Reframing Disease Contextually will be of particular interest to philosophers of medicine, bioethicists, and philosophers. It may also be of value to medical professionals, historians of western medicine, and health policy makers who take interest in the conceptual foundations of medicine.

This book:
- provides an overview of key debates in the history of modern western medicine on the nature, knowledge, and value of disease;
- illustrates how these debates relate;
- provides a "contextual" or "localized" way of understanding disease;
- includes case studies of e.g. AIDS, genetic disease, and gendered disease;
- conveys the importance of the intersection and interrelation between and among factors that make up disease;
- illustrates how bioethical discussions about disease naming, classification, diagnosis, prognosis, and treatment are part of a much greater discussion in philosophy of medicine.

debating (and possibly ratifying) the Convention at the national level 13]. The Convention identified basic principles necessary for the applica tion of medicine and the life sciences. It set out to protect the dignity and identity of all human beings: ''The interests and welfare of the human being shall prevail over the sole interest of society or science" (art. 2). It also requests that appropriate measures be taken to provide equitable access to healthcare of appropriate quality. The principle of respecting the free and informed consent of the person is clearly stressed. The issue of interventions on persons unable to provide an informed consent has been controversial for a long time; in the first draft, the exact formulation of the relevant article remained open. Now it states that interventions may be carried out on persons with impaired decision-making capacities, but only for their benefit, and only if minimal risks and minimal burdens are imposed. Consensus apparently exists over a broad range of issues. Privacy and free access to information are defined as rights, in article 10. Discrimination against a person on the basis of his or her genetic heritage is prohibited. Sex selection in medically assisted procreation is prohibited (except to avoid serious hereditary, sex-related diseases). Financial gain from using the human body and its parts is explicitly prohibited. The more controversial issues in bioethics are not addressed in this Convention, however. An exception is research on embryos in vitro."

Healthcare providers are constantly confronted with illness and injury, and the challenges of healing. Yet this very work, the relief of suffering, inflicts on healthcare providers suffering of their own that is often crippling. The most common terms for the pain caregivers and healers suffer from are burnout and moral distress. These common terms are, however, often used judgmentally—as if those trying to heal others have failed themselves, their colleagues, and their patients. The net result is that much discussion of burnout and moral distress, and the interventions they underwrite, have served only to worsen the crisis. Into the Field of Suffering: Finding the Other Side of Burnout provides a much-needed reframing of burnout and moral distress. These depleting experiences are approached as trials virtually inevitable in the course of the healer's vocation. The challenge medical professionals and caregivers face is not avoiding them, but meeting them directly with insight into the role of moral distress and burnout in the development of their vocation. Into the Field of Suffering presents a set of analytical frameworks and awareness skills, which have the potential to transform the work of healers and caregivers. There is a growing body of academic literature on these topics, and many memoirs recounting distressing situations and wounding traumas. Into the Field of Suffering takes its place alongside these works, while offering a distinctly different approach that treats as essential the spiritual dimension of the healing vocation. Practices, teachings and dialogues to assist in the cultivation of compassion and gratitude are key components in this presentation. Schenck and Neely address their readers in a direct voice, speaking to the sense of failure and discouragement so many healthcare professionals and caregivers experience on a daily basis. This is a book that carries a mentor's voice and presence, born out of experience with burnout and moral distress, and grounded in hundreds of conversations, de-briefings and interviews with healthcare workers and caregivers, patients and families.

Enhanced knowledge of the nature and causes of mental disorder have led increasingly to a need for the recruitment of cognitively vulnerable participants in biomedical research. These individuals often fall into the grey area between obvious decisional competence and obvious decisional incompetence and, as a result, may not be recognised as having the legal capacity to make such decisions themselves. At the core of the ethical debate surrounding the participation of cognitively vulnerable individuals in research is when, if at all, we should judge them decisionally and legally competent to consent to or refuse research participation on their own behalf and when they should be judged incompetent in this respect.

In this book, the author develops a novel justificatory framework for making judgments of decisional competence to consent to biomedical research with reference to five groups of cognitively vulnerable individuals - older children and adolescents, adults with intellectual disabilities, adults with depression, adults with schizophrenia and adults with dementia, including Alzheimer s disease. Using this framework, the author argues that we can make morally defensible judgments about the competence or incompetence of a potential participant to give contemporaneous consent to research by having regard to whether a judgment of competence would be more harmful to the generic rights of the potential participant than a judgment of incompetence. The argument is also used to justify an account of supported decision-making in research, and applied to evaluate the extent to which this approach is evident in existing ethical guidelines and legal provisions. The book will be of interest to bioethicists as well as psychiatrists and academic medical lawyers interested in normative questions raised by the concepts of competence and capacity."

A major focus of the philosophy of medicine and, in general, of the philosophy of science has been the interplay of facts and values. Nowhere is an evaluation of this interplay more important than in the ethics of diagnosis. Traditionally, diagnosis has been understood as an epistemological activity which is concerned with facts and excludes the intrusion of values. The essays in this volume challenge this assumption. Questions of knowledge in diagnosis are intimately related to the concerns with intervention that characterize the applied science of medicine. Broad social and individual goals, as well as diverse ethical frameworks, are shown to condition both the processes and results of diagnosis. This has significant implications for bioethics, implications that have not previously been developed. With this volume, the ethics of diagnosis' is established as an important branch of bioethics.

Religious beliefs and attitudes have long been recognized as playing an important role in sexual functioning, but the relationship between religion and sexual behavior has rarely been studied in a comprehensive way. The essays in this volume bring the views of sex counsellors, therapists. theologians, and bioethicists to bear on the relationship between religion and sexuality. A major theme emerging from these essays is that religion and counselling need to learn from one another. Religious traditions, at the popular or theological levels, are often marked by ignorance and misinformation about sexuality and can benefit by the insights of those who work closely with patients in medical and counselling settings. Counsellors, in turn, need to develop a sensitivity to past and present religious attitudes toward sexuality in order to assist their patients achieve sexual health.

in the culture of medicine, and they saw their mission as a generation of profit for stockholders, not necessarily medical care for clients. Cost-effective medicine was the goal in the context of a profit-making enterprise. Although preventive health care programs were promised, very few were realized and they were not nearly comprehensive. The definition of unnecessary testing slowly expanded to mean virtually any high-cost test requiring the service of a medical specialist, and low priced generalist physicians with limited diagnostic and therapeutic skills were made available to patients with the instruction they should limit their access to high-cost specialists. Managed care organizations tended to re ward primary care physicians who avoided specialty referrals, and severed contracts with those who persisted in sending their patients to outside consultants. Most notoriously, managed care organizations maintained veto authority over the provision of complex and expensive care, and that veto was often wielded in defiance of a physician's recommendation by managed care employees without medical training or experience. Managed care did indeed slow the rate in increase of medical costs, but not without limitations on the care provided to patients and the professional integrity of physicians. Managed care organizations were so successful that they could provide extremely high salaries to their executives even in the context of limiting cost and care. It is these developments that the papers of this symposium addressed. The most fundamental ethical issue is posed in the first paper by Dr."

This is the first book in healthcare ethics addressing the moral issues regarding ownership of the human body. Modern medicine increasingly transforms the body and makes use of body parts for diagnostic, therapeutic and preventive purposes. The book analyzes the concept of body ownership. It also reviews the ownership issues arising in clinical care (for example, donation policies, autopsy) and biomedical research. Societies and legal systems also have to deal with issues of body ownership. A comparison is made between specific legal arrangements in The Netherlands and France, as examples of legal approaches. In the final section of the book, different theoretical perspectives on the human body are analyzed: libertarian, personalist, deontological and utilitarian theories of body ownership.

The idea of preparing a new critical edition of Elisha Bartlett's Essay on the Philosophy of Medical Science was suggested to me several years ago by Dr. H. Tristram Engelhardt, Jr. Since that time it has been a pleasure to get to know the life and work of Elisha Bartlett. I am pleased to be completing this book in the bicentennial year of Bartlett's birth. Bartlett was born in 1804 in Smithfield, Rhode Island, less than twenty-five miles from Worcester, Massachusetts, my present home-a short journey even in Bartlett's day. I have been able to walk at some of the sites to which Bartlett continually returned during his life. Visiting Bartlett's grave in the Slatersville cemetery has been an inspiration for the preparation of this book. Proximity to several institutions with rich holdings in Bartlett's works and in nineteenth-century American history of medicine greatly facilitated my research. First, though, I want to acknowledge the College of the Holy Cross for supporting my sabbatical leave for the academic year 2003-2004. The American Antiquarian Society, in Worcester, Massachusetts, was generous in giving me access to its remarkable resources. I was able to find many of Bartlett's published works and other nineteenth-century medical literature there, and the entire library staff provided quick and able research assistance.

In 1978, the World Health Organization (WHO) designated the year 2000 as the "due date" for world health. The Alma Ata declaration set the turn of the century as the target for a level of health that would permit all people of the world to lead a socially and economically productive life. ' At that (magic but arbitrary) date most infectious diseases and many chronic conditions, including diabetes and cancer, were expected to have been eradicated or at least controlled. Such predictions were based on solid foundations. In the 1 20 h century, and particularly since the 1970's, Western science and technology based (or "modern") medicine has made quantum leaps in numerous areas as diverse as pharmacology, genetic and molecular biology, surgical techniques, infertility treatments, and pre- and neo-natal care. This impressive trajectory of progress, which continues unabatedly, gave every reason to assume that come the year 2000 humanity would finally be free from many of its ancient scourges. However, as we are all too well aware, the new millennium witnesses also ever more terrifying threats to our health as a result of the emergence of 2 AIDS in the early 80's, the resurgence of infectious diseases such as 3 tuberculosis and malaria, now drug resistant, the absence of significant breakthroughs in the treatment of cancer and cardiovascular diseases, and the continuing dramatic gap in health care between industrialized and developing countries, to mention but a few examples.

Genetic Democracy involves an in-depth analysis of the ethical, social and philosophical issues related to modern genetic research and gene technology. The aim of the book is to introduce systematic research on the social and ethical impacts of the use and development of genetically modified organisms (GMOs) as well as the acquisition, use and storage of human genetic information (HGI). The book contributes to enhancing public discussion and reaching fair and democratic decision-making practices in GMO and HGI use and development both on local and global level.

There are currently few European texts which address the issues involved in a theoretical and systematical manner. Genetic Democracy has been written from the viewpoint of social and political philosophy rather than that of traditional bioethics. There is a clear need for a throughout and authoritative philosophical and ethical analysis of the issues involved in genetic research and gene technology. The book will appeal to philosophers, social scientists, genetics professionals, policy makers, academics, industrial organisations and human rights organisations as well as university students and legal scholars. The book will have a broad appeal across Europe, Asia and America since many states are currently considering policy responses to many of the practices discussed in the books (e.g., human biobanks)."

This book assists health care providers to understand the specific interplay of the roles and relationships currently forming the debates in pediatric clinical ethics. It builds on the fact that, unlike adult medical ethics, pediatric ethics begins within an acutely and powerfully experienced dynamic of patient-family-state-physician relationship. The book provides a unique perspective as it interacts with established approaches as well as recent developments in pediatric ethics theory, and then explores these developments further through cases. The book first focuses on setting the stage by introducing a theoretical framework and elaborating how pediatric ethics differ from non-pediatric ethics. It approaches different theoretical frameworks in a critical manner drawing on their strengths and weaknesses. It helps the reader in developing an ability to engage in ethical reasoning and moral deliberation in order to focus on the wellbeing of the child as the main participant in the ethical deliberation, as well as to be able to identify the child's moral claims. The second section of the book focuses on the practical application of these theoretical frameworks and discusses specific areas pertaining to decision-making. These are: the critically ill child, new and enduring ethical controversies, and social justice at large, the latter of which includes looking at the child's place in society, access to healthcare, social determinants of health, and vaccinations. With the dynamic changes and challenges pediatric care faces across the globe, as well as the changing face of new technologies, no professional working in the field of pediatrics can afford not to take due note of this resource.

Stem cells and the emerging field of regenerative medicine are at the frontiers of modern medicine. These areas of scientific inquiry suggest that in the future, damaged tissue and organs might be repaired through personalized cell therapy as easily as the body repairs itself, revolutionizing the treatment of numerous diseases. Yet the use of stem cells is fraught with ethical and public policy dilemmas that challenge scientists, clinicians, the public health community, and people of good will everywhere. How shall we deal with these amazing biomedical advances, and how can we talk about potential breakthroughs with both moral and scientific intelligence? This book provides an innovative look at these vexing issues through a series of innovative Socratic dialogues that elucidate key scientific and ethical points in an approachable manner. Addressing the cultural and value issues underlying stem cell research while also educating readers about stem cells' biological function and medical applications, Stem Cell Dialogues features fictional characters engaging in compelling inquiry and debate. Participants investigate the scientific, political, and socioethical dimensions of stem cell science using actual language, analysis, and arguments taken from scientific, philosophical, and popular literature. Each dialogue centers on a specific, recognizable topic, such as the policies implemented by the George W. Bush administration restricting the use of embryonic stem cells; the potential role of stem cells in personalized medicine; the ethics of cloning; and the sale of eggs and embryos. Additionally, speakers debate the use of stem cells to treat paralysis, diabetes, stroke effects, macular degeneration, and cancer. Educational, entertaining, and rigorously researched (with 300 references to scientific literature), Stem Cell Dialogues should be included in any effort to help the public understand the science, ethics, and policy concerns of this promising field.

This book is available as open access through the Bloomsbury Open Access programme and is available on www.bloomsburycollections.com. The field of biotechnology has provided us with radical revisions and reappraisals of the nature and possibilities of our biological existence. Yet beyond its immediate utility, does a life that is healthier, longer, or freer from disease make us 'better' or more moral people? Bioscience and the Good Life explores the complex relationship between modern biosciences and human flourishing, their sympathies and schisms, and the instances of their reconciliation. Here cognitive enhancement, longevity, and the spectacle of excellence in sports, are examined within the context of what constitutes a life well lived. Framing biotechnological innovation in the discourse of duty and ethics, Brassington advances an insightful and involved response to the existing debates between bioscientific optimists and pessimists, one which mediates their differences, and expands the traditional scope of their arguments.

The Neonatal Intensive Care Unit is a site where hi-tech medicine and vulnerable human beings come into close contact. Focusing on a number of medical and ethical challenges encountered by staff and parents, this book provides a new perspective on the complexity of these treatments and the inventiveness of those involved.

Mainstream discussions of ethics often search for a problem-solving theory or explore ontological status. This book argues instead that the proper starting point should be the words and deeds of ordinary people in ordinary disagreements - the ethical concepts in play can only derive full meaning within the context of ordinary human lives.

Environmental health encompasses the assessment and control of those environmental factors that can potentially affect human health, such as radiation, toxic chemicals and other hazardous agents. It is often assumed that the assessment part is just a matter of scientific research, and the control part a matter of implementing standards which unambiguously follow from that research. But it is less commonly understood that environmental health also requires addressing questions of an ethical nature. How can we determine the "acceptable" risk level for the general population or for certain groups? How should we deal with uneven distributions of risks and benefits? How do we communicate about risks with the stakeholders? This multidisciplinary collection brings together a number of leading researchers and scholars in order to generate discussion surrounding these key questions, and to bring the ethical implications of science and technology to the forefront of critical thought. Providing a broad overview of the Ethics of Environmental Health, its philosophical foundations and practical applications, this book offers a significant contribution to ongoing discussions in sustainable development and will be of interest to scholars and practitioners of Environmental Health, urban studies and healthcare.

This title was first published in 2003. Xenotransplantation - the transplantation of animal organs into humans - poses a fascinating moral dilemma. Should this ability to extend the lives of millions of older people be permitted given that it might trigger a new pandemic similar to AIDS? This study examines the moral dilemma from a combination of humanistic, legalistic, bioethical, economical and technological perspectives. The first part of the book demonstrates that xenografts are the only realistic near-term technological answer to the organ shortage problem. The balance of the book is devoted to assessing whether doctrines such as the 'right to health care' trump the moral and ethical conundrums posed by xenotransplantation. The book concludes with a 'geoethical' solution that proposes authorization of xenotransplantation subject to the prior implementation of a new international organization for epidemiology and basic health care. It also suggests that the costs of operating such an organization could be covered by a global tax on xenografts.

Our ability to map and intervene in the structure of the human brain is proceeding at a very quick rate. Advances in psychiatry, neurology, and neurosurgery have given us fresh insights into the neurobiological basis of human thought and behavior. Technologies like MRI and PET scans can detect early signs of psychiatric disorders before they manifest symptoms. Electrical and magnetic stimulation of the brain can non-invasively relieve symptoms of obsessive-compulsive disorder, depression and other conditions resistant to treatment, while implanting neuro-electrodes can help patients with Parkinsons and other motor control-related diseases. New drugs can help regenerate neuronal connections otherwise disrupted by schizophrenia and similar diseases.
All these procedures and drugs alter the neural correlates of our mind and raise fascinating and important ethical questions about their benefits and harms. They are, in a sense, among the most profound bioethical questions we face, since these techniques can touch on the deepest aspects of the human mind: free will; personal identity; the self; and the soul. This is the first single-author book on what has come to be known as neuroethics. Walter Glannon uses a philosophical framework that is fully informed by cutting edge neuroscience as well as contemporary legal cases such as Terri Schiavo, to offer readers an introduction to this fascinating topic. He starts by describing the state of the art in neuroscientific research and treatment, and gives the reader an up-to-date picture of the brain. Glannon then looks at the ethical implications of various kinds of treatments, such as: whether or not brain imaging will end up changing our viewson free will and moral responsibility; whether patients should always be told that they are at future risk for neurological diseases; if erasing unconscious emotional memories implicated in depression can go too far; if forcing behavior-modifying drugs or surgery on violent offenders can ever be justified; the implications of drugs that enhance cognitive abilities; and how to define brain death and the criteria for the withdrawal of life-support. While not exhaustive, Glannons work addresses a wide range of fascinating issues and his pathbreaking work should appeal to philosophers, psychiatrists, neurologists, neurosurgeons, radiologists, psychologists, and bioethicists.

This is a book for anyone who has ever paused to wonder: Will cloning ever be legal? Why it is that 'saviour siblings' and sex selection provoke such strong reactions? Will there ever be such a thing as an artificial womb? Assisted reproductive technologies are unique in their capacity to challenge our assumptions and elicit passionate responses. Looking at the moral, philosophical, and legal issues surrounding cases of surrogacy, single or same-sex parenthood, retrieval of sperm from dead or dying patients, and the insemination of post-menopausal women, this book questions whether these rapidly-developing technologies are refashioning the nature of the family. The UK has played a unique role in the development and regulation of reproductive technologies, and has been at the forefront of controversy over 'saviour siblings', designer babies, reproductive cloning, and embryo research. This book provides a clear and simple account of the techniques involved in assisted reproduction and embryo research, and discusses the legal and ethical implications of some of these technologies, illustrated by compelling descriptions of real-life cases. The book also addresses the ways in which reproductive technologies are regulated, critically examining the role of the Human Fertilisation and Embryology Authority and comparing the UK's approach with that of other countries. Finally, it contemplates the possibility that some of our most deeply-held assumptions about human nature may be called into question by further developments in stem cell research and fertility treatments.

This is a book for anyone who has ever paused to wonder whether cloning will ever be legal. Why it is that "savior siblings" and sex selection provoke such strong reactions? Will there ever be such a thing as an artificial womb?
Assisted reproductive technologies are unique in their capacity to challenge our assumptions and elicit passionate responses. Looking at the moral, philosophical, and legal issues surrounding cases of surrogacy, single or same-sex parenthood, retrieval of sperm from dead or dying patients, and the impregnation of post-menopausal women, this book questions whether these rapidly-developing technologies are refashioning the nature of the family.
The US and UK have played unique roles in the development and regulation of reproductive technologies, and has been at the forefront of controversy over "savior siblings," designer babies, reproductive cloning, and embryo research. This book provides a clear and simple account of the techniques involved in assisted reproduction and embryo research, and discusses the legal and ethical implications of some of these technologies, illustrated by compelling descriptions of real-life cases. The book also addresses the ways in which reproductive technologies are regulated, critically examining the role of the Human Fertilization and Embryology Authority and comparing the UK's approach with that of other countries. Finally, it contemplates the possibility that some of our most deeply-held assumptions about human nature may be called into question by further developments in stem cell research and fertility treatments.

This volume considers the place of feminist bioethics within the broader international bioethics community.

Since its emergence two decades ago, the feminist perspective on bioethics has existed at the periphery of the discipline's mainstream. Concerns over reproduction and women's health issues--along with the concept that prevailing bioethical thought was fundamentally gendered--were largely subsumed by such overarching issues as the protection of research subjects and by theoretical and methodological frameworks derived from Kantian philosophy and practice-oriented principalism. Now feminist bioethics belongs to both the mainstream and the margins. The essays collected here explore the relation of feminist bioethics to mainstream bioethical thought and practice.

The first section looks at the current trajectory of feminist bioethics, its contributions to the mainstream, and how different types of feminism can inform and strengthen feminist bioethics. In the second section, contributors address autonomy, universalism, and trust to probe how feminist perspectives have altered bioethical theory. The third section examines such challenging issues as cancer genetics, childbirth, rape, and prenatal selection to demonstrate the effect of feminist bioethics on mainstream methodology. Contributors to the fourth section reflect on the relationship between feminist bioethical thought and the viewpoints of racial, ethnic, and cultural minorities, including people with disabilities.

Philosophically grounded, methodologically sound, and theoretically rigorous, this paradigm-challenging collection ponders the most dynamic areas of feminist inquiry into bioethical thought and practice and sketches future directions for this rapidly growing field.

The genie is out of the bottle. A whole new world of genetics research is underway with its exciting potential for a better understanding of heredity and genetically inherited disease, with opportunities for prevention, management and cure. But the current explosion of human genetic information has the potential for abuse also, for damage to rights, privacy and fair treatment for individuals and vulnerable groups. This book brings us up to date with important contributions from the authoritative "Encyclopaedia of the Human Genome" on the urgent social, legal and ethical aspects of the Human Genome enterprise, accessibly written and introduced for the undergraduate, postgraduate and general reader.

What role should religion play in a religiously pluralistic liberal society? Public bioethics unavoidably raises this question in a particularly insistent fashion. As the 20 papers in this collection demonstrate, the issues are complex and multifaceted. The authors address specific and highly contested issues as assisted suicide, stem cell research, cloning, reproductive health, and alternative medicine as well as more general questions such as who legitimately speaks for religion in public bioethics, what religion can add to our understanding of justice, and the value of faith-based contributions to healthcare. Christian (Catholic and Protestant), Jewish, Islamic, and Buddhist viewpoints are represented. The first book to focus on the interface of religion and bioethics, this collection fills a significant void in the literature.