When bioethicists debate the use of technologies like surgery and pharmacology to shape our selves, they are, ultimately, debating what it means for human beings to flourish. They are debating what makes animals like us truly happy, and whether the technologies at issue will bring us closer to or farther from such happiness. The positions that participants adopt in debates regarding such ancient and fundamental questions are often polarized, and cannot help but be deeply personal. It is no wonder that the debates are sometimes acrimonious. How, then, should critics of and enthusiasts about technological self-transformation move forward? Based on his experience at the oldest free-standing bioethics research institute in the world, Erik Parens proposes a habit of thinking, which he calls "binocular." As our brains integrate slightly different information from our two eyes to achieve depth of visual perception, we need to try to integrate greatly different insights on the two sides of the debates about technologically shaping our selves-if depth of intellectual understanding is what we are after. Binocular thinking lets us benefit from the insights that are visible from the stance of the enthusiast, who emphasizes that using technology to creatively transform our selves will make us happier, and to benefit from the insights that are visible from the stance of the critic, who emphasizes that learning to let our selves be will make us happier. Parens observes that in debates as personal as these, we all-critics and enthusiasts alike-give reasons that we are partial to. In the throes of our passion to make our case, we exaggerate our insights and all-too-often fall into the conceptual traps that language sets for us. Foolishly, we make conceptual choices that no one who truly wanted understanding would accept: Are technologies value-free or value-laden? Are human beings by nature creators or creatures? Is disability a medical or a social phenomenon? Indeed, are we free or determined? Parens explains how participating in these debates for two decades helped him articulate the binocular habit of thinking that is better at benefiting from the insights in both poles of those binaries than was the habit of thinking he originally brought to the debates. Finally, Parens celebrates that bioethics doesn't aspire only to deeper thinking, but also to better acting. He embraces not only the intellectual aspiration to think deeply about meaning questions that don't admit of final answers, but also the ethical demand to give clear answers to practical questions. To show how to respect both that aspiration and that demand, the book culminates in the description of a process of truly informed consent, in the context of one specific form of using technology to shape our selves: families making decisions about appearance normalizing surgeries for children with atypical bodies.

University researchers in the United States seeking to observe, survey, or interview people are required first to complete ethical training courses and to submit their proposals to an institutional review board (IRB). Under current rules, IRBs have the power to deny funding, degrees, or promotion if their recommended modifications to scholars' proposals are not followed. This volume explains how this system of regulation arose and discusses its chilling effects on research in the social sciences and humanities.

Zachary M. Schrag draws on original research and interviews with the key shapers of the institutional review board regime to raise important points about the effect of the IRB process on scholarship. He explores the origins and the application of these regulations and analyzes how the rules--initially crafted to protect the health and privacy of the human subjects of medical experiments--can limit even casual scholarly interactions such as a humanist interviewing a poet about his or her writing. In assessing the issue, Schrag argues that biomedical researchers and bioethicists repeatedly excluded social scientists from rule making and ignored the existing ethical traditions in nonmedical fields. Ultimately, he contends, IRBs not only threaten to polarize medical and social scientists, they also create an atmosphere wherein certain types of academics can impede and even silence others.

The first work to document the troubled emergence of today's system of regulating scholarly research, "Ethical Imperialism" illuminates the problems caused by simple, universal rule making in academic and professional research. This short, smart analysis will engage scholars across academia.

Biomedical research on humans is an important part of medical progress. But, when health and lives are at risk, safety and ethical practices need to be the top priority. The need for the committees that regulate and oversee such research -- institutional review boards, or IRBs -- is growing. Evaluating the Science and Ethics of Research on Humans is a guide for new and veteran members of IRBs that will help them better understand the issues involved and the tasks they will be required to perform.

The most important purpose of an IRB is to protect the human participants in research. For three major research areas -- drugs, medical devices, and genetic information -- Dennis J. Mazur shares the methods he has found useful in protecting human participants through the systematic review of scientific protocols and informed consent forms and through adherence to the federal regulations that apply. New members will gain understanding of how proposed research projects are to be reviewed from both scientific and ethical dimensions, how and when to ask key questions of principal investigators, how to work with principal investigators and research teams to ensure the best protection of human participants, and why to schedule regularly spaced reviews of a project that may have adverse outcomes.

Containing helpful summaries and checklists throughout and based on Mazur's thirty years of research experience, this accessible and informative guide will give all IRB members the tools they need to protect human lives and facilitate the research process.

In the warped world of prescription drug pricing, generic drugs can cost more than branded ones, old drugs can be relaunched at astronomical prices, and low-cost options are shut out of the market. In Drugs, Money and Secret Handshakes, Robin Feldman shines a light into the dark corners of the pharmaceutical industry to expose a web of shadowy deals in which higher-priced drugs receive favorable treatment and patients are channeled toward the most expensive medicines. At the center of this web are the highly secretive middle players who establish coverage levels for patients and negotiate with drug companies. By offering lucrative payments to these middle players (as well as to doctors and hospitals), drug companies ensure that inexpensive drugs never gain traction. This system of perverse incentives has delivered the kind of exorbitant drug prices - and profits - that everyone loves except for those who pay the bills.

This is a lucid, readable discussion of ethical questions in health care as they arise on the business or organizationl level: an effort to spell out an ethical perspective for healthcare organizations. It will be of use to students in health services management programmes, health care professionals, healthcare administrators, and members of healthcare ethics committees.

Deficiencies and shortfalls in the supply of human organs for transplantation and human tissue for research generate policy dilemmas across the world and have often given rise to major and deleterious controversies, such as those relating to organ and tissue retention practices following post-mortem examination. They also create an environment in which illegitimate commercial activities flourish. At the same time, patients are denied the therapy they desperately require and researchers are impeded from carrying out vital work into the causes of, and efficacious treatments for, major illnesses and diseases. David Price sets out a clear and integrated legal and policy framework which emanates from the tissue source but protects the interests of donors and relevant professionals through tailored property entitlements, but without presupposing rights to trade in 'original' materials.

Ethical dilemmas are not new in the area of health care and policy making, but in recent years, their frequency and diversity have grown considerably. All health professionals now have to consider the ethical implications of an increasing array of treatments, interventions and health promotion activities on an almost daily basis. This goes hand in hand with increasing medical knowledge, and the growth of new and innovative medical technologies and pharmaceuticals. In addition, the same technology and knowledge is increasing professional and public awareness of new potential public health threats (e.g. pandemic influenza). At the level of public policy, concerns over the rising costs of health care have led to a more explicit focus on 'health promotion', and the surveillance of both 'patients' and the so-called 'worried well'. Health professionals and policy makers also have to consider the implications of managing these risks, for example restricting individual liberty through enforced quarantine (in the wake of SARS and more recently swine flu) and the more general distribution of harms and benefits. Balancing the rights and responsibilities of individuals and wider populations is becoming more complex and problematic. This book will play a key role in opening out a discussion of public health ethics. It examines the principles and values that support an ethical approach to public health practice and provides examples of some of the complex areas which those practising, analysing and planning the health of populations have to navigate. It will therefore be essential reading for current practitioners, those involved in public health research and a valuable aid for anyone interested in examining the tensions within and the development of public health.

Bioethics was "born in the USA" and the values American bioethics embrace are based on American law, including liberty and justice. This book crosses the borders between bioethics and law, but moves beyond the domestic law/bioethics struggles for dominance by exploring attempts to articulate universal principles based on international human rights. The isolationism of bioethics in the US is not tenable in the wake of scientific triumphs like decoding the human genome, and civilizational tragedies like international terrorism. Annas argues that by crossing boundaries which have artificially separated bioethics and health law from the international human rights movement, American bioethics can be reborn as a global force for good, instead of serving mainly the purposes of U.S. academics. This thesis is explored in a variety of international contexts such as terrorism and genetic engineering, and in U.S. domestic disputes such as patient rights and market medicine. The citizens of the world have created two universal codes: science has sequenced the human genome and the United Nations has produced the Universal Declaration of Human Rights. The challenge for American bioethics is to combine these two great codes in imaginative and constructive ways to make the world a better, and healthier, place to live.

A book for nurses, doctors and all who provide end of life care, this essential volume guides readers through the ethical complexities of such care, including current policy initiatives, and encourages debate and discussion on their controversial aspects. Divided into two parts, it introduces and explains clinical decision-making processes about which there is broad consensus, in line with guidance documents issued by WHO, BMA, GMC, and similar bodies. The changing political and social context where 'patient choice' has become a central idea, and the broadened scope of patients' best interests, have added to the complexity of decision-making in end of life care. The authors discuss issues widely encountered by GPs, nurses, and hospital clinicians. These include patient choice, consent, life prolonging treatment, and symptom relief including sedation. Part two explores the more controversial current end of life care initiatives, such as advance care planning, preferred place of care and death, euthanasia and assisted suicide, extended ideas of 'best interests', and the view that there are therapeutic duties to the relatives of patients. Throughout their discussion the authors draw attention to loose ends and contradictions in some of the proposals. Examining the current policy of consumerist choice, they reject its place in the health service, proposing a realistic, fair, humane, and widely adoptable system of end of life care.
As knowledge of ethical theories is required in training courses, and the vocabulary of ethical theory is widespread in current discussions, a substantial appendix on ethical theories and terms is available online.
Written by the same authors as The Philosophy of Palliative Care: Critique and Reconstruction, which won the Medical Journalists' Association Specialist Book Award 2007, this new book for non-specialists is essential reading for all health care professionals involved in providing end of life care.

Eating disorders (EDs) have become a social epidemic in the developed world. This book addresses the close links between EDs and exercise, helping us to understand why people with EDs often exercise to excessive and potentially harmful levels. This is also the first book to examine this issue from an ethical and legal perspective, identifying the rights and responsibilities of people with EDs, their families and the fitness professionals and clinicians that work with them.

The book offers an accessible account of EDs and closely examines the concept of addiction. Drawing on a wide range of medical, psychological, physiological, sociological and philosophical sources, the book examines the benefits and risks of exercise for the ED population, explores the links between EDs and other abuses of the body in the sports environment and addresses the issue of athletes with disordered eating behaviour. Importantly, the book also surveys current legislation and professional codes of conduct that guide the work of fitness professionals and clinicians in this area and presents a clear and thorough set of case histories and action points to help professionals better understand, and care for, their clients with EDs.

Exercise and Eating Disorders is important reading for students of applied ethics, medical ethics and the ethics of sport, as well as for fitness professionals, psychiatrists, clinical psychologists, sports coaches and sport and exercise scientists looking to improve their understanding of this important issue.

When Joseph Murray performed the first successful living kidney donor transplant in 1954, he thought this would be a temporary stopgap. Today, we are no closer to the goal of adequate organ supply without living donors-if anything, the supply-demand ratio is worse. While most research on the ethics of organ transplantation focuses on how to allocate organs as a scarce medical resource, the ethical treatment of organ donors themselves has been relatively neglected. In The Living Organ Donor as Patient: Theory and Practice, Lainie Friedman Ross and J. Richard Thistlethwaite, Jr. argue that living donor organ transplantation can be ethical provided that we treat living solid organ donors as patients in their own right. Ross and Thistlethwaite develop a five-principle framework to examine some of the attempts to increase living donation. It uses the three principles of the Belmont Report: respect for persons, beneficence, and justice modified to organ transplantation, as well as the principles of vulnerability and special relationships creating special obligations. Their approach requires that the transplant community fully embrace current and prospective living organ donors as patients to whom we have special obligations. Only when living organ donors are regarded as patients in their own right and have a living donor advocate team dedicated to their well-being can the moral limits of living solid organ donation be realized and living donors be given the full respect and care they deserve.

This second edition addresses a variety of ethical issues that arise in the care of oncology patients. Many volumes have been written on medical ethics in the past 30 years. However, few have focused on ethical issues specific to the care of cancer patients. This book brings together such a focused examination. The contributors include clinicians, (doctors, nurses, and social workers), ethicists, medical humanists, medical educators, and a cancer survivor. The issues raised have direct relevance to the care of oncology patients in treatment as well as research settings. The chapters address issues that are central to contemporary medical practice and medical ethics inquiry.

Ethical Issues in Cancer Patient Care, Second Edition will have direct importance for practicing physicians, nurses and others caring for cancer patients. In addition, medical students, medical educators and ethicists will find this book of interest.

Was konnen die psychologischen und gesellschaftlichen Ursachen von diversen Suchten und Zwangen und Krankheiten sein? Besteht ein Zusammenhang zwischen dem eigenen Menschenbild und unserem Verstandnis von Krankheit und Gesundheit? Was hat Krankheit mit unerfullten Sehnsuchten zu tun? Was bedeutet die Sehnsucht nach dem eigenen Selbst?

Dieses Werk nimmt den Leser mit auf eine Reise zum tieferen Verstandnis von seelischen Ursachen von Suchten, Zwangen und chronischen Erkrankungen. Dabei verbindet der Autor Dr. Otto Teischel eine existenz- und psychoanalytisch verstehende therapeutische mit einer philosophischen Perspektive.

Er verdeutlicht, welche Auswirkungen ungestillte Sehnsuchte, z.B. die Sehnsucht nach Freiheit und Autonomie, auf das korperliche Wohlbefinden haben konnen. Erhellende Erklarungen zu Filmbeispielen mit Szenenfotos, beispielhafte Analysen und Patienten-Falldarstellungen dienen zur Veranschaulichung der Inhalte.

Abgerundet wird das Werk durch das Aufzeigen von Praventions- und Heilungswegen, die verdeutlichen, wie Menschen gesund werden bzw. gesund bleiben konnen.

Zielgruppen sind alle, die mit mehr oder weniger leidenden Menschen arbeiten und sich fur die Zusammenhange von Korper, Seele und Geist interessieren."

Following recent high profile cases of surgical error in the Uk and USA, patient safety has become a key issue in healthcare, now placed at the heart of junior doctor's training. Errors made by doctors are very similar to those made in other high risk organizations, such as aviation, nuclear and petrochemical industries. Practical Patient Safety aims to demonstrate how core principles of safety from these industries can be applied in surgical and medical practice, in particular through training for health care professionals and healthcare managers.
While theoretical aspects of risk management form the backdrop, the book focuses on key techniques and principles of patient safety in a practical way, giving the reader practical advice on how to avoid personal errors, and more importantly, how to start patient safety training within his or her department or hospital.

Obwohl der Gewissenbegriff im Bewusstsein der meisten Medizinethiker durch den Strukturwandel im Gesundheitswesen in den letzten Jahrzehnten erheblich an Bedeutung verloren hat, bahnt sich im Zuge der fortschreitenden Pluralisierung des Wertempfindens in modernen Gesellschaften (nicht zuletzt durch das Wiedererstarken religioes-weltanschaulicher Positionen) eine erneute Diskussion um den Gewissensvorbehalt bei der Erbringung medizinischer Leistungen an. Der vorliegende Band nahert sich der Gewissenthematik bewusst aus interdisziplinarer Perspektive, um die verschiedenen Dimensionen einer Gewissenentscheidung auszuleuchten und die Folgen der fortschreitenden Verrechtlichung und OEkonomisierung fur die Gewissensfreiheit der verschiedenen im Gesundheitswesen tatigen Berufsgruppen kritisch zu reflektieren.

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.

This book presents a critical analysis of the debate in Muslim countries at the religious, legal and political level, sparked by the introduction of new biomedical technologies such as cloning, genetics, organ transplants and in vitro fertilisation. The book draws on law, sociology, anthropology, politics and the history of science. For this reason it will be of interest to scholars and operators in a wide variety of disciplines and fields.

The field of medical education and training has undergone dramatic changes within the past few years, and continues to evolve. Modernising Medical Careers, changes in the statutory role of the Postgraduate Medical Education and Training Board, and the Good Doctors, Safer Patients report from Liam Donaldson, Chief Medical Officer, are just some of the factors affecting the way doctors are now learning. In this book, Yvonne Carter and Neil Jackson, experienced medical educators of both undergraduates and postgraduates who have demonstrated a long standing commitment to multi-professional education and training, bring together a prestigious team of contributors with a wide variety of experience across diverse academic, service and lay backgrounds, to provide a comprehensive, up to date review of medical education and training.
With the demands on young doctors increasing, along with higher patient expectations, the need for ongoing education and training within the medical profession has never been higher. This book offers theoretical and practical guidance for those planning, delivering, and receiving education and training in ever-changing healthcare environments. Themes covered include assessment, professionalism and medical regulation, educational standards, patients' expectations, Continuing Professional Development, leadership and management, the European Working Time Directive, Fitness to Practice, interprofessional learning, the development of the NHS workforce, equality and diversity, and ethical and legal issues. Medical education needs to be a lifelong process, and this book integrates both undergraduate and postgraduate issues throughout, to encourage continued learning.
This book will help ensure that future generations of doctors are trained to meet the changing needs of our population.

This textbook introduces the reader to basic problems in the philosophy of science and ethics, mainly by means of examples from medicine. It is based on the conviction that philosophy, medical science, medical informatics, and medical ethics are overlapping disciplines. It claims that the philosophical lessons to learn from the twentieth century are not that nature is a 'social construction' and that 'anything goes' with respect to methodological and moral rules. Instead, it claims that there is scientific knowledge, but that it is never completely secure; that there are norms, but that they are situation-bound; and that, therefore, it makes good sense to search for scientific truths and try to act in a morally decent way. Using philosophical catchwords, the authors advocate 'fallibilism' and 'particularism'; a combination that might be called 'pragmatic realism'.

Can trust be restored by making people and institutions more accountable? Or do complex systems of accountability and control damage trust? Onora O'Neill challenges current approaches, investigates sources of deception in our society and re-examines questions of press freedom. This year's Reith Lectures present a philosopher's view of trust and deception and ask whether and how trust can be restored in modern democracy.

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.

The goals of healthcare and health policy, and the health-related dilemmas facing policy makers, professionals, and citizens are extensively analyzed and debated in a range of disciplines including public health, sociology, and applied philosophy. Health and the Good Society is the first full-length work that addresses these debates in a way that cuts across these disciplinary boundaries.
Alan Cribb's core argument is that clinical ethics needs to be understood in the context of public health ethics. This entails healthcare ethics embracing "the social dimension" of health in two overlapping senses: first, the various respects in which health experiences and outcomes are socially determined; and second, the ways in which health-related goods are better understood as social rather then purely individual goods. This broader approach to the ethics of healthcare includes a concern with the social construction of both healthcare goods and the roles, ideals, and obligations of agents; that is to say it focuses upon the 'value field' of health-related action and not only upon the ethics of action within this value field. This groundbreaking book thus seeks to "open up" the agenda of healthcare ethics both methodologically and substantively: it argues that population-oriented perspectives are central to all healthcare ethics, and that everybody has some share of responsibility for securing health-related goods including the good of greater health equality. One of its major conclusions is that the rather limited tradition of health education policy and practice needs a complete re-think.

Lainie Ross presents a rigorous critical investigation of the development of policy governing the involvement of children in medical research. She examines the shift in focus from protection of medical research subjects, enshrined in post-World War II legislation, to the current era in which access is assuming greater precedence. Infamous studies such as Willowbrook (where mentally retarded children were infected with hepatitis) are evidence that before the policy shift protection was not always adequate, even for the most vulnerable groups. Additional safeguards for children were first implemented in many countries in the 1970s and 1980s; more recent policies and guidelines are trying to promote greater participation. Ross considers whether the safeguards work, whether they are fair, and how they apply in actual research practice. She goes on to offer specific recommendations to modify current policies and guidelines.
Ross examines the regulatory structures (e.g. federal regulations and institutional review boards), the ad hoc policies (e.g. payment in pediatric research and the role of schools as research venues), the actual practices of researchers (e.g. the race/ethnicity of enrolled research subjects or the decision to enroll newborns) as well as the decision-making process (both parental permission and the child's assent), in order to provide a broad critique. Some of her recommendations will break down current barriers to the enrolment of children (e.g. permitting the payment of child research subjects; allowing healthy children to be exposed to research that entails more than minimal risk without requiring recourse to 407 panels); whereas other recommendations may createnew restrictions (e.g., the need for greater protection for research performed in schools; restrictions on what research should be done in the newborn nursery). The goal is to ensure that medical research is done in a way that promotes the health of current and future children without threatening, to use the words of Hans Jonas, "the erosion of those moral values whose loss . . . would make its most dazzling triumphs not worth having."

This book presents an up to date ethical framework for radiological protection in medicine. It is consistent with the requirements of the system of radiation protection and with the expectations of medical ethics. It presents an approach rooted in the medical tradition, and alert to contemporary social expectations. It provides readers with a practical framework against which they can assess the safety and acceptability of medical procedures, including patients' concerns. It will be an invaluable reference for radiologists, radiation oncologists, regulators, medical physicists, technologists, other practitioners, as well as academics, researchers and students of radiation protection in medicine. Features: An authoritative and accessible guide, authored by a team who have contributed to defining the area internationally Includes numerous practical examples/clinical scenarios that illustrate the approach, presenting a pragmatic approach, rather than dwelling on philosophical theories Informed by the latest developments in the thinking of international organizations

What is the goal of public health promotion today? If the leading causes of mortality are primarily attributable to lifestyle behaviours, is the purpose of research to develop the power to change those behaviours, in the same way that science has been able to control infectious diseases? Or is the quest for effective behaviour modification techniques antithetical to the idea of promoting well-being defined in terms of individual autonomy, dignity and integrity? An Ethic for Health Promotion explores these questions.