This is a collection of Ruth Macklin's previously published articles that appeared in scholarly journals or as chapters in books. Dr. Macklin's pioneering work in ethics and global health spans more than two decades. The articles in this volume range from a chapter in a book published in 1989 to a journal article currently in press. The essays fall into two broad categories: policy and practice, and multinational research. Topics in the first category include cultural beliefs and attitudes regarding family planning, long-acting contraception, abortion, and more broadly, policies and practices affecting women's health. Two essays dealing with justice focus on HIV/AIDS: how developing country governments might distribute medications fairly to all who are in need; and what obligations do industrialized countries and world leaders have to provide affordable medications to developing countries. A theme that runs throughout the essays is a defense of the universality of ethical principles, despite cultural differences that exist around the globe. The section on multinational research includes articles on international ethics guidance documents, such as the Declaration of Helsinki; discussion of the obligations of researchers and sponsors when they conduct research in developing countries; what constitutes exploitation when research is conducted in resource-poor countries; and, as in the first section of the book, the application of universal ethical principles to the global research enterprise. The author criticizes the view that double standards in research are acceptable: one standard for rich countries, and a lower standard for developing countries. Several essays deal with sensitive and controversial ethical aspects of research on reproductive health and HIV/AIDS.

Empirical studies of life science research and biotechnologies in Asia show how assemblages of life articulate bioethics governance with global moralities and reveal why the global harmonization of bioethical standards is contrived.

Recent surveys demonstrate a high and possibly increasing prevalence of mental disorders in prisoners. They have an increased risk of suffering from a mental disorder that transcends countries and diagnoses. Ethical dilemmas in prison psychiatry arise from resource allocation and include issues of patient choice and autonomy in an inherently coercive environment. Ethical conflicts may arise from the dual role of forensic psychiatrists giving raise to tensions between patient care/protection of the public.This book describes models and ethical issues of psychiatric healthcare in prison in several countries. Relevant issues are: the professional medical role of a psychiatrist and/or psychotherapist working in prison, the involvement of psychiatrists in disciplinary or coercive measures; consent to treatment, the use of coercion in forcing a prisoner to undergo treatment, hunger strike, confidentiality. The book ends with consensus guidelines concerning good practice in Prison Psychiatry.

This volume addresses some of the most prominent questions in contemporary bioethics and philosophy of medicine: 'liberal' eugenics, enhancement, the normal and the pathological, the classification of mental illness, the relation between genetics, disease and the political sphere, the experience of illness and disability, and the sense of the subject of bioethical inquiry itself. All of these issues are addressed from a "continental" perspective, drawing on a rich tradition of inquiry into these questions in the fields of phenomenology, philosophical hermeneutics, French epistemology, critical theory and post-structuralism. At the same time, the contributions engage with the Anglo-American debate, resulting in a fruitful and constructive conversation that not only shows the depth and breadth of continental perspectives in bioethics and medicine, but also opens new avenues of discussion and exploration. For decades European philosophers have offered important insights into the relation between the practices of medicine, the concept of illness, and society more broadly understood. These interventions have generally striven to be both historically nuanced and accessible to non-experts. From Georges Canguilhem's seminal The Normal and the Pathological, Michel Foucault's lectures on madness, sexuality, and biopolitics, Hans Jonas's deeply thoughtful essays on the right to die, life extension, and ethics in a technological age, Hans-Georg Gadamer's lectures on The Enigma of Health, and more recently Jurgen Habermas's carefully nuanced interventions on the question of liberal eugenics, these thinkers have sought to engage the wider public as much as their fellow philosophers on questions of paramount importance to current bioethical and social-political debate. The essays contained here continue this tradition of engagement and accessibility. In the best practices of European philosophy, the contributions in this volume aim to engage with and stimulate a broad spectrum of readers, not just experts. In doing so the volume offers a showcase of the richness and rigor of continental perspectives on medicine and society.

The human microbiome is the bacteria, viruses, and fungi that cover our skin, line our intestines, and flourish in our body cavities. Work on the human microbiome is new, but it is quickly becoming a leading area of biomedical research. What scientists are learning about humans and our microbiomes could change medical practice by introducing new treatment modalities. This new knowledge redefines us as superorganisms comprised of the human body and the collection of microbes that inhabit it and reveals how much we are a part of our environment. The understanding that microbes are not only beneficial but sometimes necessary for survival recasts our interaction with microbes from adversarial to neighborly. This volume explores some of the science that makes human microbiome research possible. It then considers ethical, legal, and social concerns raised by microbiome research. Chapters explore issues related to personal identity, property rights, and privacy. The authors reflect on how human microbiome research challenges reigning views on public health and research ethics. They also address the need for thoughtful policies and procedures to guide the use of the biobanked human samples required for advancing this new domain of research. In the course of these explorations, they introduce examples from the history of biomedical science and recent legal cases that shed light on the issues and inform the policy recommendations they offer at the end of each topic's discussion. This volume is the product of an NIH Human Microbiome Project grant. It represents three years of conversations focused on consensus formation by the twenty-seven members of the interdisciplinary Microbiome Working Group. "The microbiome is a relatively new area of medical attention. Ethical issues related to the microbiome have barely been identified, much less carefully analyzed. This volume is an excellent start toward that ethical analysis. Many of the arguments are persuasive and provocative. In particular, some contributors challenge the ethical need for anonymizing microbiome specimens as well as the need for individual informed consent for specific uses of these specimens. I highly recommend this volume for all those interested in the microbiome and in new frontiers in medical ethics." -Leonard M. Fleck, Michigan State University

Organ transplantation is one of the most dramatic interventions in modern medicine. Since the 1950s thousands of people have lived with 'new' hearts, kidneys, lungs, corneas, and other organs and tissues transplanted into their bodies. From the beginning, though, there was simply a problem: surgeons often encountered shortages of people willing and able to give their organs and tissues. To overcome this problem, they often brokered financial arrangements. Yet an ethic of gift exchange coexisted with the 'commodification of the body'. The same duality characterized the field of blood transfusion, which was essential to the development of modern surgery.
This book will be the first to bring together the histories of blood transfusion and organ transplantation. It will show how these two fields redrew the lines between self and non-self, the living and the dead, and humans and animals. Drawing on newspapers, magazines, legal cases, films and the papers and correspondence of physicians and surgeons, Lederer will challenge the assumptions of some bioethicists and policymakers that popular fears about organ transplantation necessarily reflect timeless human concerns and preoccupations with the body. She will show how notions of the body- intact, in parts, living and dead- are shaped by the particular culture in which they are embedded.

Ross presents an original and controversial examination of the moral principles that guide parents in making health care decisions for their children, and the role of children in the decision-making process. She argues against the current movement to increase child autonomy, in favour of respect for family autonomy, and proposes significant changes in what informed consent allows and requires for paediatric health care decisions.

This book provides an assessment of some ethical implications of increasing life spans. Taking as a starting point the idea that to increase longevity is a form of medical enhancement, it examines the value of living longer; the means for extending life spans; the consequences of greater longevity for the fair distribution of resources and healthcare in particular.

"Mercy killing," "assisting a suicide," "planning your own death," and "euthanasia" are once again high-profile issues. Recent popular referendums have sought to legalize doctor-assisted suicide, while best-selling books have been published about how to kill yourself. In short, Americans are searching for more control over their own mortality.
Hemlock's Cup is the first history of the active euthanasia movement in America, as represented by its most visible proponent, the Hemlock Society. Donald W. Cox traces the growth of the society from its beginnings as a three-person cause to its current world-wide fame. The work of Derek Humphrey, the society's founder, is reviewed and the publicity surrounding Dr. Jack Kevorkian and his controversial "suicide machine" is discussed.
Cox also addresses the Washington and California initiatives to legalize doctor-assisted suicide and the ethical questions they pose. He reflects on the impact of the Quinlan and Cruzan cases to establish the "right to die" for all Americans and he explores the reasons for the delays in enacting living-will laws in various states. In addition, Cox examines the significant connections among AIDS, abortion, and assisted suicide.

This book discusses and provides insight on the legal and ethical dilemmas of managing those with Fetal Alcohol Spectrum Disorder (FASD). This book provides a clear perspective for those clinicians and legal professionals who are working with those with this disorder, and correspondingly increases their understanding when arranging effective supports for this population. Historically, the primary focus on FASD has been on children. However, this is a lifelong disorder and the implications of this disorder become even more prominent and complex in adulthood. Those with this condition can struggle with impulsiveness, and a host of cognitive difficulties. This correspondingly impacts their independence and employability, and produces an elevated risk for homelessness and other residential issues, involvement in substance use, being exploited, development of behavioural issues, and subsequent legal difficulties. Their cognitive difficulties result in challenges for legal systems around the world to understand their issues, and to design appropriate remedial strategies, recommendations for treatments and supports, and even for understanding the failure of many of these individuals to be able to change their behaviours effectively. This produces various legal and ethical dilemmas, which are discussed in detail in this volume by 28 authors from Europe, New Zealand and North America. These include discussions regarding the rights of the unborn child, the alcohol industry's duty to warn, whether small amounts of alcohol during pregnancy can be condoned, and even the current use of involuntary hospitalization for addicted mothers. Other chapters discuss the need for training on FASD for front line officers, use of lies during interrogation of those with FASD, medical and legal interventions for offenders with FASD, access to diagnostic services and follow-up supports, and whether FASD can be considered a mitigating factor for sentencing. Furthermore, caregivers also provide their stories regarding the daily dilemmas that are faced in raising those with FASD.

Shocked by the fact that, in the Netherlands, psychiatric patients are considered potentially appropriate candidates for physician-assisted suicide, Olevitch examines the research and data and finds that, even in the United States, the situation is threatening. She describes how the rhetoric of the assisted-suicide movement can confuse potential suicide victims and their helpers, and how surrogate medical decisions are a growing threat in the lives of incompetent patients. Olevitch argues the assisted-suicide movement is based not on the level-headed realism its advocates claim, but on a lack of information about up-to-date ways of bringing about psychological wellness, on a misguided panic about finances, a phobic view of medical procedures, a lack of understanding of the support needed by average medical patients, and a misguided belief in superficial safeguards.

Olevitch describes how Rational Emotive Behavior Therapy and Cognitive Behavior Therapy can be used to help terminally ill or disabled people overcome their profound depression. Another cognitive focus is added as she presents material answering questions including what patients are really thinking when they request assisted suicide or when they decline medical procedures. Well-known psychologist Albert Ellis says of the volume, Carefully read this unusual book and see how it can be useful to you, whether you are a physician, a mental health professional, or an unfortunate patient

Biobank research and genomic information are changing the way we look at health and medicine. Genomics challenges our values and has always been controversial and difficult to regulate. In the future lies the promise of tailored medical treatments and pharmacogenomics but the borders between medical research and clinical practice are becoming blurred. We see sequencing platforms for research that can have diagnostic value for patients. Clinical applications and research have been kept separate, but the blurring lines challenges existing regulations and ethical frameworks. Then how do we regulate it? This book contains an overview of the existing regulatory landscape for biobank research in the Western world and some critical chapters to show how regulations and ethical frameworks are developed and work. How should international sharing work? How design an ethical informed consent? An underlying critique: the regulatory systems are becoming increasingly complex and opaque. The international community is building systems that should respond to that. According to the authors in fact, it is time to turn the ship around. Biobank researchers have a moral responsibility to look at and assess their work in relation to the bigger picture: the shared norms and values of current society. Research ethics shouldn't only be a matter of bioethicists writing guidelines that professionals have to follow. Ethics should be practiced through discourse and regulatory frameworks need to be part of that public discourse. Ethics review should be then not merely application of bureaucracy and a burden for researchers but an arena where researchers discuss their projects, receive advice and practice their ethics skills.

Commercial pharmaceutical companies have been much criticised for their activities yet, at the same time, there is relatively little ethical information available to those working in the industry. This book addresses this need and develops pharmaceutical ethics as a field independent to medical ethics in general.

The combined experience of authors drawn from around Europe and the United States, currently working within and outside the Pharmaceutical industry, gives this book wide appeal. It should be read by anyone interested in the production and use of pharmaceuticals in contemporary society, be they established pharmaceutical scientists, pharmacy and medical practitioners, students just entering the profession, or interested lay persons.

Topics covered include:

• Ethical theory and the relationship between theory and real life decision-making

• The concept of informed consent

• The moral and political problems surrounding the use of pharmaceuticals in wider society

• The ethical responsibility in the choice of pharmaceutical agents and the cost of medicine related problems

• Ethical dilemmas of advertising, reimbursement and the affordability of medicines

• The ethical responsibility to the patient

This volume brings together a set of critical essays on the thought of Professor Doctor H. Tristram Engelhardt Junior, Co-Founding Editor of the Philosophy and Medicine book series. Amongst the founders of bioethics, Professor Engelhardt, Jr. looms large. Many of his books and articles have appeared in multiple languages, including Italian, Romanian, Portuguese, Spanish, and Chinese. The essays in this book focus critically on a wide swath of his work, in the process elucidating, critiquing, and/or commending the rigor and reach of his thought. This volume compasses analyses of many different aspects of Engelhardt's work, including social and political philosophy, biopolitics, the philosophy of medicine, and bioethics. It brings together internationally known scholars to assess key elements of Engelhardt's work.

This book is a multi-disciplinary collection of essays from leading researchers and practitioners, exploring legal, ethical, social, psychological and practical aspects of surrogate motherhood in Britain and abroad. It highlights the common themes that characterise debates across countries as well as exploring the many differences in policies and practices. Surrogacy raises questions for medical and welfare practitioners and dilemmas for policy makers as well as ethical issues of concern to society as a whole. The international perspective adopted by this book offers an opportunity for questions of law, policy and practice to be shared and debated across countries. The book links contemporary views from research and practice with broader social issues and bio-ethical debates. The book will be of interest to an international audience of academics and their students (in law, social policy, reproductive medicine, psychology and sociology), practitioners (including doctors, counsellors, midwives and welfare professionals) as well as those involved in policy-making and implementation.

The Legal and Ethical Issue, Guest Edited by Dana Bjarnason and Michele A. Carter, focuses on: Moral Accountability and Integrity in Nursing Practice; Care and Meaning in War Zone Nursing; Reflections on Delegation; Transcultural Nursing Practices; Information Technology; Science, Art or Both; Health Care Equity; Trust, Power and Vulnerability; Moral Certitude; and Nursing Responsibilities in Clinical Research.

This textbook considers the medical, surgical, legal and ethical aspects of establishing and maintaining an office-based egg donation programme. Chapters discuss: indications and success rates; screening and demographics of recipients and donors; preparation of the endometrium; synchronization of cycles; obstetrical outcomes; risks and complications; gestational carriers; consents and contracts; and ethics.

What is it like to be a psychologist or a psychiatrist today? Professionals with different kinds of practices and training from around the country talk candidly about their work, the effect that clients have upon them, and the various professional problems they face. They discuss how they have been trained, how they handle ethical questions, and how they feel about the profession. This short collection of interview material, based upon a national survey, provides a revealing and honest insider's view for clinicians, counselors, educators, and all those interested or touched by the mental health profession.

There is a growing conflict in medicine between the research imperative, with its implicit goal of overcoming death itself, and the re-emergent clinical imperative to treat death as a part of life, and to make the process of dying as tolerable as possible. Central to this conflict is the rise of scientific medicine and the decline of religious and associated moral discourses. Many of the Anglo Saxon countries are also marked by a moral and religious pluralism which breeds controversy over bioethical issues such as euthanasia.
It seems that modern medicine has put the cure of bodies before the care of persons. Some scholars attribute this to a metaphysical heritage of dualism and reductionism. This heritage has become problematic in the modern age when waning belief in a divine order leaves the individual self as the bearer of meaning. At the same time, knowledge about nature and society has been increasing at such an accelerated pace, it has become even more difficult to develop a unified secular worldview. When the dying self contemplates its own disintegration in this context, the search for meaning may rest heavy indeed.
Chapters one and two address these larger issues. Chapter three focuses on medicine's approach to cancer as a prime example of the strengths and weaknesses of the research imperative. Chapter four looks at the diffusion of the theory and practice of palliative care throughout the Anglo Saxon world. The fifth chapter discusses the development of effective pain control, essential to palliative care and one of modern medicine's unsung triumphs. The sixth chapter addresses the changing meaning of euthanasia in Western history in the past century, as ittransitioned from a philosophical position to a widely-debated policy proposal.
This book is for palliative care practitioners, and all health care professionals with an interest in end-of-life care. It is also for students in palliative care and the history of medicine, and for anyone interested in the history of this intriguing field.

Ethics plays an especially important and unique role in psychiatry, and this issue is a must-read for psychiatrists as they navigate these sometime tricky waters. With an eye on the most current developments in the psychiatric field, authors discuss topics such as ethics in research, ethics in clinical treatment, ethics in education, genetics, and the military. The section on clinical concerns contains separate articles on children, adults, and older patients, with special attention paid to women's mental health, forensics, addiction psychiatry, consultation/liaison psychiatry, and community psychiatry.

Public policy surrounding the hotly debated issue of physician-assisted suicide is examined in detail. You ll find an analysis of the current legal standing and practice of physician-assisted suicide in several countries. Authors discuss the ethical principles underlying its legal and professional regulation. Personal narratives provide important first-hand accounts from professionals who have been involved in end-of-life issues for many years.

Transhumanists advocate for the development and distribution of technologies that will enhance human intellectual, physical, and psychological capacities, even eliminate aging. What if the dystopian futures and transhumanist utopias found in the pages of science journals, Margaret Atwood novels, films like "Gattaca," and television shows like "Dark Angel" are realized? What kind of world would humans have created?

Maxwell J. Mehlman considers the promises and perils of using genetic engineering in an effort to direct the future course of human evolution. He addresses scientific and ethical issues without choosing sides in the dispute between transhumanists and their challengers. However, "Transhumanist Dreams and Dystopian Nightmares" reveals that radical forms of genetic engineering could become a reality much sooner than many people think, and that we need to encourage risk-management efforts.

Whether scientists are dubious or optimistic about the prospects for directed evolution, they tend to agree on two things. First, however long it takes to perfect the necessary technology, it is inevitable that humans will attempt to control their evolutionary future, and second, in the process of learning how to direct evolution, we are bound to make mistakes. Our responsibility is to learn how to balance innovation with caution.