To its proponents, the ultrasound scanner is a safe, reliable, and indispensable aid to diagnosis. Its detractors, on the other hand, argue that its development and use are driven by the technological enthusiasms of doctors and engineers (and the commercial interests of manufacturers) and not by concern to improve the clinical care of women. In some U.S. states, an ultrasound scan is now required by legislation before a woman can obtain an abortion, adding a new dimension to an already controversial practice. "Imaging and Imagining the Fetus" engages both the development of a modern medical technology and the concerted critique of that technology.

Malcolm Nicolson and John Fleming relate the technical and social history of ultrasound imaging--from early experiments in Glasgow in 1956 through wide deployment in the British hospital system by 1975 to its ubiquitous use in maternity clinics throughout the developed world by the end of the twentieth century. Obstetrician Ian Donald and engineer Tom Brown created ultrasound technology in Glasgow, where their prototypes were based on the industrial flaw detector, an instrument readily available to them in the shipbuilding city. As a physician, Donald supported the use of ultrasound for clinical purposes, and as a devout High Anglican he imbued the images with moral significance. He opposed abortion--decisions about which were increasingly guided by the ultrasound technology he pioneered--and he occasionally used ultrasound images to convince pregnant women not to abort the fetuses they could now see.

"Imaging and Imagining the Fetus" explores why earlier innovators failed where Donald and Brown succeeded. It also shows how ultrasound developed into a "black box" technology whose users can fully appreciate the images they produce but do not, and have no need to, understand the technology, any more than do users of computers. These "images of the fetus may be produced by machines," the authors write, "but they live vividly in the human imagination."

Mental illness is the poor, and somehow "damaged," cousin to physical ailments in the eyes of too many in our society. Compare the difference in how people would respond to someone who had fallen and broken their leg on the street, to how most react to those mentally ill among us, on those same streets, who spend their winters on steam grates and forage for food in dumpsters. " Rationing Sanity "is a provocative analysis of the mental health care system in the United States, dealing with issues of justice and access to mental health care.

How should a decent society, affluent but facing many serious calls on its resources, best care for citizens afflicted with severe and persistent mental illnesses? James Lindemann Nelson brings together, for the first time, scholars of the ethics of mental health care and top managed care policy analysts to address this crucial problem. "Rationing Sanity" integrates those perspectives with the thoughtful practice-based experience of physicians well versed in the actual care of people with emotional and behavioral problems. Over a period of years, the contributors met face-to-face to engage each other on the ethics of managed mental health care -- the result is a unique, collaborative effort that provides a wealth of important new insights on not only how Americans can readjust their attitudes toward the mentally ill -- but also how we may find more just and humane treatment for those afflicted.

In this age of increasing headlines about drug addiction and prescription drug abuse, this book is a timely revelation of how the nursing profession is also impacted by substance abuse. It allows nurses, who are the most trusted profession in society, who have been hidden within their profession and living with substance use disorders, to openly voice their personal experiences with addiction. Seven nurses detail their journey through family dynamics, early use as nursing students and later career nurses as they traveled deeper and deeper into their addiction. They discuss their shame, humiliation and dejection under the throes of the compelling forces of drugs and alcohol. They also describe how their family, other nurses, the healthcare system, and society assisted them in perpetuating their deception and denial about their disease. They explain how they lied, stole and cheated those around them to maintain their addiction. Each explains in detail the confrontations and the "jolt" and "wake up call" it took for them to awaken, become sober and truly enter recovery. They are all candid and forthright in order to help others that are impacted by this horrific and complex disease. They each share how recovery is possible when appropriate attitudes and tools are put in place to support nurses suffering from the devastation of addiction. Their stories bring attention to the importance of intervention, treatment, and recovery communities within the nursing profession. Recovery is emphasized as a "gift" by each of these nurses. The nurses and the researcher provide suggestions and recommendations to assist the healthcare community in addressing addiction in nursing. This book reveals how recovery for nurses is a major public health benefit.

The Handbook of Medical Leadership and Management couples the essentials of clinical leadership with a practical approach to help healthcare professionals be effective clinical leaders and managers. Beginning with a theoretical analysis it then focuses on practical ways of being a good manager and leader and the day-to-day requirements of a consultant working within a multi-professional clinical team. This is an essential resource for all those leading and managing a clinical team and those who aspire to lead, covering a broad understanding of the requirements of effective leadership. This includes quality care, patient safety, how to ensure good outcomes, using data for improvement, commissioning services and developing business cases, as well as the development of person-centred care and the education of the next generation of leaders.

"Will the future confront us with human GMOs? Greely provocatively declares yes, and, while clearly explaining the science, spells out the ethical, political, and practical ramifications."-Paul Berg, Nobel Laureate and recipient of the National Medal of Science Within twenty, maybe forty, years most people in developed countries will stop having sex for the purpose of reproduction. Instead, prospective parents will be told as much as they wish to know about the genetic makeup of dozens of embryos, and they will pick one or two for implantation, gestation, and birth. And it will be safe, lawful, and free. In this work of prophetic scholarship, Henry T. Greely explains the revolutionary biological technologies that make this future a seeming inevitability and sets out the deep ethical and legal challenges humanity faces as a result. "Readers looking for a more in-depth analysis of human genome modifications and reproductive technologies and their legal and ethical implications should strongly consider picking up Greely's The End of Sex and the Future of Human Reproduction... [It has] the potential to empower readers to make informed decisions about the implementation of advancements in genetics technologies." -Dov Greenbaum, Science "[Greely] provides an extraordinarily sophisticated analysis of the practical, political, legal, and ethical implications of the new world of human reproduction. His book is a model of highly informed, rigorous, thought-provoking speculation about an immensely important topic." -Glenn C. Altschuler, Psychology Today

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.

What roles do different kinds of knowledge play in medicine? What roles should they play? What standards (epistemic, ethical, practical) should be met before knowledge is used to develop policy or practice? Medical decision-making, whether in the clinic or at the policy level, can have serious and far-reaching consequences. It is therefore important to base decisions on the best available knowledge. Yet deciding what should count as the best available knowledge is not easy. This important book addresses philosophical questions about what kinds of knowledge should be taken into account, and how knowledge should inform practice and policy. The chapters in this volume examine the relationship between knowledge and action in medical research, practice, and policy. "Knowledge" is broadly construed to include knowledge from clinical, laboratory, or social science research, and from the clinical encounter, as well as broader background assumptions prevalent in society that inform both the kinds of knowledge that are taken to be relevant to medicine and how that knowledge is interpreted in decision-making. Such knowledge may be relevant not only to clinical decision-making with regard to the care of individual patients, but also to the practice of scientific research, the development of policy and practice guidelines, and decisions made by patients or by patient advocacy groups.

This book is designed to consolidate the relevant literature as well as the thoughts of professionals currently working in the field into a practical and accessible reference for the emergency medical technician, student, nurse, resident, and attending emergency physician. Each chapter is divided into four sections: case presentation, discussion, review of the current literature, and recommendations. Designed to serve simultaneously as a learning and reference tool, each chapter begins with a real case that was encountered in an ED setting. The case presentation is followed by a short discussion of the case, as if at a morbidity and mortality conference, by a panel of experienced attending physicians explaining how they would approach the ethical dilemmas associated with the case, and a review of the existing literature.

Rapid advances in modern medicine have revolutionized the way we think about death and the processes of dying. Once death was defined as the absence of respiration or heartbeat; today patients hooked up to a respirator and feeding tube can be kept alive for months or years. Ivan and Melrose carefully explain the various medical processes involved in death and dying. In doing so they also confront the many ethical, moral and legal dilemmas that face doctors today, as well as the decisions that must be taken by relatives.

Perhaps no medical breakthrough in the twentieth century is more spectacular, more hope-giving, or more fraught with ethical questions than organ transplantation. Each year some 25,000 Americans are pulled back from the brink of death by receiving vital new organs. Another 5,000 die while waiting for them. And what distinguishes these two groups has become the source of one of our thorniest ethical questions. In Raising the Dead, Ronald Munson offers a vivid, often wrenchingly dramatic account of how transplants are performed, how we decide who receives them, and how we engage the entire range of tough issues that arise because of them. Each chapter begins with a detailed account of a specific case--Mickey Mantle's controversial liver transplant, for example--followed by careful analysis of its surrounding ethical questions (the charges that Mantle received special treatment because he was a celebrity, the larger problems involving how organs are allocated, and whether alcoholics should have an equal claim on donor livers). In approaching transplant ethics through specific cases, Munson reminds us of the complex personal and emotional dimension that underlies such issues. The book also ranges beyond our present capabilities to explore the future possibilities in xenotransplantation (transplanting animal organs into humans) and stem cell technology that would allow doctors to grow new organs from the patient's own cells. Based on extensive scientific research, but written with a novelist's eye for the human condition, Raising the Dead shows readers the reality of organ transplantation now, the possibility of what it may become, and how we might respond to the ethical challenges it forces us to confront.

"The Double-Edged Helix" explores the impact of recent genetic discoveries on both different population segments and society as a whole. The authors address the medical and ethical implications of the new technologies, outlining potential positive and negative effects of genetic research on minorities, individuals with disabilities, and those of diverse sexual orientations. Presenting a wide array of perspectives, this book emphasizes the need to ensure that research into genetics research does not result in discrimination against people on the basis of their DNA.

Whilst activities like transplantation and medical research have typically been considered on a discrete basis, they are also actually part of a broader phenomenon of medical means being employed to make use of human beings. This book is the first ever systematic critique of such medical use of the human being as a whole. It is divided into two parts. The first part considers what constitutes an appropriate normative lens through which to view such medical use and its constraint. It makes a reasoned ethical and human-rights-based case for preferring respect for human worth over any of the main alternative approaches that have been drawn on in specific contexts and outlines what this preference practically implies. The second part uses this respect-based lens to critique use discourse, law and practice. Drawing on three contrasting case study areas of warfare-related medical use, transplantation and human tissue research, this book exposes both the context-specific and thematic nature of shortfalls in respect. Overall this book provides a compelling analysis of how medical use ought to be constrained and a compelling critique of the excesses of discourse, practice and governance. It is recommended to academics, students, policymakers and professionals whose work is focused on or intersects with the medical sector and anyone else with an interest in medicine and its limits.

This book explores the issues that surround medically assisted reproduction. It addresses the place of destiny, including how to think about individual destinies in an age of increasingly accessible gene sequencing paired with a growing link between procreation and prediction.

This book provides an account of the ethics of chronic illness. Chronic illness differs from other illnesses in that it is often incurable, patients can live with it for many years, and its day-to-day management is typically carried out by the patient or members of their family. These features problematise key distinctions that underlie much existing work in medical ethics including those between beneficence and autonomy, between treatment and prevention, and between the recipient and provider of treatment. The author carries out a detailed reappraisal of the roles of both autonomy and beneficence across the different stages of treatment for a range of chronic illnesses. A central part of the author's argument is that in the treatment of chronic illness, the patient and/or the patient's family should be seen as acting with healthcare professionals to achieve a common aim. This aspect opens up unexplored questions such as what healthcare professionals should do when patients are managing their illness poorly, the ethical implications of patients being responsible for parts of their treatment, and how to navigate sharing information with those directly involved in patient care without violating privacy or breaching confidentiality. The author addresses these challenges by engaging with philosophical work on shared commitments and joint action, responsibility and justice, and privacy and confidentiality. The Ethics of Chronic Illness provides a new, and much needed, critical reappraisal of healthcare professionals' obligations to their patients. It will be of interests to academics working in bioethics and medical ethics, philosophers interested in the topics of autonomy, responsibility, and consent, and medical practitioners who treat patients with chronic illness.

Disorders of Consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders, and focused renewed attention on the medical and ethical problem of misdiagnosis. This book examines the entanglement of epistemic and ethical uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads in this work: the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice. With applications to various decisional contexts where uncertainty and ethical risk interact, this ethical approach enables surrogate decision makers facing fraught and risky choices to fulfill their obligations as moral and epistemic agents.

The Covid-19 pandemic has shown the need for a fresh look at health and health care. This book offers a philosophical critique of medicine as applied science, but more positively it stresses the social causes of disease and argues for greater equity in the distribution of resources and the benefits of a wider evidence-base for medical treatments. The suggested approach requires a new direction for medical ethics, one which uses the arts and humanities and leads to a revised idea of medical education and medical professionalism. The suggested approach implies a move away from the individualistic philosophy of medicine towards a new aim - community-based quality of life. The achievement of this aim certainly requires an expansion of public health medicine and health promotion but it also requires medical co-operation with the many arts and other community agencies concerned with our health and well-being. Doctors and other health professionals must work through the community rather than on it.

One of the most fundamental issues in health care delivery is who should decide which items of medical care are not worth their cost. This book is a fresh and comprehensive exploration of how health care rationing decisions are made. Unlike prior works, its focus is not on the specific criteria for rationing, like age or quality of life. Instead, the author provides comparative analysis of alternative social mechanisms for making medical spending decisions: (1) consumers paying for their medical treatment out of pocket; (2) payers, government officials, or other centralized authorities setting limits on what doctors can do and what insurance will pay for; and (3) physicians motivated to make these decisions at the bedside level. His analysis of each of these mechanisms reveals that none is uniformly superior, and each is better suited for certain decisions that others. Therefore, a mix of all three is inevitable. The author develops his analysis along three dimensions: political economics, ethics, and law. The political economic dimension discusses the practical and theoretical aspects of each method for making spending decisions, synthesizing empirical studies of the situations in which each mechanism has been tested. The ethical dimension is based on several strands of philosophical theory, principally classic liberalism, social contract theory, and communitarianism, as well as conceptual analysis of terms such as autonomy and coercion. The legal dimension addresses recent developments in legal doctrine such as informed consent, insurance coverage disputes, and the emerging direction of federal regulation. Hall concludes that physician rationing at the bedside is far more promising than medical ethicists and the medical profession have traditionally allowed. The best way to allocate authority for making medical spending decisions in both public and private systems, he believes, is the informed purchase of different types of health insurance in a managed competition framework.

The foundations of research ethics are riven with fault lines emanating from a fear that if research is too closely connected to weighty social purposes an imperative to advance the common good through research will justify abrogating the rights and welfare of study participants. The result is an impoverished conception of the nature of research, an incomplete focus on actors who bear important moral responsibilities, and a system of ethics and oversight highly attuned to the dangers of research but largely silent about threats of ineffective, inefficient, and inequitable medical practices and health systems. In For the Common Good: Philosophical Foundations of Research Ethics, Alex John London defends a conception of the common good that grounds a moral imperative with two requirements. The first is to promote research that generates the information necessary to enable key social institutions to effectively, efficiently, and equitably safeguard the basic interests of individuals. The second is to ensure that research is organized as a voluntary scheme of social cooperation that respects its various contributors' moral claims to be treated as free and equal. Connecting research to the goals of a just social order grounds a framework for assessing and managing research risk that reconciles these requirements and justifies key oversight practices in non-paternalistic terms. Reconceiving research ethics as resolving coordination problems and providing credible assurance that these requirements are being met expands the issues and actors that fall within the purview of the field and provides the foundation for a more unified and coherent approach to domestic and international research. This is an open access title available under the terms of a CC BY-NC-ND 4.0 license. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations.

David Rothman gives us a brilliant, finely etched study of medical practice today. Beginning in the mid-1960s, the practice of medicine in the United States underwent a most remarkable--and thoroughly controversial--transformation. The discretion that the profession once enjoyed has been increasingly circumscribed, and now an almost bewildering number of parties and procedures participate in medical decision making.

Well into the post-World War II period, decisions at the bedside were the almost exclusive concern of the individual physician, even when they raised fundamental ethical and social issues. It was mainly doctors who wrote and read about the morality of withholding a course of antibiotics and letting pneumonia serve as the old man's best friend, of considering a newborn with grave birth defects a "stillbirth" thus sparing the parents the agony of choice and the burden of care, of experimenting on the institutionalized the retarded to learn more about hepatitis, or of giving one patient and not another access to the iron lung when the machine was in short supply. Moreover, it was usually the individual physician who decided these matters without formal discussions with patients, their families, or even with colleagues, and certainly without drawing the attention of journalists, judges, or professional philosophers.

The impact of the invasion of outsiders into medical decision-making, most generally framed, was to make the invisible visible. Outsiders to medicine--that is, lawyers, judges, legislators, and academics--have penetrated its every nook and cranny, in the process giving medicine exceptional prominence on the public agenda and making it the subject of popular discourse. The glare of the spotlight transformed medical decision making, shaping not merely the external conditions under which medicine would be practiced (something that the state, through the regulation of licensure, had always done), but the very substance of medical practice--the decisions that physicians made at the bedside.

This new book will enable family practitioners, obstetricians and pediatricians to answer the concerns of the families in their care. It is the first book to make information on this important topic so easily accessible to clinicians. The book is firmly rooted in clinical practice and based on many years of experience, much of it involving the development and implementation of new techniques for examining the fetus in utero. The techniques now available are assessed and better ways to identify pregnancies which are eligible to their application are proposed. The authors describe both the sampling and laboratory techniques available. Other sections cover both predictable and unpredictable pregnancy risks from genetic diseases to abnormal ultrasound, including the possibilities for laboratory evaluation, and the risks and limitations. Throughout the book, the special status of the fetus as a patient is emphasized and the concerns and questions of families are considered, making this the first fully comprehensive and authoritative volume on fetal medicine.

By the time of his death, Herve Guibert had become a singular literary voice on the impact of AIDS in France. He was prolific. His oeuvre contained some twenty novels, including To the Friend Who Did Not Save My Life and The Compassion Protocol. He was thirty-six years old. In Cytomegalovirus, Guibert offers an autobiographical narrative of the everyday moments of his hospitalization because of complications of AIDS. Cytomegalovirus is spare, biting, and anguished. Guibert writes through the minutiae of living and of death-as a quality of invention, of melancholy, of small victories in the face of greater threats-at the moment when his sight (and life) is eclipsed. This new edition includes an Introduction and Afterword contextualizing Guibert's work within the history of the AIDS pandemic, its relevance in the contemporary moment, and the importance of understanding the quotidian aspects of terminal illness.

Autobiography of a Disease documents, in experimental form, the experience of extended life-threatening illness in contemporary US hospitals and clinics. The narrative is based primarily on the author's sudden and catastrophic collapse into a coma and long hospitalization thirteen years ago; but it has also been crafted from twelve years of research on the history of microbiology, literary representations of illness and medical treatment, cultural analysis of MRSA in the popular press, and extended autoethnographic work on medicalization. An experiment in form, the book blends the genres of storytelling, historiography, ethnography, and memoir. Unlike most medical memoirs, told from the perspective of the human patient, Autobiography of a Disease is told from the perspective of a bacterial cluster. This orientation is intended to represent the distribution of perspectives on illness, disability, and pain across subjective centers-from patient to monitoring machine, from body to cell, from caregiver to cared-for-and thus makes sense of illness only in a social context.

This book exposes, and fills, a notable void in the educational content generally covered in modern schools of medicine. It provides an introduction to the field at large in terms of content that is relevant for each of the specialties and subspecialties of medicine; and to this end, it addresses the modern counterpart of the Hippocratic philosophy that was at the root of the genesis of modern medicine. The much-needed but still-missing introductory content for the interdisciplinary 'medical common,' provided in this book, addresses mainly the most elementary concepts and principles of medicine. Those concepts flow, hierarchically, from the essence of (health and) ill-health/illness for one and that of medicine for another, both of these critically formulated; and those principles are dictates of logic and ethics, both specific to medicine. While a modern physician is expected to be competent as a scholar in his/her particular discipline of medicine, study of this book is essential for the development of that competence -- for learning, for example, to make a tenable distinction between scientific medicine and medical science, and between knowledge-based medicine (scientific and other) and its opinion-based substitutes ('evidence-based' and other). "To me it is astonishing and to medicine actually shameful that it has taken up to year 2015 before there is a work in which the essence of medicine is described and discussed." -- J. Steurer, University of Zurich "[In this book], Miettinen beautifully elucidates the concepts and principles of knowledge-based diagnosis, and prognosis, within medicine. Now, after six decades of keen observation and study, and critical reflection on medicine and medical research, Miettinen, in this book, shares the fundamental understandings he has reached; ..." -- T. J. VanderWeele, Harvard University "The aim of this book ... is admirable. The composition of the book -- from the key concepts to logical and ethical principles -- is very clear and systematic. I am convinced that this kind of book is needed." -- I. Niiniluoto, University of Helsinki

This book delves into risks that can easily bedevil any psychotherapist and what can happen if they are ignored. Dramatic storytelling, based on actual incidents from the author's experiences as a member of ethics committees and as an ethics teacher and consultant, explores actions prompting clients to issue formal complaints. Set in the context of an ethics committee meeting over the course of a weekend, twelve psychologists face their peers who will stand in judgment. Issues include the fallout from losing one's temper with a difficult client, a personal disclosure gone terribly wrong, a bartering arrangement that literally falls apart, a private life revealed in a most public way, a vengeful act that sullies the reputation of an entire department, breaking confidentiality when a client threatened harm, and the slippery slope to sexual exploitation. The stories are absorbing, enlightening, sometimes shocking, and often stranger than fiction. Narrative nonfiction puts human faces and emotions on what would otherwise be cursory statistics. What led to the formal complaint from both the vantage point of the complainant and the psychologist offers insights not otherwise available unless the dynamics of their private lives leading up to the conflict are revealed. An author's commentary and discussion questions follow every story. Both new and seasoned practitioners, as well as those still in training, will find this to be an invaluable resource.