This analysis of the law's approach to healthcare decision-making critiques its liberal foundations in respect of three categories of people: adults with capacity, adults without capacity and adults who are subject to mental health legislation. Focusing primarily on the law in England and Wales, the analysis also draws on the law in the United States, legal positions in Australia, Canada, Ireland, New Zealand and Scotland and on the human rights protections provided by the ECHR and the Convention on the Rights of Persons with Disabilities. Having identified the limitations of a legal view of autonomy as primarily a principle of non-interference, Mary Donnelly questions the effectiveness of capacity as a gatekeeper for the right of autonomy and advocates both an increased role for human rights in developing the conceptual basis for the law and the grounding of future legal developments in a close empirical interrogation of the law in practice.

In April 1982, an infant boy was born in Bloomington, Indiana, with Down syndrome and a defective, but surgically correctable, esophagus. His parents refused to consent to surgery or intravenous feeding. The hospital unsuccessfully sought a court order to force treatment, and appeals to higher courts also failed. The child, identified as Baby Doe by the news media, subsequently died. The events in Bloomington became the catalyst for action by the Reagan administration, the courts, and Congress that culminated in a federal policy that makes failure to treat newborns with disabilities a form of child neglect. This book centers on the public policy aspects of withholding treatment from critically ill newborns who are disabled. Specifically, it deals with why the policy was enacted and what impact it has had on health care workers, families, and infants. Some of the contributors to this book spearheaded the early debate on withholding treatment. Anthony Shaw's New York Times Magazine article in 1972 was the first to address these issues in the popular press. The following year, he published a related article in the New England Journal of Medicine. Also appearing in this same issue of NEJM, was the pathbreaking study, coauthored by A. G. M. Campbell, on withholding treatment in the special care nursery at Yale-New Haven Hospital. Each of these articles promoted much public and professional discussion.

New Harvest includes contributions from specialists in medical, philosophical, psychological, religious, and legal fields. These essays are not simply a collection, but were developed from a single conception of the four ethical concerns of trans plan tation described in the first chapter. The indi vid ual chapters are all parts of a structure unified by the search for ethical foundations basic to the four concerns. Transplantation is surrounded by a great deal of under standable emotional sensitivi ty. The authors trust that words like "procurement," "harvest," and possibly other expressions found in this book will not offend. We use the current lan but do so with objectivity and respect for those who guage, are personally involved in transplantation. We have made room for, and indeed have invited, different and sometimes conflicting points of view on the complicated ethical ques tions raised by transplant operations. We can not assume that there is one right answer to these questions, at least at our present level of scientific knowledge and ethical wisdom. We do not presume to have identified and analyzed all the ethical questions raised with equal thoroughness. There are four ways in which the scope of the book is limited. Identifying these limitations also helps designate what it is in its own right. First, some questions have been given more attention than others.

This book is about trust and its implications for a medical theological ethics. Beginning with its earliest work, there has been attention to trust running through the bioethics literature in the United States, and much of this discussion has examined its theological elements. Clearly, trust is indispensable when describing the patient-physician relationship, so why is there a need for yet another study? There is no doubt that people generally trust physicians. Traditionally the physician is the patient's fiduciary agent, whose sole obligation is to act only in the patient's best interest. In recent times, however, there is a perception on the part of people within and without health care that physicians have other obligations that compete with their obligation to the patient. If we acknowledge that one price for the successes of technological biomedicine is high in terms of financial cost, another price of Sllccess seems to be distrust, cynicism, and suspicion directed by the public toward the medical profes sion. If this uneasiness is the price society pays for medical success, what is the price of success for the doctor? Because of their role within the social order, physicians have claimed and been granted autonomy, authority, and special status. In return, the profes sion has pledged to serve the well-being and interests of humankind. This fiduciary commitment becomes a taken-for-granted aspect of the physician's identity, both for the physician for whom this dedication is definitional and for the public which expects trustworthy service from this person."

This book analyses the major issues of research ethics through a careful review of the treatment in official policies on research ethics developed throughout the world (especially North America, Western Europe, and the Pacific Rim). Among the issues covered are animal research, research on human subjects, epidemiological research, genetic research, reproductive research, research on vulnerable subjects, clinical trials, drug approval and the reserch process, and research on women and minorities. Brody also evaluates the content and the methods of developing these policies in light of his philosophical position of pluralistic casuistry. This is the only book that analyses all the major issues in research ethics. It is the only book which deals with these issues from an international perspective rather than just a US perspective. Major official policies from important research-intensive countries are reprinted in the appendix (close to 200 plates of otherwise difficult material).

While neuroscience has provided insights into the structure and function of nervous systems, hard questions remain about the nature of consciousness, mind, and self. Perhaps the most difficult questions involve the meaning of neuroscientific information, and how to pursue and utilize neuroscientific knowledge in ways that are consistent with some construal of social 'good'. Written for researchers and graduate students in neuroscience and bioethics, Scientific and Philosophical Perspectives in Neuroethics explores important developments in neuroscience and neurotechnology, and addresses the philosophical, ethical, and social issues and problems that such advancements generate. It examines three core questions. First, what is the scope and direction of neuroscientific inquiry? Second, how has progress to date affected scientific and philosophical ideas, and finally, what ethical issues and problems does this progress and knowledge incur, both now and in the future?

Should we make people healthier, smarter, and longer-lived if genetic and medical advances enable us to do so? Matti Hayry asks this question in the context of genetic testing and selection, cloning and stem cell research, gene therapies and enhancements. The ethical questions explored include parental responsibility, the use of people as means, the role of hope and fear in risk assessment, and the dignity and meaning of life. Taking as a starting point the arguments presented by Jonathan Glover, John Harris, Ronald M. Green, Jurgen Habermas, Michael J. Sandel, and Leon R. Kass, who defend a particular normative view as the only rational or moral answer, Matti Hayry argues that many coherent rationalities and moralities exist in the field, and that to claim otherwise is mistaken.

Public attention on embryo research has never been greater. Modern reproductive medicine technology and the use of embryos to generate stem cells ensure that this will continue to be a topic of debate and research across many disciplines. This multidisciplinary book explores the concept of a 'healthy' embryo, its implications on the health of children and adults, and how perceptions of what constitutes child and adult health influence the concept of embryo 'health'. The concept of human embryo health is considered from preconception to pre-implantation genetic diagnosis to recent foetal surgical approaches. Burgeoning capacities in both genetic and reproductive science and their clinical implications have catalysed the necessity to explore the concept of a 'healthy' embryo. The authors are from five countries and 13 disciplines in the social sciences, humanities, biological sciences and medicine, ensuring that the book has a broad coverage and approach.

Scientists and philosophers have long struggled to answer the questions of when human life begins and when human life has inherent value. The phenomenon of identical (monozygotic) twinning presents a significant challenge to the view that human life and human personhood begin at conception. The fact that a single embryo can split to generate two (or more) genetically identical embryos seems to defy the notion that prior to splitting an embryo can be a single human individual. In Untangling Twinning, Maureen Condic looks at the questions raised by human twinning based on a unique synthesis of molecular developmental biology and Aristotelian philosophy. She begins with a brief historical analysis of the current scientific perspective on the embryo and proceeds to address the major philosophic and scientific concerns regarding human twinning and embryo fusion: Is the embryo one human or two (or even more)? Does the original embryo die, and if not, which of the twins is the original? Who are the parents of the twins? What do twins, chimeras, cloning, and asexual reproduction in humans mean? And what does the science of human embryology say about human ensoulment, human individuality, and human value? Condic's original approach makes a unique contribution to the discussion of human value and human individuality, and offers a clear, evidence-based resolution to questions raised by human twinning. The book is written for students and scholars of bioethics, scientists, theologians, and attorneys who are involved in questions surrounding the human embryo.

Every one of us will die, and the processes we go through will be our own unique to our own experiences and life stories. It is reasonable to reflect on what kinds of dying processes may be better or worse for us as we move toward our end. Such consideration, however, can raise troubling ethical concerns for patients, families, and healthcare providers. Even after forty years of concerted focus on biomedical ethics, these moral concerns persist in the care of lethally impaired, terminally ill, and inured patients. End-of-Life Care and Pragmatic Decision Making provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death. D. Micah Hester takes seriously the complexities of experiences and argues that when making end-of-life decisions healthcare providers ought to pay close attention to the narratives of patients and the communities they inhabit so that their dying processes embody their life stories. He discusses three types of end-of-life patient populations adults with decision-making capacity, adult without capacity, and children (with a strong focus on infants) to show the implications of pragmatic empiricism and the scope of decision making at the end of life for different types of patients.

This volume offers a theoretical and practical overview of the ethics of pediatric medicine. It serves as a fundamental handbook and resource for pediatricians, nurses, residents in training, graduate students, and practitioners of ethics and healthcare policy. Written by a team of leading experts, Pediatric Bioethics addresses those difficult ethical questions concerning the clinical and academic practice of pediatrics, including an approach to recognizing boundaries when confronted with issues such as end of life care, life-sustaining treatment, extreme prematurity, pharmacotherapy, and research. Thorny topics such as what constitutes best interests, personhood, or distributive justice and public health concerns such as immunization and newborn genetic screening are also addressed.

We have provided the reader with a resource for applied ethical decision-making for use in clinical, educational, and research settings. The Rehabilitation Psychologist using this book will have a choice of utilizing a Quick Reference guide including pro-con positions regarding possible resolutions and a tabular summary of the varied case examples presented, or making use of more detailed discussion of the ethical concepts pertinent to each case. The most important aspect of this book is inclusion of psycho-social context information for each case example. This critical factor allows the reader to understand the flow of events and other factors influencing the actions of the key stakeholders, thereby facilitating the ethical decision-making process. The mix of case examples is intentionally broad-based, including ample clinical practice situations, along with challenges found in educational and research settings. There is also variety among the case examples, with two detailed scenarios in each chapter, along with two briefer learning exercises with focused summaries. The reader is challenged to analyze each case and compare the results with the preferred resolution proposed by the authors. Finally, at the end of the book, the reader has access to a list of ethics-relevant reading resources. These resources are divided into categorical domains that will assist with literature searches and further research into applied ethics. The authors trust that this book will serve as a preparatory experience for those psychologists studying for the Rehabilitation Psychology specialty board exam, as well as trainees and clinicians at all levels who desire an applied approach to utilizing the APA Ethics Code as an invaluable guide to everyday professional practice.

Michael Ryan (d. 1840) remains one of the most mysterious figures in the history of medical ethics, despite the fact that he was the only British physician during the middle years of the 19th century to write about ethics in a systematic way. Michael Ryan s Writings on Medical Ethics offers both an annotated reprint of his key ethical writings, and an extensive introductory essay that fills in many previously unknown details of Ryan s life, analyzes the significance of his ethical works, and places him within the historical trajectory of the field of medical ethics."

Learning medical professionalism is a challenging, evolving, and life-long endeavor. Professionalism in Medicine: A Case-Based Guide for Medical Students helps begin this process by engaging students and their teachers in reflection on cases that resonate with the experiences of life in medicine. Through the book's seventy-two cases, commentaries, videos, and literature-based reviews, students explore the many challenging areas of medical professionalism. Readers will appreciate the provocative professionalism dilemmas encountered by students from the pre-clinical years and clinical rotations and by physicians of various specialities. Each case is followed by two commentaries by writers who are involved in health care decisions related to that case, and who represent a wide variety of perspectives. Authors represent 46 medical schools and other institutions and include physicians, medical students, medical ethicists, lawyers, psychologists, nurses, social workers, pharmacists, health care administrators, and patient advocates.

This is the second volume of Biomedical Ethics Reviews, a series of texts designed to review and update the literature on issues of central importance in bioethics today. Five topics are dis cussed in the present volume. Section I, Public Policy andRe search with Human Subjects, reviews the history of the moral issues involved in the history of research with human subjects, and confronts most of the major legal and moral problems involving research on human subjects. Questions addressed in this section range from those concerning informed and proxy consent to those dealing with the adequacy of monitoring hu man research via institutional review boards (IRBs). Section II deals with a second broad topic in bioethics, The Right to Health Care in a Democratic Society. Here the concern not merely that of determining whether there is a right to is health care, but also, if there is such a right, how it ought best be understood and implemented. To answer questions such as these, we learn that one must distinguish legal from moral rights, assess the merits of various theories of rights, clarify the relationship between rights and duties, and attempt to deter mine a just method for the distribution of health care. Advances in medical technology often pose new legal and moral problems for legislators and health care practitioners."

During the last thirty years we have witnessed sweeping changes in health care worldwide, including new and expensive biomedical technologies, an increasingly powerful and influential pharmaceutical industry, steadily increasing health care costs in industrialised nations, and new threats to medical professionalism. The essays collected in this book concern costs and profits in relation to just health care, the often controversial practices of pharmaceutical companies, and corruption in the professional practice of medicine. Leading experts discuss justice in relation to business-friendly strategies in the delivery of health care, access to life saving drugs, the ethics of pharmaceutical company marketing practices, exploitation in drug trials, and undue industry influence over medicine. They offer guidance regarding the ethical delivery of health care products and services by profit-seeking organisations operating in a global marketplace, and recommend pragmatic solutions to enhance organisational integrity and curb medical corruption in the interest of patient welfare.

Inthis Brief, Daniel Sokol interprets'doing medical ethics' broadly to capture the application of ethical knowledge to a concrete situation, rather than just resolving a moral dilemma contained within a case.It instructs clinicians on how toidentify and analyse a clinical ethics case, andguides the reader inpublishing in general medical, specialist medical, and medical ethics journals, andthrough presenting on ethical issues at conferences. In addition to this, advice on how to teach medical ethics, and apply for research ethics approval, is included.

..".an admirably short and clear guide to doing medical ethics... I welcome this book and urge medical students and doctors of all grades to read it in paper, on-line or on your portable screen reader." Sir Richard Thompson, President of the Royal College of Physicians, UK

"Dr. Sokol has provided the field with a much needed, easy and comprehensive tool on 'doing' clinical ethics that all should have in their back pockets." Dr. Nneka Mokwunye, Director of Bioethics, Washington Hospital Center, Washington DC, USA

"This is a magnificent guide to clinical ethics and reflects the author's very well known and widely respected academic gravitas and real life experience in clinical ethics. It is a "must read" for anyone involved in the field." Mr. Vassilios Papalois, Consultant Surgeon and Chairman, Imperial College Healthcare NHS Trust Clinical Ethics Committee, UK "

Recent years have seen a growing interest in the questions of ethics and aging. Advances in medical technology have created dilemmas for physicians, nurses, and other health care professionals over such questions as the allocation of resources and a patient's "right to die." At the same time, the aging of the American population raises concerns about social policies that involve the role of government. In "Ethics in an Aging Society" Harry R. Moody examines both the clinical and the policy issues that center around aging.

Moody pays special attention to the ethical problems associated with two particularly timely concerns--Alzheimer's disease and the increasingly controversial issue of "rational suicide" for reasons of age. He also focuses on the rights of patients in long-term care and on the question of justice between generations (Are older patients using more than their "fair share" of scarce health care dollars?).

"These ethical questions," Moody emphasizes, "are not abstract ones. They arise in the specific historical and political context of America in the closing decade of the twentieth century... This book can best be understood as a meditation on two compelling liberal ideas--autonomy and justice--that have inspired our thinking about ethics and the aging society. The story which unfolds in the book is a story both about the power of those ideals and also about inescapable facts of old age that make those ideals problematic."

Alasdair Maclean analyses the ethical basis for consent to medical treatment, providing both an extensive reconsideration of the ethical issues and a detailed examination of English law. Importantly, the analysis is given a context by situating consent at the centre of the healthcare professional-patient relationship. This allows the development of a relational model that balances the agency of the two parties with their obligations that arise from that relationship. That relational model is then used to critique the current legal regulation of consent. To conclude, Alasdair Maclean considers the future development of the law and contrasts the model of relational consent with Neil Manson and Onora O'Neill's recent proposal for a model of genuine consent.

Psychiatry and religion/spirituality (R/S) share an interest in human flourishing, a concern with beliefs and values, and an appreciation for community. Yet historical tensions between science and religion continue to impede dialogue, leaving clinicians uncertain about how to approach ethical questions arising between them. When are religious practices such as scrupulosity disordered? What distinguishes healthy from unhealthy religion? How should a therapist approach a patient's existential, moral or spiritual distress? What should clinicians do with patients' R/S convictions about faith healing, same-sex relationships, or obligations to others? Discussions of psychiatric ethics have traditionally emphasized widely accepted principles, generally admired virtues, and cultural competence. Relatively little attention has been devoted to the ways that R/S inform the values of patients and their clinicians, shape preferred virtues, and interact with culture. Ethical Considerations at the Intersection of Psychiatry and Religion aims to give mental health professionals a conceptual framework for understanding the role of R/S in ethical decision-making and serve as practical guidance for approaching challenging cases. Part I addresses general considerations, including the basis of therapeutic values in a pluralistic context, the nature of theological and psychiatric ethics, spiritual issues arising in diagnosis and treatment, unhealthy and harmful uses of religion, and practical implications of personal spirituality. Part II examines how these considerations apply in specific contexts: inpatient and outpatient, consultation-liaison, child and adolescent, geriatric, disability, forensic, community, international, addiction and disaster and emergency psychiatry, as well as in the work of religious professionals, ethics committees, psychiatric education, and research. Thick descriptions of case examples analyzed using the framework of Jonson and Winslow show the clinical relevance of understanding the contributions of religion and spirituality to patient preferences, quality of life, decision making, and effective treatment.

The 'sorting society' expresses what many people believe will be the outcome of advances in genetic technology: a society in which many characteristics of children are no longer the result of genetic chance but of deliberate selection. This book focuses on the ethical, legal and social issues raised by this technology. Is the prospect of a sorting society something that we should welcome or deplore? Do concerns about how parents or societies might exercise the choice given to them by genetic technology give us reason to restrain its creation or use? Would a sorting society increase the freedom of parents and the well being of children, or would it undermine values that are central to a liberal democratic society? These are questions of the most profound significance, bearing on the world in which our children, grandchildren, and great-grandchildren will live. This is a must-read for everyone interested in the forefront of genetics and bioethics.

A distinguished team of contributors from the fields of medicine, philosophy and law address some of the issues which arise over the provision of care for dependent elderly patients. Some of the chapters are concerned with the challenge of achieving good quality medical care, the chronic inadequacies of policy making in the UK context, and the prospects for improvement in the medium term. Other chapters look at some of the threats to dependent elderly patients posed by longer-term social and ideological trends which find expression in proposals for age-limits to health care, advocacy of living wills and euthanasia, arguments for withdrawing tube-feeding from certain categories of patient, and certain proposals for resource allocation. This interdisciplinary volume will have a wide appeal to those involved in care of the dependent elderly, to health policy analysts and health care economists, and to bioethicists.

The result of two key social developments in recent years are examined here: the partial dismantling of the welfare state and the progress of genetics. Genetic insights are increasingly valuable for risk assessment, and insurers would like to use these insights to help determine premiums. Combined with the fact that social welfare is being curtailed, this could potentially create an uninsured high-risk population. Along with considerations of autonomy and privacy, this is the basis for an ethical critique of insurer's access to information. The result has often been regulation of such information; but the authors argues that due to adverse selection, regulation will not solve these problems, and this may jeopardize the survival of private personal insurance. Instead, we should look towards the resurrection of social insurance, a key component of the welfare state. This will interest academic researchers as well as professionals involved with genetics and insurance.

Interesting and important ethical questions confront researchers, regulators, institutional review boards, support personnel, and research participants committed to the ethical conduct of human subjects research at all stages of research. Questions encompass - but are not limited to - study design, enrolling participants, balancing the clinical needs of participants against the research agenda, ending trials, discharging post-trial obligations, and resolving conflicts. Straightforward solutions to these types of questions are often not found in regulations, ethics codes, or the bioethics literature. These resources may leave room for interpretation, offer conflicting guidance, or simply fail to address particular questions. Ethics consultation, which has been offered in clinical care settings with regularity since the 1980s, has since the turn of the century increasingly been sought in the clinical research context. Because there has only lately been recognition that ethics consultants can play a valuable role helping the research community conduct research in the most ethically informed way, there are many open questions in the field of research ethics consultation including the appropriate role of consultants and the best methods of consultation. The Clinical Center Bioethics Consultation Service has been serving the NIH community of researchers, administrators, healthcare providers, and research participants for more than a decade, conducting nearly 1,000 consultations in that time. In this book, members of the Bioethics Consultation Service reflect on this long track-record and unparalleled range of research ethics consultations to share a collection of their most interesting and informative research ethics consultations and to start a dialogue on remaining open questions. Although the NIH experience is unique, this book focuses on cases - and associated lessons - that are generalizable and valuable for the entire clinical research community. This book will be valuable to ethics consultants, clinical investigators, students and teachers, and others desiring insight into clinical research ethics and ethics consultation.

Does a competent person suffering from a terminal illness or enduring an otherwise burdensome existence, who considers his life no longer of value but is incapable of ending it, have a right to be helped to die? Should someone for whom further medical treatment would be futile be allowed to die regardless of expressing a preference to be given all possible treatment? These are some of the questions that are asked and answered in this wide-ranging discussion of both the morality of medically assisted death and the justifiability of making certain instances legal. A case is offered in support of the moral and legal permissibility of specified instances of medically assisted death, along with responses to the main objections that have been levelled against it. The philosophical argument is bolstered by empirical evidence from The Netherlands and Oregon where voluntary euthanasia and physician-assisted suicide are already legal.