In Intimations of Mortality, Barbara Reich offers an empirically-based critique of the failures of end-of-life communication and decision-making in the United States. Using England and Canada as occasional foils, Reich explores why U.S. physicians, patients, and families struggle to have the conversations necessary to provide seriously ill and dying patients with medical care consistent with their preferences. Reich also shows how a number of different factors -including payment mechanisms, liability fears, cultural phenomena, communication avoidance, death denial, and clinical uncertainty -impact physician-patient communication and medical decision-making, leave patients and families without the tools they need to make informed choices, and instead leave the default practices in place. Ultimately, this groundbreaking analysis unveils the interconnectedness of the many obstacles to better communication and decision-making in end-of-life communications and offers much-needed suggestions for improvement.

Regulators have been more permissive for medical devices compared to their drug and biologic counterparts. While innovative products can thereby reach consumers more quickly, this approach raises serious public health and safety concerns. Additionally, the nature of medical devices is rapidly changing, as software has become as important as hardware. Regulation must keep pace with the current developments and controversies of this technology. This volume provides a multidisciplinary evaluation of the ethical, legal, and regulatory concerns surrounding medical devices in the US and EU. For medical providers, policymakers, and other stakeholders, the book offers a framework for the opportunities and challenges on the horizon for medical device regulation. Readers will gain a nuanced overview of the latest developments in patient privacy and safety, innovation, and new regulatory laws. This book is also available as Open Access on Cambridge Core.

The focus of bioethical debates on exceptional cases neglects the underlying values-like justice and community-that would lend to a broader, more well-rounded understanding of today's world. Discussions of ethical problems in health care too often concentrate on exceptional cases. Bioethical controversies triggered by experimental drugs, gene-edited babies, or life extension are understandably fascinating: they showcase the power of medical science and technology while addressing anxieties concerning health, disease, suffering, and death. However, the focus on rare individual cases in the media spotlight turns attention away from more pressing ethical issues that impact global populations, such as access to health care, safe food and water, and the prevention of emerging infectious diseases. In Bizarre Bioethics, Henk A.M.J. ten Have argues that this focus on bizarre cases leads to bizarre bioethics with a narrow agenda for ethical debate. In other words, although these extreme cases are undeniably real, they present a limited and skewed view of everyday moral reality. This focus also assumes that individuals are rational decision-makers, so that the role of feelings and emotions can be downgraded. Larger questions related to justice, solidarity, community, meaning, and ambiguity are not appreciated. Such questions used to be posed by philosophical and theological traditions, but they have been exorcised and marginalized in the development of bioethics. Science, ten Have writes, is not a value-free endeavor that provides facts and evidence: it is driven by underlying value perspectives that are often based on metaphors and world views from philosophical and theological traditions. Drawing on a rich analysis of the literature, ten Have explains how bioethical discussion can be enriched by these metaphors and develops a broader approach that critically delves into the imaginative world views that determine understanding of the world and human existence. Examining the roles of the metaphors of ghosts, monsters, pilgrims, prophets, and relics, ten Have illustrates how science and medicine are animated by imaginations that fuel the search for hope, salvation, healing, and a predictable future. Bizarre Bioethics invites students, researchers, policymakers and teachers interested in ethics and health care to think about the value perspectives on health and disease today.

Baruch A. Brody has been one of the most important voices in bioethics over the last several decades, asking new and challenging questions about a range of problems, examining recalcitrant issues in novel ways, always with the goal of offering practical solutions to complex problems. This volume presents a sustained philosophical analysis of Brody's contributions to biomedical ethics. Done well, philosophical work can clarify complex issues, facilitate creative problem solving, and lead to real-world solutions to difficult situations. Each contributor carefully and critically explores Brody's writings in biomedical ethics and the philosophy of medicine, illustrating his appreciation that thorough and critical scientific research and philosophical analysis are central to reining in the untutored human desire to ameliorate pain and suffering so that medical treatments and health care policy do more good than harm.

How is modern medicine failing? Why is a more human approach required? This book challenges the dogma of modern technological medicine that ignores both the therapeutic effect of the doctors and the self-healing powers of the patient. It reviews the vast weight of evidence on the effectiveness of this 'human effect', and uses the evidence to describe how to use the human effect in everyday practice. This book is about a vision. A vision that practitioners and patients will recognise and regain their therapeutic potential. It provides a shift in perspective on what doctors can achieve. Thoroughly referenced, it is vital for general practitioners, and also very relevant to all doctors, nurses, health managers, policy makers and indeed patients. 'Pendulums swing in most fields of life, and medicine and general practice are no exceptions. At the mid-point of the twentieth century the human side of medicine was well understood and implicitly accepted by most working practitioners. As the century progressed, the personal aspects came second (but now) the pendulum of thought has started to swing back again towards the personal.

Much has been written about whether end-of-life law should change and what that law should be. However, the barriers and facilitators of such changes - law reform perspectives - have been virtually ignored. Why do so many attempts to change the law fail but others are successful? International Perspectives on End-of-Life Law Reform aims to address this question by drawing on ten case studies of end-of-life law reform from the United Kingdom, the United States, Canada, the Netherlands, Belgium and Australia. Written by leading end-of-life scholars, the book's chapters blend perspectives from law, medicine, bioethics and sociology to examine sustained reform efforts to permit assisted dying and change the law about withholding and withdrawing life-sustaining treatment. Findings from this book shed light not only on changing end-of-life law, but provide insight more generally into how and why law reform succeeds in complex and controversial social policy areas.

Narrative Medicine: A Rhetorical Rx rests on the principles that storytelling is central to medical encounters between caregivers and patients and that narrative competence enhances medical competence. Thus, the book's goal is to develop the narrative competence of its reader. Grounded in the rhetorical theory of narrative that Phelan has been constructing over the course of his career, this volume utilizes a three-step method: Offering a jargon-free explication of core concepts of narrative such as character, progression, perspective, time, and space. Demonstrating how to use those concepts to interpret a diverse group of medical narratives, including two graphic memoirs. Pointing to the relevance of those demonstrations for caregiver-patient interactions. Narrative Medicine: A Rhetorical Rx is the ideal volume for undergraduate students interested in pursuing careers in healthcare, students in medical and allied health professional schools, and graduate students in the health humanities and social sciences.

Ethics in Community Mental Health Care: Commonplace Concerns examines everyday ethical issues that clinicians encounter as they go about their work caring for people who have severe and persistent mental disorders. Individuals (psychiatrists, social workers, case managers, nurses, psychologists, peer counselors, primary care physicians) who serve on the front line of community mental health clinical and social services find that they must deal, on a daily basis, with significant ethical dilemmas that involve personal, social, and policy matters: overstepping personal boundaries and coercive practices, dealing with violence in the home and in the workplace, breaching confidentiality, and ensuring the rights and welfare of vulnerable individuals.

This book prompts and provokes readers to recognize, to analyze, to reflect upon, and to respond to the range of commonplace ethical concerns that arise in community mental health care practice with persons who have mental disorders that may impede their ability to protect their own interests.

Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical duties to patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparities when allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

For the average person, genetic testing has two very different faces. The rise of genetic testing is often promoted as the democratization of genetics by enabling individuals to gain insights into their unique makeup. At the same time, many have raised concerns that genetic testing and sequencing reveal intensely personal and private information. As these technologies become increasingly available as consumer products, the ethical, legal, and regulatory challenges presented by genomics are ever looming. Assembling multidisciplinary experts, this volume evaluates the different models used to deliver consumer genetics and considers a number of key questions: How should we mediate privacy and other ethical concerns around genetic databases? Does aggregating data from genetic testing turn people into products by commercializing their data? How might this data reduce or exacerbate existing healthcare disparities? Contributing authors also provide guidance on protecting consumer privacy and safety while promoting innovation.

For the average person, genetic testing has two very different faces. The rise of genetic testing is often promoted as the democratization of genetics by enabling individuals to gain insights into their unique makeup. At the same time, many have raised concerns that genetic testing and sequencing reveal intensely personal and private information. As these technologies become increasingly available as consumer products, the ethical, legal, and regulatory challenges presented by genomics are ever looming. Assembling multidisciplinary experts, this volume evaluates the different models used to deliver consumer genetics and considers a number of key questions: How should we mediate privacy and other ethical concerns around genetic databases? Does aggregating data from genetic testing turn people into products by commercializing their data? How might this data reduce or exacerbate existing healthcare disparities? Contributing authors also provide guidance on protecting consumer privacy and safety while promoting innovation.

Reproductive health care professionals in fields such as Obstetrics and Gynecology, Family Medicine, and Pediatrics face difficult ethical issues because they work at the crossroads of patient decision-making, scientific advancement, political controversy, legal regulation, and profound moral considerations. The dilemmas these professionals face expose big-picture bioethics questions of interest to everyone. Yet for clinicians striving to deliver excellent patient care, the ethical questions that make daily practice challenging can be just as nuanced. This volume presents a carefully curated compilation of essays written by leading experts in the fields of medicine, ethics, and law, who address key issues at the forefront of reproductive ethics. It is organized into three main sections: I. Contraception and Abortion Ethics - Preventing Pregnancy and Birth, II. Assisted Reproduction Ethics - Initiating Pregnancy, and III. Obstetric Ethics - Managing Pregnancy and Delivery. Each section begins with a short introduction by the editors providing an overview of the area and contextualizing the essays that follow. This volume's primary aim is to be useful to practicing clinicians, students, and trainees by providing short and practical essays covering urgent topics-from race, religion and abortion, to legal liability, violations of confidentiality and maternal choices that risk future children's health. This collection provides clinicians at all levels of training with frameworks they need to approach the intimate and high-stakes encounters central to their profession.

'Astonishing' Stephen Fry 'Exceptional' Douglas Stuart, author of the Booker Prize-winning SHUGGIE BAIN 'Now is the time for this book' DBC Pierre, author of the Booker Prize-winning VERNON GOD LITTLE 'Funny. Disturbing. Brilliant' Lily Allen Funny, smart, damaged, Tom is lost in the machinery of the British mental health system, talking to a voice no one else can hear; the voice of Malamock, the Octopus God - sometimes loving, sometimes cruel, but always there to fill his life with meaning. Once an outstanding law student, Tom is now cared for by his long-suffering sister Tess, who encourages him into an experimental drugs trial that promises to silence the voice forever. The Octopus God, however, does not take kindly to being threatened... Deeply moving and tragi-comic, The Octopus Man is a bravura literary performance that asks fundamental questions about belief and love.

Over the past decades, public trust in medical professionals has steadily declined. This decline of trust and its replacement by ever tighter regulations is increasingly frustrating physicians. However, most discussions of trust are either abstract philosophical discussions or social science investigations not easily accessible to clinicians. The authors, one a surgeon-turned-philosopher, the other an analytical philosopher working in medical ethics, joined their expertise to write a book which straddles the gap between the practical and theoretical. Using an approach grounded in the methods of conceptual analysis found in analytical philosophy which also draws from approaches to medical diagnosis, the authors have conceived an internally coherent and comprehensive definition of trust to help elucidate the concept and explain its decline in the medical context. This book should appeal to all interested in the ongoing debate about the decline of trust - be it as medical professionals, medical ethicists, medical lawyers, or philosophers.

Respect for autonomy has become a fundamental principle in human research ethics. Nonetheless, this principle and the associated process of obtaining informed consent do have limitations. This can lead to some groups, many of them vulnerable, being left understudied. This book considers these limitations and contributes through legal and philosophical analyses to the search for viable approaches to human research ethics. It explores the limitations of respect for autonomy and informed consent both in law and through the examination of cases where autonomy is lacking (infants), diminished (addicts), and compromised (low socio-economic status). It examines alternative and complementary concepts to overcome the limits of respect for autonomy, including beneficence, dignity, virtue, solidarity, non-exploitation, vulnerability and self-ownership. It takes seriously the importance of human relationality and community in qualifying, tempering and complementing autonomy to achieve the ultimate end of human research - the good of humankind.

History will mark the twenty-first century as the dawn of the age of precise genetic manipulation. Breakthroughs in genome editing are poised to enable humankind to fundamentally transform life on Earth. Those familiar with genome editing understand its potential to revolutionize civilization in ways that surpass the impact of the discovery of electricity and the development of gunpowder, the atomic bomb, or the Internet. Significant questions regarding how society should promote or hinder genome editing loom large in the horizon. And it is up to humans to decide the fate of this powerful technology. Rewriting Nature is a compelling, thought-provoking interdisciplinary exploration of the law, science, and policy of genome editing. The book guides readers through complex legal, scientific, ethical, political, economic, and social issues concerning this emerging technology, and challenges the conventional false dichotomy often associated with science and law, which contributes to a growing divide between both fields.

History will mark the twenty-first century as the dawn of the age of precise genetic manipulation. Breakthroughs in genome editing are poised to enable humankind to fundamentally transform life on Earth. Those familiar with genome editing understand its potential to revolutionize civilization in ways that surpass the impact of the discovery of electricity and the development of gunpowder, the atomic bomb, or the Internet. Significant questions regarding how society should promote or hinder genome editing loom large in the horizon. And it is up to humans to decide the fate of this powerful technology. Rewriting Nature is a compelling, thought-provoking interdisciplinary exploration of the law, science, and policy of genome editing. The book guides readers through complex legal, scientific, ethical, political, economic, and social issues concerning this emerging technology, and challenges the conventional false dichotomy often associated with science and law, which contributes to a growing divide between both fields.

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.

Key Features * Discusses the various aspects of cheating in publications: spin, protocol changes; failure to publish negative studies, including current data on the publishing industry and its issues, like the menace of predatory journals, poor peer review, coupled with lack of early education in ethics, and its significant impact on rational prescribing. * Assesses the impact of misconduct and fraud on clinicians and healthcare professionals as they attempt to balance the risk-benefit ratio which is supported by multiple contemporary studies. * Presents shocking data on bribes to physicians, journal editors and other key opinion leaders, exposing the ultimate root of the problem which lies in the economics of the healthcare system, badly in need of repair.

Res Ipsa Loquitur and Medical Negligence: A Comparative Survey analyses the application of the doctrine of res ipsa loquitur ('it speaks for itself') to medical negligence cases. The book aims to establish conclusively that the approach of the South African courts, that the doctrine should never find application in medical negligence cases, is untenable and out of touch with modern approaches adopted in other countries. Constitutional principles such as procedural equality, access to courts, access to health care, access to information, post-constitutional legislation, medical ethics and policy considerations are also discussed.

The book further provides a theoretical and practical legal framework for the application of the doctrine to medical negligence cases in South Africa in future. The authors argue for the application of the doctrine, not only in medical negligence cases, but also to related legal procedures that follow a medical accident such as medical inquests, criminal prosecutions and disciplinary inquiries instituted by the Health Professions Council of South Africa.

Res Ipsa Loquitur and Medical Negligence includes a comprehensive comparison of the practical application of the doctrine to medical negligence cases in South Africa, England and the United States of America.

Written by four internationally renowned bioethicists, From Chance to Choice is the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late 19th and early 20th centuries. In addition, appendices explain the nature of genetic causation, gene-environment interaction, and expose widespread misconceptions of genetic determinism, as well as outlining the nature of the ethical analysis used in the book. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science.

The Human Embryo in vitro explores the ways in which UK law engages with embryonic processes under the Human Fertilisation and Embryology Act 1990 (as amended), the intellectual basis of which has not been reconsidered for almost thirty years. McMillan argues that in regulating 'the embryo' - that is, a processual liminal entity in itself - the law is regulating for uncertainty. This book offers a fuller understanding of how complex biological processes of development and growth can be better aligned with a legal framework that purports to pay respect to the embryo while also allowing its destruction. To do so it employs an anthropological concept, liminality, which is itself concerned with revealing the dynamics of process. The implications of this for contemporary regulation of artificial reproduction are fully explored, and recommendations are offered for international regimes on how they can better align biological reality with social policy and law.

Metastatic cancer and costly precision medicines generate extremely complex problems of health care justice. Targeted cancer therapies yield only very marginal gains in life expectancy for most patients at very great cost, thereby threatening the just allocation of limited health care resources. Philosophers have high hopes for the utility of their theories of justice in addressing the challenges of resource allocation; however, none of these theories can address adequately the "wicked" ethical problems that have resulted from these targeted therapies. What we need instead, bioethicist Leonard M. Fleck argues, is a political conception of health care justice, following Rawls, and a fair and inclusive process of rational democratic deliberation governed by public reason. His account makes the basic assumption that we have only limited health care resources to meet unlimited health care needs generated by emerging medical technologies. The primary ethical and political virtue of rational democratic deliberation is that it allows citizens to fashion autonomously shared understandings of how to fairly address the complex problems of health care justice generated by precision medicine. While ideally just outcomes are a moral and political impossibility, "wicked" problems can metastasize if rationing decisions are made invisibly-in ways effectively hidden from those affected by those decisions. As Fleck demonstrates, a fair and inclusive process of democratic deliberation could make these "wicked" problems visible, and subject, to public reason.

Advances in medical technology force us to struggle with new and often gut-wrenching decisions. How do we know when someone is dead and not just in a coma? Should a convicted felon qualify for a new heart? In The Woman Who Decided to Die, novelist and medical ethicist Ronald Munson takes readers to the very edges of medicine, where treatments fail and where people must cope with helplessness, mortality, and doubt. Using personal narratives that place us right next to doctors, patients, and care givers as they make decisions, Munson explores ten riveting case-based stories, told with a writer's eye for illuminating detail. These include a young woman with terminal leukemia more worried about her family than herself, a stepfather asked to donate a liver segment to his stepson, a student who believes she is being controlled by invisible Agents, and a psychiatrist-patient who prizes his autonomy until the end. Raising fundamental questions about human relationships, this is an essential book about the very nature of life and death.

Although the subject of federally mandated Institutional Review Boards (IRBs) has been extensively debated, we actually do not know much about what takes place when they convene. The story of how IRBs work today is a story about their past as well as their present, and "Behind Closed Doors "is the first book to meld firsthand observations of IRB meetings with the history of how rules for the treatment of human subjects were formalized in the United States in the decades after World War II. Drawing on extensive archival sources, Laura Stark reconstructs the daily lives of scientists, lawyers, administrators, and research subjects working--and "warring"--on the campus of the National Institutes of Health, where they first wrote the rules for the treatment of human subjects. Stark argues that the model of group deliberation that gradually crystallized during this period reflected contemporary legal and medical conceptions of what it meant to be human, what political rights human subjects deserved, and which stakeholders were best suited to decide. She then explains how the historical contingencies that shaped rules for the treatment of human subjects in the postwar era guide decision making today--within hospitals, universities, health departments, and other institutions in the United States and across the globe. Meticulously researched and gracefully argued, "Behind Closed Doors" will be essential reading for sociologists and historians of science and medicine, as well as policy makers and IRB administrators.