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Books > Medicine > General issues > Medical ethics
Healthcare delivery in the 21st century has become increasingly complex and demanding . Clinical consultations frequently raise scientific, ethical and legal challenges. While scientific issues may be resolved using an evidence-based medicine (EBM) approach, ethical theory is needed to justify decision making in the face of ethical conflict. Medical ethics, law and human rights: a South African perspective provides the conceptual background and analytic skills necessary to assist with the resolution of ethical dilemmas encountered in the South African healthcare environment. Medical ethics, law and human rights: a South African perspective uses case studies to help the healthcare team to identify and analyse ethical, moral and value concepts, and to apply these to scenarios that they may encounter on a daily basis. Part 1 explores theories and principles of ethics (including African philosophy), introduces medical law, discusses health and human rights, and also makes the transition from theory to practice. Part 2 looks at specific topics in healthcare that raise challenges from an ethics perspective - HIV/AIDS, use of social media, euthanasia, human reproduction, genetics and genomics. In view of the increasing emphasis on ethical considerations in healthcare from the Health Professions Council of South Africa (HPCSA), coupled with the rising incidence of litigation in healthcare, Medical ethics, law and human rights: a South African perspective is essential reading for health science, law and philosophy students as well as practising healthcare professionals.
Nurses are faced with questions related to professional practice and what they may or may not do on a daily basis. Nurses also need to deal with the many conflicting demands made by patients, colleagues and hospital management. The ‘new approach’ adopted in this book offers insight into the dilemmas faced by the 21st century nurse. The professional practice issues are addressed in the form of case studies, using real-life examples that put the problems into context. This approach also offers a broad view of the nursing profession, taking into account macro-environmental influences, as well as the new technologies impacting on the profession. A New Approach to Professional Practice explains the legal, professional and ethical framework within which the nurse must practise. The text also touches on the professional heritage and explains the rights of the patient and the rights and responsibilities of the nurse. Subjects such as modern-day challenges, legal and ethical questions, accountability, duty to care, responsibility, and maintenance of standards are also addressed. Key Features:
Clinical Ethics at the Crossroads of Genetic and Reproductive Technologies offers thorough discussions on preconception carrier screening, genetic engineering and the use of CRISPR gene editing, mitochondrial gene replacement therapy, sex selection, predictive testing, secondary findings, embryo reduction and the moral status of the embryo, genetic enhancement, and the sharing of genetic data. Chapter contributions from leading bioethicists and clinicians encourage a global, holistic perspective on applied challenges and the moral questions relating the implementation of genetic reproductive technology. The book is an ideal resource for practitioners, regulators, lawmakers, clinical researchers, genetic counselors and graduate and medical students. As the Human Genome Project has triggered a technological revolution that has influenced nearly every field of medicine, including reproductive medicine, obstetrics, gynecology, andrology, prenatal genetic testing, and gene therapy, this book presents a timely resource.
Hospice care is one of the fastest-growing segments of the U. S. healthcare system, a trend that is expected to accelerate as the median age of the population continues to rise over the next three decades. Despite over forty percent of the population now dying while on hospice care, very little has been published on the ethical opportunities and challenges experienced in the everyday lives of those giving and receiving hospice care. This book is the first comprehensive collection devoted to analyzing distinctive ethical issues arising in the delivery of hospice care and designed to promote best ethical practices for hospice care professionals and organizations. Thirteen newly commissioned chapters by seventeen hospice experts populate three thematic sections of the book, each devoted to an aspect of the intersection between ethics and hospice care. Contributors have unique qualifications and abilities to articulate and respond to ethically significant phenomena that - while not always unique to hospice care - arise in especially poignant and complex ways when caring for patients enrolled in hospice. As the shift or return to home-based care at the end of life continues, hospice professionals and programs will be faced with a broader array of terminal illnesses, cultural beliefs and traditions, and patient and family values than ever before. Hospice will no longer be tailored solely to the final stage of cancer, but will need to accommodate patients whose illnesses are variable in their progression and whose treatment plans include many medical options. The ethical orientations and frameworks that have served hospice for the past 50 years will need to be supplemented and refined if hospice is to fulfill this changing social mission. Hospice Ethics explores a new paradigm for hospice ethics from a multi-disciplinary and provides an important educational resource for professional training in end of life care.
The philosopher Henry Richardson's short book is a defense of a position on a neglected topic in medical research ethics. Clinical research ethics has been a longstanding area of study, dating back to the aftermath of the Nazi death-camp doctors and the Tuskegee syphilis study. Most ethical regulations and institutions (such as Institutional Review Boards) have developed in response to those past abuses, including the stress on obtaining informed consent from the subject. Richardson points out that that these ethical regulations do not address one of the key dilemmas faced by medical researchers - whether or not they have obligations towards subjects who need care not directly related to the purpose of the study, termed 'ancillary care obligations'. Does a researcher testing an HIV vaccine in Africa have an obligation to provide anti-retrovirals to those who become HIV positive during the trial? Should a researcher studying a volunteer's brain scan, who sees a possible tumor, do more than simply refer him or her to a specialist? While most would agree that some special obligation does exist in these cases, what is the basis of this obligation, and what are its limits? Richardson's analysis of those key questions and the development of his own position are at the heart of this book, which will appeal to bioethicists studying research ethics, to policy makers, and to political and moral philosophers interested in the obligations of beneficence, one of the key issues in moral theory.
The Globalization of Health Care is the first book to offer a
comprehensive legal and ethical analysis of the most interesting
and broadest reaching development in health care of the last twenty
years: its globalization. It ties together the manifestation of
this globalization in four related subject areas - medical tourism,
medical migration (the physician "brain drain"), telemedicine, and
pharmaceutical research and development, and integrates them in a
philosophical discussion of issues of justice and equity relating
to the globalization of health care.
While scholars typically view Plato's engagement with medicine as uniform and largely positive, Susan B. Levin argues that from the Gorgias through the Laws, his handling of medicine unfolds in several key phases. Further, she shows that Plato views medicine as an important rival for authority on phusis (nature) and eudaimonia (flourishing). Levin's arguments rest on careful attention both to Plato and to the Hippocratic Corpus. Levin shows that an evident but unexpressed tension involving medicine's status emerges in the Gorgias and is explored in Plato's critiques of medicine in the Symposium and Republic. In the Laws, however, this rivalry and tension dissolve. Levin addresses the question of why Plato's rivalry with medicine is put to rest while those with rhetoric and poetry continue. On her account, developments in his views of human nature, with their resulting impact on his political thought, drive Plato's striking adjustments involving medicine in the Laws. Levin's investigation of Plato is timely: for the first time in the history of bioethics, the value of ancient philosophy is receiving notable attention. Most discussions focus on Aristotle's concept of phronesis (practical wisdom); here, Levin argues that Plato has much to offer bioethics as it works to address pressing concerns about the doctor-patient tie, medical professionalism, and medicine's relationship to society.
Despite the massive scale of global inequalities, until recently few political philosophers or bioethicists addressed their ethical implications. Questions of justice were thought to be primarily internal to the nation state. Over the last decade or so, there has been an explosion of interest in the philosophical issues surrounding global justice. These issues are of direct relevance to bioethics. The links between poverty and health imply that we cannot separate questions of global health from questions about fair distribution of global resources and the institutions governing the world order. Similarly, as increasing numbers of medical trials are conducted in the developing world, researchers and their sponsors have to confront the special problems of doing research in an unjust world, with corresponding obligations to correct injustice and avoid exploitation. This book presents a collection of original essays by leading thinkers in political theory, philosophy, and bioethics. They address the key issues concerning global justice and bioethics from two perspectives. The first is ideal theory, which is concerned with the social institutions that would regulate a just world. What is the relationship between human rights and the provision of health care? How, if at all, should a global order distinguish between obligations to compatriots and others? The second perspective is from non-ideal theory, which governs how people should behave in the unjust world in which we actually find ourselves. What sort of medical care should actual researchers working in impoverished countries offer their subjects? What should NGOs do in the face of cultural practices with which they deem unethical? If coordinated international action will not happen, what ought individual states to do? These questions have more than theoretical interest; their answers are of direct practical import for policymakers, researchers, advocates, NGOs, scholars, and others. This book is the first collection to comprehensively address the intersection of global justice and bioethical dilemmas.
This book examines the principles and realities of ethics in midwifery practice today. It explains basic ethical theory, looking at how dilemmas occur and the ethical bases on which conflicts can be resolved. Through a series of case studies, options and issues for consideration are reviewed, particularly in areas of increasing concern and debate such as confidentiality, autonomy, screening, abortion, assisted conception and withholding treatment. This book will be of value to all students and practicing midwives who need to understand the principles and practice of ethics, especially how to apply ethical thought and action in their own day-to-day work.Explains clearly ethical theory, especially how dilemmas occur, the bases for ethical decisions and how conflicts may be resolved Outlines specifically how ethical principles can be applied in real-life practice, and in situations which may involve midwives in team decisionsOutlines detailed case studies which illustrate key ethical dilemmas and ways to consider resolutions within these Explores and clearly delineates the ethical dimensions of the midwifes role (new chapter in the second edition)Includes a new chapter on conscientious objection to participation in abortion Has greater focus on assisted conception and issues surrounding this, as this becomes a topic of more widespread interestAdds a new chapter on withholding and withdrawing treatment, mainly in relation to neonates, again to reflect an area of growing concern and controversy All of Part One the general foundations are updated and revised New chapter on ethical dimensions of the midwifes role, with an emphasis on the midwife as the researcherNew case in the confidentiality chapter New case in the accountability chapter on client abuse, with a focus on the accountability of the midwife who knew about this but did nothingNew case in the autonomy and consent chapter looking at enforced caesarian section, with a focus on ethics rather than the law (where the focus usually lies in reviewing this area) New chapter on assisted conception, replacing resource allocation which looked only briefly at thisNew chapter on withholding and withdrawing treatment relating mainly to neonates
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.
According to popular belief, technical skill is far more important for surgeons than thoughtful deliberation. Nothing could be further from the truth. Although surgeons must sometimes make decisions rapidly on the basis of incomplete evidence and must respond to unexpected catastrophes in the operating room rapidly, those events are intermittent - most of the time surgeons deliberate on diagnostic problems and thoughtfully manage postoperative care, which is often intellectually challenging. The relationship of surgeons with their patients is, in a real sense, far more intimate and trusting than that of any other professional, a claim that is supported by the fact that patients surrender their bodies to their surgeons in a state of total helplessness and vulnerability when they undergo anesthesia. Because of that responsibility, no other professional group has a greater sense of dedication to the welfare of their patients than surgeons. Surgical culture is deeply steeped in ethics, and surgeons confront and resolve ethical dilemmas as much or more than most other professionals, although they often may not recognize the situations they resolve are problems in ethics - they are just part of the daily routine. This book is a compendium of articles from the recent surgical literature that address ethical issues chosen by surgeons because they are controversial and pertinent to the practice of surgery. The reader will not find a great deal of sophisticated dissection of fine philosophical distinctions in these discussions of ethical conflicts and controversies in surgery. Instead, they will discover differing viewpoints from thoughtful essayists, mostly surgeons, whose feet are firmly in contact with the ground and who have extensive experience in the real world of surgery, medicine, and law.
Decisions about life-sustaining treatment are often ethically challenging for patients, surrogate decision-makers, and health care professionals. Providing safe, effective, and compassionate care near the end of life is a priority for health care organizations. In times of uncertainty, crisis, or reflection, and in efforts to improve health care for seriously ill patients, guidelines can help. This is the first updated, expanded edition of The Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying, which shaped the ethical and legal framework for decision-making on treatment and end-of-life care in the United States. The new edition, the product of an authoritative consensus process, incorporates 25 years of research, innovation, and developments in law and policy. It summarizes the current framework for making good decisions about treatment and care and identifies educational and organizational goals for health care systems. It covers care planning, decision-making for adults and for children, care transitions, the determination of death, and the policies and processes that support good care at the bedside. It also addresses the psychological and social dimensions of care near the end of life, with attention to effective communication with patients and loved ones and among team members. This book is written for physicians, nurses, and other clinicians in hospitals, nursing homes, home care, and hospice. It is structured for ease of reference during difficult clinical situations and includes extensive practical recommendations supported by print and online resources. This book is also essential reading for clinical ethicists, ethics committee members, health lawyers, and medical and nursing directors. As the U.S. confronts the challenges of health care reform, an aging population, increasing technological capacity to extend life, and serious cost implications, The Hastings Center Guidelines are invaluable to educators, scholars, and policymakers.
On August 5, 2010, a cave-in left thirty-three Chilean miners trapped underground. The Chilean government embarked on a massive rescue effort that is estimated to have cost between ten and twenty million dollars. There is a puzzle here. Many mine safety measures that would have been more cost effective had not been taken in Chile earlier, either by the mining companies, the Chilean government or by international donors. The Chilean story illustrates a persistent puzzle: the identified lives effect. Human beings show a greater inclination to assist persons and groups identified as those at high risk of great harm than to assist persons and groups who will suffer - or already suffer - similar harm but are not identified as yet. The problem touches almost every aspect of human life and politics: health, the environment, the law. What can social and cognitive sciences teach us about the origin and triggers of the effect? Philosophically and ethically, is the effect a "bias" to be eliminated or is it morally justified? What implications does the effect have for health care, law, the environment and other practice domains? This volume is the first book to tackle the effect from all necessary perspectives: psychology, public health, law, ethics, and public policy.
Biomedical ethics is a burgeoning academic field with complex and
far-reaching consequences. Whereas in Western secular bioethics
this subject falls within larger ethical theories and applications
(utilitarianism, deontology, teleology, and the like), Islamic
biomedical ethics has yet to find its natural academic home in
Islamic studies.
In ancient Rome parents would consult the priestess Carmentis shortly after birth to obtain prophecies of the future of their newborn infant. Today, parents and doctors of critically ill children consult a different oracle. Neuroimaging provides a vision of the child's future, particularly of the nature and severity of any disability. Based on the results of brain scans and other tests doctors and parents face heart-breaking decisions about whether or not to continue intensive treatment or to allow the child to die. Paediatrician and ethicist Dominic Wilkinson looks at the profound and contentious ethical issues facing those who work in intensive care caring for critically ill children and infants. When should infants or children be allowed to die? How accurate are predictions of future quality of life? How much say should parents have in these decisions? How should they deal with uncertainty about the future? He combines philosophy, medicine and science to shed light on current and future dilemmas.
This book tells the extraordinary story of how the function of the first - and so far almost the only - human organ was replaced by a machine, and the "artificial kidney" entered medical and public folk-lore. A practical artificial kidney, or dialyser, came about by advances in science followed by the acquisition of new synthetic materials which made the application of these ideas possible. However it was the dedication and persistence of a number of talented pioneers who pressed ahead against professional opposition to achieve success, first in the treatment of temporary, recoverable kidney failure, and then permanent renal shut-down which made it a success. The apparent high cost and limited availability of this form of treatment immediately raised ethical questions which had never been questioned before, centering around equity of access to treatment, when and if treatment could be denied, and - worst of all - the agonising decision of when, once established, it should be stopped. Spiralling costs as the true number of people with kidney failure became evident raised major political and financial questions, which were addressed in different countries in different ways which reflected - but also helped change - patterns of how medical care is provided. In developed countries, the problem could be solved by allocating a disproportionate amount of money to the treatment of relatively few kidney patients, but in the developing world the cost of treatment still limits its availability, as it does all forms of modern health care. Nevertheless, today almost one million people world-wide are maintained alive following terminal kidney failure, two thirds of them by various forms of dialysis and the remainder bearing kidney transplants, almost always placed after a period on dialysis. The story is also the sum of the often heroic lives of these hundreds of thousands of patients, a few of whom have today been maintained alive and active for more than 35 years, and many of whom suffered known, but also unexpected complications as a result of their treatment.
Reprogenetic technologies, which combine the power of reproductive techniques with the tools of genetic science and technology, promise prospective parents a remarkable degree of control to pick and choose the likely characteristics of their offspring. Not only can they select embryos with or without particular genetically-related diseases and disabilities but also choose embryos with non-disease related traits such as sex. Prominent authors such as Agar, Buchanan, DeGrazia, Green, Harris, Robertson, Savulescu, and Silver have flocked to the banner of reprogenetics. For them, increased reproductive choice and reduced suffering through the elimination of genetic disease and disability are just the first step. They advocate use of these technologies to create beings who enjoy longer and healthier lives, possess greater intellectual capacities, and are capable of more refined emotional experiences. Indeed, Harris and Savulescu in particular take reprogenetic technologies to be so valuable to human beings that they have insisted that their use is not only morally permissible but morally required. Rethinking Reprogenetics challenges this mainstream view with a contextualised, gender-attentive philosophical perspective. De Melo-Martin demonstrates that you do not have to be a Luddite, social conservative, or religious zealot to resist the siren song of reprogenetics. Pointing out the flawed nature of the arguments put forward by the technologies' proponents, Rethinking Reprogenetics reveals the problematic nature of the assumptions underpinning current evaluations of these technologies and offers a framework for a more critical and sceptical assessment.
Stem cell therapy is ushering in a new era of medicine in which we
will be able to repair human organs and tissue at their most
fundamental level- that of the cell. The power of stem cells to
regenerate cells of specific types, such as heart, liver, and
muscle, is unique and extraordinary. In 1998 researchers learned
how to isolate and culture embryonic stem cells, which are only
obtainable through the destruction of human embryos. An ethical
debate has raged since then about the ethics of this research,
usually pitting pro-life advocates vs. those who see the great
promise of curing some of humanity's most persistent
diseases.
Ethical Issues in International Biomedical Research is the definitive book on the ethics of research involving human subjects in developing countries. Using 21 actual case studies, it covers the most controversial topics, including the ethics of placebo research in Africa, what benefits should be provided to the community after completion of a research trial, how to address conflicts between IRBs in developed and developing countries, and undue inducement of poor people in developing countries. Each case is accompanied by two expert commentaries, written by many of the worlds leading experts in bioethics as well as new voices with research experience in developing countries. No other volume has this scope. Students in bioethics, public and international health, and ethics will find this book particularly useful.
In Death, Dying, and Organ Transplantation: Reconstructing Medical
Ethics at the End of Life, Miller and Truog challenge fundamental
doctrines of established medical ethics. They argue that the
routine practice of stopping life support technology in hospitals
causes the death of patients and that donors of vital organs
(hearts, lungs, liver, and both kidneys) are not really dead at the
time that their organs are removed for life-saving transplantation.
These practices are ethically legitimate but are not compatible
with traditional rules of medical ethics that doctors must not
intentionally cause the death of their patients and that vital
organs can be obtained for transplantation only from dead donors.
Contemporary bioethics, now roughly 40 years old as a discipline,
originated in the United States with a primarily Anglo-American
cultural ethos. It continues to be professionalized and
institutionalized as a maturing discipline at the intersections of
philosophy, medicine, law, social sciences, and humanities.
Increasingly bioethics - along with its foundational values,
concepts and principals - has been exported to other countries, not
only in the developed West, but also in developing and/or Eastern
countries. Bioethics thus continues to undergo intriguing
transformations as it is globalized and adapted to local cultures.
These processes have occurred rapidly in the last two decades, with
relatively little reflection and examination. "At last-an unabashedly sociological and anthropological look at
the globalization of bioethics, a really fresh approach to a
maturing discipline. The chapters speak from the perspective of
sophisticated Western-developed exporters of the bioethical
paradigm and equally sophisticated] Eastern-developing and
third-world and interdisciplinary critics suspicious of the
canonical view. Trained in the dominant school of American,
mainstream philosophy, Myser draws on her long-standing commitment
to a social and cultural approach to bioethics to take a fresh look
at bioethics globally. She grasps the globalization of bioethics
and the skepticism about analytical philosophy's Americanized
consensus. The book sets the stage for a new era in bioethics
theory and practice {debating] whether a universal common morality
underlies the rich variation in national and cultural bioethics
traditions."
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