to the conditions as they existed at Zurich. This is a book for Zwingli aficionados. It is an example of extremely well-done Continental scholarship: precise, insightful, and dry. No doubt the work has already become a definitive work on Zwingli's notion of theocracy.--W. A. J. (shrink)

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)

T he O bject of this paper is the development of a view of punishment which incorporates what is of importance in retributive and utilitarian justifications of the practice of punishment. This proposed theory was noted and referred to as the plene esse , but not fully worked out, in the course of a discussion paper in which my concern was to offer an alternative view, to that of Mr Anthony Quinton, by construing ‘the right to punishment’ as meaning that (...) ‘the offender has the right to be regarded as responsible for his actions’. (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)

Background. South Africa (SA) currently has a golden opportunity to legislate on human heritable genome editing (HHGE), as the country is revising its assisted reproductive technology regulations. A set of sub-regulations that deals with HHGE, which could seamlessly slot into the current regulations, has already been developed. The principles underlying the proposed set of sub-regulations are as follows: HHGE should be regulated to improve the lives of the people and should not be banned; the well-established standard of safety and efficacy (...) should be used in the regulation of HHGE; quality of life is what matters, and not preserving a ‘normal’ genome; parents’ reproductive autonomy must be respected; and equality of access to approved HHGE technology should be promoted. Objectives. To ascertain whether the proposed set of sub-regulations that deals with HHGE is aligned with public opinion in SA, and SA’s Bill of Rights. Methods. Public opinion in SA is determined with reference to a deliberative public engagement study on HHGE conducted among South Africans, and the relevant rights in the Bill of Rights are interpreted with reference to recent case law. Results. This proposed set of sub-regulations that deals with HHGE is aligned with public opinion in SA, and SA’s Bill of Rights. Conclusion. Despite the legal and ethical complexities of HHGE, the proposed set of sub-regulations provides a targeted and effective legislative approach. They fit seamlessly into the country’s existing health law framework, creating specific legal standards for HHGE that align with both public opinion and the country’s Bill of Rights. (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.