Contemporary Bioethics: A Reader with Cases is the most cutting-edge bioethics anthology/casebook available. Incorporating introductions, readings, and cases that span the breadth of the discipline, this exceptional volume captures the spirit of bioethics as a rich, exciting, and continuously evolving field. Addressing all of the essential topics--including abortion, reproductive ethics, end-of-life care, research ethics, and the allocation of resources--it also moves beyond the "classic" approach of other books by extending into timely and provocative issues like terrorism, (...) cosmetic surgery, immigration, genetic manipulations, links between first- and third-world health, and--unique to this book--environmental sustainability and climate change. In addition, Contemporary Bioethics is the only book of its kind that includes both philosophical and religious perspectives.The text opens with a substantial introduction that presents key ethical principles, theories, and methods and shows students how to use these tools to frame and address ethical dilemmas in medicine. Covering the brief yet captivating history of the field, the introduction also considers the role of religion in the development of bioethics and examines differences between secular and religious modes of argumentation. Each of the seven topical chapters contains an in-depth introduction, a selection of concise readings representing a diverse range of moral perspectives, discussion questions, and a collection of full-length and provocative case studies that enable students to further explore the issues.Ideal for introductory courses in bioethics and biomedical ethics, Contemporary Bioethics is supplemented by a Instructor's Manual on CD and a Companion Website containing resources for both students and professors, including chapter summaries, additional cases with discussion questions, ideas for further reading, vocabulary flashcards, self-quizzes, and more. (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning (...) the choice are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

This paper, which is based on an extensive analysis of the literature, gives a brief overview of the main ways in which solidarity has been employed in bioethical writings in the last two decades. As the vagueness of the term has been one of the main targets of critique, we propose a new approach to defining solidarity, identifying it primarily as a practice enacted at the interpersonal, communal, and contractual/legal levels. Our three-tier model of solidarity can also help to explain (...) the way in which crises of solidarity can occur, notably when formal solidaristic arrangements continue to exist despite ‘lower tiers’ of solidarity practices at inter-personal and communal levels having ‘broken away’. We hope that this contribution to the growing debate on the potential for the value of solidarity to help tackle issues in bioethics and beyond, will stimulate further discussion involving both conceptual and empirically informed perspectives. (shrink)

Patients and physicians can inhabit distinctive social worlds where they are guided by diverse understandings of moral practice. Despite the contemporary presence of multiple moral traditions, religious communities and ethnic backgrounds, two of the major methodological approaches in bioethics, casuistry and principlism, rely upon the notion of a common morality. However, the heterogeneity of ethnic, moral, and religious traditions raises questions concerning the singularity of common sense. Indeed, it might be more appropriate to consider plural traditions of moral (...) reasoning. This poses a considerable challenge for bioethicists because the existence of plural moral traditions can lead to difficulties regarding "closure" in moral reasoning. The topics of truth-telling, informed consent, euthanasia, and brain death and organ transplantation reveal the presence of different understandings of common sense. With regard to these subjects, plural accounts of "common sense" moral reasoning exist. (shrink)

Increasingly, genomic analysis is being utilized to diagnose children with developmental delay or dysmorphic facial features suggestive of a congenital disorder. Genetic testing has rapidly evolved, and the genome-wide tests that we use today are significantly different from the more targeted single-gene tests of the last decade. Chromosomal microarray analysis is now a first line test for children with multiple birth defects, children with intellectual impairment, and children with an unusual constellation of symptoms that do not fit with a known (...) disease. There are three types of CMA that are currently clinically available. CMA by oligonucleotide array-based comparative genomic hybridization compares the hybridization signal from the patient's DNA to that of a reference DNA sample for each oligonucleotide on the array. Depending on the specific array, this can range from tens of thousands to hundreds of thousands of oligonucleotides. (shrink)

Increasingly, genomic analysis is being utilized to diagnose children with developmental delay or dysmorphic facial features suggestive of a congenital disorder. Genetic testing has rapidly evolved, and the genome-wide tests that we use today are significantly different from the more targeted single-gene tests of the last decade. Chromosomal microarray analysis is now a first line test for children with multiple birth defects, children with intellectual impairment, and children with an unusual constellation of symptoms that do not fit with a known (...) disease. There are three types of CMA that are currently clinically available. CMA by oligonucleotide array-based comparative genomic hybridization compares the hybridization signal from the patient's DNA to that of a reference DNA sample for each oligonucleotide on the array. Depending on the specific array, this can range from tens of thousands to hundreds of thousands of oligonucleotides. (shrink)

Two fundamental problems in all thought can be identified: One, life and world affirmation and second, life and world negation. Indian approach is characterized as the second and hence it is claimed that moral problems have not been persistently pursued and successfully tackled in India. Points like the advaita concept of liberation, law of karma, the system of social stratification, stages of life and duties associated with them are picked up to show that theIndian system is ethically bankrupt. But along (...) with the science of salvation, the science of statecraft (arthasastra) and four objectives of human life are emphasized. The two functions of knowledge namely, theoretical and practical (arthaparicchiti and phalaprapti) referring to fact and value are recognized and it is held that knowledge of facts lead to the pursuit of values. Value is taken as the ‘object of desire’. The concept of svadharma and ahimsa are basic to it. The ‘ought of ethics’ (Dharma) is foundational to all Indian thought. A comprehensive value system consisting of spiritual, moral, material and social values and the distinction between instrumental and intrinsic values are recognized. Contemporary ethical issues relating to human rights and women, suicide, abortion and the host of problems thrown open by science and biotechnology find proper place in it. (shrink)

Physicians' duties to their patients traditionally have been construed narrowly in time and scope to focus on the specific episode of care or clinical encounter. Physicians generally have had no ethical or legal duty to notify patients about new medical information discovered after a visit, notwithstanding the health care benefits to patients that might flow from receiving the information. The rule was based on the relatively high burdens that notification would impose on physicians compared with the likelihood of benefits to (...) patients. This established view, however, no longer may be appropriate in light of new physician-patient relationships and the reduced burden of patient notification using new types of health information technology. This article explores the duty to inform patients and former patients about relevant, medical developments subsequent to their episode of care. It concludes by recommending the recognition in ethics and law of a limited, ongoing duty to notify patients of significant information relevant to their health. (shrink)

Recently, an agonizing twist intersecting predictive genetic tests and surrogacy contracts made news headlines in Canada. The intended parents, a couple from British Columbia, instructed the surrogate mother with whom they were working to undergo First Trimester Screening and Chorionic Villi Sampling, which revealed the fetus likely had Down syndrome. The parents directed the surrogate to terminate the fetus or they would abdicate their parental claim upon birth. This story raised numerous legal and ethical questions relating to the transferability of (...) decision making for prenatal screening, diagnostic tests, and the connected decision of termination when additional interested parties – the intended parents – are involved in the medical decision-making relationship. First, although the surrogate is the patient, what are the implications when the intended parents' wishes influence or even dictate the relationship between her and her obstetrician and genetic counselor? Second, if the intended parents' level of authority reaches explicit demands, may the intended parents ethically and legally require the surrogate to waive her right to informed consent for prenatal screening and diagnosis? (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which (...) treatment choices are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

In this chapter, I provide a critical exposition of the contemporary bioethics of life extension (LE). First, I provide critical socio-historical contextualization for contemporary bioethics in general by locating it within postmodernity, which discloses crucial implications for what normative claims can possibly be justified within contemporary bioethics and clarifies the typical form that transgression of these limits takes in contemporary bioethics. In the next section, I analyze the structure of the debate over (...) LE into arguments for the necessary desirability (or undesirability) of LE and those for the contingent desirability (or undesirability) of LE, and I provide a survey of the latter. Then, in the next two sections, I critically explicate the main arguments for the necessary desirability and undesirability of LE. I conclude with some final critical remarks on the debate, emphasizing the need for public bioethicists to recognize and be more responsive to the theoretical and empirical pluralism characteristic of the postmodern liberal states in which they typically operate. (shrink)

From the earliest days of the Human Genome Project, the holy grail of genomics was the ability to perform whole-genome sequencing quickly, accurately, and relatively inexpensively so that the benefits of genomics would be widely available in clinical settings. Although the mythical $1,000 genome sequence seemed elusive for many years, next-generation sequencing technologies and other recent advances clearly indicate that inexpensive whole-genome sequencing is at hand.Whole-genome sequencing has demonstrable value in elucidating the genetic etiology of rare disorders, in identifying atypical (...) variants in common diseases, in determining pharmacogenomically appropriate drugs and dosages, in performing tumor genome sequencing, and in aiding other clinical applications for the diagnosis and treatment of individuals who are symptomatic or whose family health history places them at substantial risk. Undoubtedly, the clinical applications of wholegenome sequencing will increase in the future. (shrink)

The seemingly interminable debates about health care reform in the last few years have focused mainly on health care access, quality, and cost. Debates on the medical malpractice component of the issue have focused almost entirely on cost. The familiar arguments in favor of limiting liability include the financial and health costs of defensive medicine; decreased physician supply in certain specialties and geographic areas; excessive awards; and high transaction costs, including attorney and expert witness fees. The equally familiar arguments in (...) favor of maintaining tort liability include the need to promote civil justice, deter substandard care, identify incompetent practitioners, and encourage systemic quality improvement.Numerous studies have explored the possible effects of damage caps and other measures on malpractice premiums, health care costs, and other financial endpoints. One relatively under-examined aspect of the issue is how federal legislation expanding access to health care might alter the number of medical malpractice claims. With the enactment of the Patient Protection and Affordable Care Act of 2010, it is especially appropriate to consider what effect, if any, the new law will have on the rate of medical malpractice claims. (shrink)

The Edge of Life: Human Dignity and Contemporary Bioethics resituates bioethics in fundamental outlook by challenging both the dominant Kantian and utilitarian approaches to evaluating how new technologies apply to human life. Drawing on an analysis of the dignity of the human person, both as an agent and as the recipient of action, The Edge of Life presents a "theoretical" approach to the problems of contemporary bioethics and applies this approach to various disputed questions. Should (...) conjoined twins be split, if the division will end the life of the weaker twin? Was Bush's stem cell research decision morally acceptable? Are the 'quality of life' and 'sanctity of life' ethics irreconcilably incompatible? Accessible to both scholars and students, The Edge of Life focuses particularly on the controversial issues surrounding the beginning and ending of human life, tackling some of the toughest practical questions of bioethics including new reproductive technologies (artificial wombs), stem cell research, abortion and physician assisted suicide, as well as many of its vexing theoretical disputes. (shrink)

Beginning in the 20th century, scientific research came to be dominated by a growing class of credentialed, professional scientists who overwhelmingly displaced the learned amateurs of an earlier time. By the end of the century, however, the exclusive realm of professional scientists conducting research was joined, to a degree, by “citizen scientists.” The term originally encompassed non-professionals assisting professional scientists by contributing observations and measurements to ongoing research enterprises. These collaborations were especially common in the environmental sciences, where citizen scientists (...) participated in counting wildlife and measuring environmental conditions. Later, patient groups began to play a more active role in supporting clinical trials and collecting health records from affected individuals. (shrink)

Encouraged by the financial incentives in the Health Information Technology for Economic and Clinical Health Act of 2009, electronic health record adoption is on the rise. According to a study by the Centers for Disease Control and Prevention published in 2014, 78% of office-based physicians had adopted some type of EHR system, up from 18% in 2001. Implementation of EHRs able to support the Department of Health and Human Services “meaningful use” requirements has also significantly increased since 2010. Such a (...) growth in EHR adoption with the capacity to achieve “meaningful use” standards suggests that the goal of nationwide, interoperable health records is moving closer to a reality.While movement toward a system-wide, interoperable EHR promises benefits of such an electronic information management tool, the risks related to patients’ privacy of their health information remains a concern. (shrink)

Encouraged by the financial incentives in the Health Information Technology for Economic and Clinical Health Act of 2009, electronic health record adoption is on the rise. According to a study by the Centers for Disease Control and Prevention published in 2014, 78% of office-based physicians had adopted some type of EHR system, up from 18% in 2001. Implementation of EHRs able to support the Department of Health and Human Services “meaningful use” requirements has also significantly increased since 2010. Such a (...) growth in EHR adoption with the capacity to achieve “meaningful use” standards suggests that the goal of nationwide, interoperable health records is moving closer to a reality.While movement toward a system-wide, interoperable EHR promises benefits of such an electronic information management tool, the risks related to patients’ privacy of their health information remains a concern. (shrink)

In the rapidly expanding field of bioethics, philosophers and critics have taken on the task of attempting to understand the ethical implications related to the development of enhancement technologies. A term which itself is still hotly contested in the field, “enhancement technologies” refer generally to the application of biotechnological devices aimed at augmenting human physical and mental traits. According to the President’s Council on Bioethics, which was commissioned in 2001 to “advise the President on bioethical issues that may (...) emerge as a consequence of advances in biomedical science and technology,” enhancement technologies are broadly defined as “those well-meaning and strictly voluntary uses of .. (shrink)

The personalist approach is an important contribution to the resolution of the re_levant problems of contemporary bioethics. After the period of universally expanded principalism, which was followed by its many-sided criticism, the bioethics finds itself unable to act effectively . In this situation personalism comes up with new insights, which make finding acceptable resolutions of moral dilemmas of contemporary biomedicine, as well as other natural sciences possible.

Discussions surrounding patient engagement and empowerment often use the terms “patient” and “consumer” interchangeably. But do the two terms hold the same meaning, or is a “patient” a passive actor in the health care arena and a “consumer” an informed, rational decision-maker? Has there been a shift in our usage of the two terms that aligns with the increasing commercialization of health care in the U.S. or has the patient/consumer dynamic always been a part of the buying and selling of (...) health care in the American system? Recent discussions of the issue exist in the popular press and in social media forums such as TEDMED, but few direct analyses of the ethical, legal, and policy ramifications of this possible shift in terminology are available in the academic literature. This paper analyzes our usage of the terms and any recent changes in the dynamic and discusses the ethical, legal, and policy implications of this simple terminology for the physicianpatient relationship. (shrink)

This third edition anthology provides a contemporary survey of current international issues for study across social science disciplines. New chapters discuss the reproductive justice in the US, immigration politics and medical duty during pandemics, climate change implications for bioethics, acoustic weaponry technologies, and vaccine politics.

In 1997 a debate broke out about the ethical acceptability of using placebo as a comparative alternative to establishe effective treatment in trials conducted in developing countries for the purpose of preventing perinatal HIV-transmission. The debate has now been going on for more than five years. In spite of extensive and numerous attempts at resolving the controversy, the case seems far from being settled. The aim of this paper is to provide an updated account of the debate, by identifying empirical (...) arguments employed in the controversy and by critically assessing their use in the debate. A notion of resolution of moral conflicts will be introduced that makes it possible to give a more positive verdict on the moral results of this controversy. Finally, the procedural problem of safe-guarding the selection of empirical arguments against undue forms of normative bias will be addressed. (shrink)

In the United States the delivery of health care traditionally has been hierarchical and strictly controlled by physicians. Physicians typically provided patients with little information about their diagnosis, prognosis, and treatment plan; patients were expected to follow their physicians’ orders and ask no questions. Beginning in the 1970s, with the widespread adoption of the doctrine of informed consent to treatment, the physician-patient relationship began to be more collaborative, although the extent of the change has been subject to debate. At a (...) minimum, physicians began to give patients more information and asked them to consent to recommended treatment, the therapeutic privilege to withhold information from patients lost support and eventually was repudiated, and physicians embraced — at least in theory — a more patient-centered conception of health care.More recently, health care and health promotion activities have moved beyond clinical encounters and the strict confines of physician-patient interactions. (shrink)

In the United States the delivery of health care traditionally has been hierarchical and strictly controlled by physicians. Physicians typically provided patients with little information about their diagnosis, prognosis, and treatment plan; patients were expected to follow their physicians’ orders and ask no questions. Beginning in the 1970s, with the widespread adoption of the doctrine of informed consent to treatment, the physician-patient relationship began to be more collaborative, although the extent of the change has been subject to debate. At a (...) minimum, physicians began to give patients more information and asked them to consent to recommended treatment, the therapeutic privilege to withhold information from patients lost support and eventually was repudiated, and physicians embraced — at least in theory — a more patient-centered conception of health care.More recently, health care and health promotion activities have moved beyond clinical encounters and the strict confines of physician-patient interactions. (shrink)

Are there universal ethical principles that should govern the conduct of medicine and research worldwide? -- Is it morally acceptable to buy and sell organs for human transplantation? -- Were it physically safe, would human reproductive cloning be acceptable? -- Is the deliberately induced abortion of a human pregnancy ethically justifiable? -- Is it ethical to patent or copyright genes, embryos, or their parts? -- Should minors have the right to refuse treatment, even when against the will of their parents (...) or guardians? -- Is physician-assisted suicide ever ethical? -- Should stem cell research utilizing embryonic tissue be conducted? -- Should we prohibit the use of chimpanzees and other great apes in biomedical research? -- Should the United States of America adopt universal health care? -- Is there a legitimate place for human genetic enhancement? -- Can there be agreement as to what constitutes human death? -- Is there ever a circumstance in which a doctor may withhold information? -- Should in vitro fertilization be an option for a woman? -- Are international clinical trials exploitative? (shrink)

: The film "Who Should Survive?: One of the Choices on Our Conscience" contains a dramatization of the death of an infant with Down syndrome as the result of the parents' decision not to have a congenital intestinal obstruction surgically corrected. The dramatization was based on two similar cases at The Johns Hopkins Hospital and was financed by the Joseph P. Kennedy, Jr., Foundation. When "Who Should Survive?" was exhibited in 1971, the public reaction was generally critical of the parents' (...) decision and the physicians' inaction. Although technological developments in medicine were a necessary condition for the production of this film and its unanticipated reception, they were not a sufficient condition. The proximate cause was a changed understanding of the capabilities of individuals with Down syndrome. Part of the impetus for this change was data showing the adverse effects of institutionalization on normal children. (shrink)

Background The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. Discussion Social Darwinism was foremost amongst the philosophies impacting views of human dignity in (...) the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans. A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. Summary Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many humans. Their widespread acceptance today would similarly lead to much human death and suffering. A different ethic in needed which views human dignity as inherent to all human individuals. (shrink)

In two articles about the controversy surrounding stem cell research, Søren Holm claims that no argument has so far been advanced in the debate to justify the necessity of destructive research on human embryos for the therapeutic potential of stem cell research to be achieved, and that it is up to the scientists themselves to produce “convincing arguments” for their case. This seemingly defeatist statement on behalf of bioethics originates from the viewpoint that neither a reiteration of old arguments (...) about the moral status of the human embryo nor the generation of new arguments of the same kind are likely to have any positive bearing on the controversy; on the other hand, the impact of science on the current debate is unquestionable, due to three “partially independent” developments. (shrink)

After recent tragedies involving mass murders on a college campus in Virginia, an Army base in Texas, a congressional constituent event at a shopping center in Arizona, and a movie theater in Colorado, one might have assumed the public had become numb to horrendous and senseless acts of killing. If so, one would have been wrong. The public was not prepared for the brutal and cold-blooded murder of 20 first-grade school children and six teachers and staff at Sandy Hook Elementary (...) School in Newtown, Connecticut, on December 14, 2012.Following the all-too-familiar emotional stages of shock, grief, and anger, many members of the public and elected officials turned to the issue of how to prevent such tragedies in the future. Two main questions quickly became the focus of policy makers. (shrink)

After recent tragedies involving mass murders on a college campus in Virginia, an Army base in Texas, a congressional constituent event at a shopping center in Arizona, and a movie theater in Colorado, one might have assumed the public had become numb to horrendous and senseless acts of killing. If so, one would have been wrong. The public was not prepared for the brutal and cold-blooded murder of 20 first-grade school children and six teachers and staff at Sandy Hook Elementary (...) School in Newtown, Connecticut, on December 14, 2012.Following the all-too-familiar emotional stages of shock, grief, and anger, many members of the public and elected officials turned to the issue of how to prevent such tragedies in the future. Two main questions quickly became the focus of policy makers. (shrink)

The “best interest standard” is the guidance principle for pediatric healthcare in the United States (US) and the United Kingdom (UK). In the UK, the best interest standard may also be used as an intervention principle when parents make good but non-ideal decisions whereas intervention in the US requires a determination of abuse or neglect. I examine whether and how the different uses of the best interest standard influence predictive genetic testing of children.

The genetic testing and screening of children has been fraught with controversy since Robert Guthrie developed the bacterial inhibition assay to test for phenylketonuria and advocated for rapid uptake of universal newborn screening in the early 1960s. Today with fast and affordable mass screening of the whole genome on the horizon, the debate about when and in what scenarios children should undergo genetic testing and screening has gained renewed attention. United States professional guidelines — both the American College of Medical (...) Genetics /American Society of Human Genetics statement and the American Academy of Pediatrics Statement on the genetic testing of children and the new AAP and ACMG joint policy statement and technical report — as well as the old UK guidelines by the Working Part of the Clinical Genetics Society and the new United Kingdom guidelines by the British Society of Human Genetics all give the same answer: genetic testing and screening should only be done if it is in the child’s best interest. (shrink)