Preventive Medicine between Obligation and Aspiration is a study of ethical questions regarding mass screening, vaccination, and health policy programmes. These interventions aim to enhance public health but may also constrain personal autonomy and cause harm, and influence our moral views. So far, these issues have hardly been subject to systematic ethical analysis. This study aims to fill this gap by providing an overview of moral problems in preventive medicine and by explicating norms for good practice. Throughout the book it is argued that some moral concerns about prevention - namely concerns about medicalization - cannot be adequately grasped in terms of strict and binding moral norms. Various moral concepts and types of norms beyond obligation' are explored and developed in order to give practical meaning to these rather vague concerns. In this way the book contributes to applied ethics as well as to ethical theory. It is of interest to professionals in public health and preventive medicine and to scholars in applied ethics and moral philosophy.

"There is hardly a reason to circumcise a little boy for medical reasons because those medical reasons don't exist," said Dr. Michael Wilks, Head of Ethics at the British Medical Association, who admitted that doctors have circumcised boys for "no good reason."

In the United States, parts of Africa, the Middle East, and in the Muslim world, 13.3 million infant boys and 2 million girls have part or all of their external sex organs cut off for reasons that defy logic and violate basic human rights. Doctors, parents, and politicians have been misled into thinking that circumcision is beneficial, necessary, and harmless.

In Circumcision and human rights, internationally respected experts in the fields of medicine, science, politics, law, ethics, sociology, anthropology, history, and religion present the latest research on this tragedy, as a part of the worldwide campaign to end sexual mutilation. They outline steps for eradicating this abusive practice to enable males and females the dignity of living out their lives with all the body parts with which they were born.

Ethics and Law in Modern Medicine is a unique book that explores the field of medical ethics and health care decision-making through hypothetical case studies. The truly unique feature of this volume is that each chapter sets forth a hypothetical fact pattern which includes role assignments to encourage participants to actively take part in group discussions and debate the controversial and cutting-edge topics that are presented. Each chapter includes in-depth discussion questions which thoroughly explore issues raised by the hypothetical fact patterns, and suggested readings provide background for participants. Additionally, the volume contains excerpts from key statutes and case law which govern the decision-making process presented in each chapter. The volume covers a wide variety of issues including HIV, the health care rights of minors, consent and confidentiality, assisted reproductive technology, property rights in bodily organs, research ethics, religious freedom and the right to refuse care, rationing of scarce resources, surrogate decision-making, and several other traditional as well as unique ethical, legal, and social issues.

Life sciences have huge controversial social implications. In doing experiments with animals, plants or humans the welfare of these living beings can be hampered; in communicating research results private and public interests can be harmed (patents!) or at least severely influenced; in being a member of a research group issues of human rights (such as discriminatory behaviour) can become prominent; individual and collective forms of responsibility because of controversial types of research can become urgent.

Funding organizations can confront scientists and engineers with new ethical issues; the public at large or, as is the case with sustainability, future generations can challenge existing ways of doing research, and educating and teaching can confront scientists with new ethical issues.

In this book, resulting from an expert workshop at Wageningen University and Research Centre, European and American experts discuss such topics and theories as the relationship between ethics, professional ethics and business ethics, the public responsibility of researchers and communicating, organizing, teaching and discussing ethical issues.

First published in 1957, with a slight update in 1964, this classic text remains one of the standard works on the doctor patient relationship (largely as found in general practice). This new edition provides an updated descriptive analysis of the doctor-patient relationship, with practical advice on the potential and limits to the doctors involvement with the patient.A new Foreword by the authors son placing his fathers work in the context of the new millenium. Across the world there are thousands of Balint groups/societies that have a growing number of members keen to read the work of their founding fatherForeword by the original authors son.

Medicine in the United States is big business. We spend 50 percent more on health care per capita than other developed countries, but a multitude of measures indicate that we are not getting health-care value for our money. In Too Big to Succeed, author Dr. Russell J. Andrews details why health care in America has become more expensive but less effective and outlines a new paradigm for health-care delivery.

Too Big to Succeed describes how American medicine is on an unsustainable course: costs are increasing while benefits are deteriorating in comparison with other developed nations. Beginning with the Hippocratic Oath and the the premedical student, Andrews traces the myriad ways in which the profit motive has infiltrated American medicine--including medical school training, current models of health-care delivery, medical professional societies, medical research, and medical drug and device development.

Presenting an insider's look into the current crisis in health care, Andrews demonstrates that until both the physician and the patient return to the relationship that underlies medicine, physicians will not experience the joy of healing those who seek their help and patients will not appreciate that a good physician is a permanent part of their lives.

The participation of German physicians in medical experiments on innocent people and mass murder is one of the most disturbing aspects of the Nazi era and the Holocaust. Six distinguished historians working in this field are addressing the critical issues raised by these murderous experiments, such as the place of the Holocaust in the larger context of eugenic and racial research, the motivation and roles of the German medical establishment, and the impact and legacy of the eugenics movements and Nazi medical practice on physicians and medicine since World War II. Based on the authors' original scholarship, these essays offer an excellent and very accessible introduction to an important and controversial subject. They are also particularly relevant in light of current controversies over the nature and application of research in human genetics and biotechnology.

Patient autonomy is a much discussed and debated subject in medical ethics, as well as in healthcare practice, medical law, and healthcare policy. This book provides a detailed and nuanced analysis of both the concept of autonomy and the principle of respect for autonomy, in an accessible style. The unique feature of this book is that it combines empirical research into hospital practice with thorough philosophical analyses. As such, it is an example of a new movement in applied ethics, that of 'empirical ethics'.

The key themes are informed consent and medical decision making, personal well-being, competence, paternalism and decision making for incompetent patients. Much attention is also devoted to autonomy in non-decision making situations - patient control over small everyday aspects of care, authenticity and existential aspects of illness, autonomy and the 'ethics of care', and the relationship between autonomy and trust in the physician-patient relationship.

This book will be of interest to those working or studying in the field of medical ethics and applied ethics but also to healthcare professionals and health policy makers.

Doctors and Rules is a unique and immensely scholarly book. It draws on material which has informed our civilization, including many of the social sciences-history, sociology, and psychology, as well as law. The author accesses the current importance of the Hippocratic tradition within medicine, and puts forward various models of its practice. He seeks to expose the often inarticulated foundation of contemporary debates about the law, medicine, and health, and to question some common assumptions of the functionsand structures of social and legal order. The book challenges the idea that legal rules should be respected merely because they exist and because they play a part in centralizing the organization of society. It rejects the notion that the courts always, or even often, offer useful mechanisms for defining and settling disputes. On the contrary, the author sees in their formalism many things which hinder the common cause of humanity. Only a skeptic trained in law but also deeply concerned by our fate and circumstances could have produced it. It also contributes both to the sociology of law and the sociology of medicine. Out of a reassertion of old ways, this book presents a new blueprint for future professional conduct. It is rich in questions and ideas for researchers, teachers, and professionals in the fields of law, medical sociology, and medicine and generally for those concerned with the place of professional conduct.

Leading physicians and scientists from around the world critically examine the pharmacological and molecular basis of the therapeutic properties of marihuana and its active ingredient, THC. They detail the broad array of marihuana's effects on brain function, the immune system, male and female reproductive functions, and cardiac and pulmonary functions, as well as evaluate its clinical applications in psychiatry, glaucoma, pain management, cancer chemotherapy, and AIDS treatment. Their studies indicate that marihuana persistently impairs the brain and reproductive function, and that marihuana smoke is more toxic and damaging to the lung than tobacco smoke. Marihuana and Medicine's reports of the latest findings on the pharmacological and molecular mechanisms of marihuana and of its clinical manifestations will be essential reading for physicians, psychiatrists, pharmacologists, health-care professionals, policy makers, public health officials, and attorneys.

The lack of trust in our healthcare system brings ominous results, from decreasing health outcomes to increasing costs, from organization inefficiencies to a pervasive pattern of litigation. This will only worsen as healthcare becomes subject to greater market mechanisms, and as patients, providers, and payers view each other with increasing suspicion. Healthcare professionals are just now coming to realize what other professionals have known for years: trust is earned, not assumed. The Trust Crisis represents the first comprehensive survey of the causes and consequences of declining trust in healthcare, and more importantly, it provides suggestions for restoring that trust.
Editor David A. Shore, founder of the Harvard School of Public Health's Trust Initiative, brings together an unparalleled collection of healthcare leaders for this volume. Chapter authors include Donald Berwick, Robert Blendon, Lucian Leape, and George Lundberg. The book also features an introduction by Cokie and Steve Roberts. Causes, consequences, and cures for the crisis in trust are specifically addressed. Critical areas treated by the authors include:
- systemic conditions that lead to medical errors, and remedies for promoting quality of care.
- outdated modes of doctor-patient communication that hinder compliance.
- novel modes of interaction to improve satisfaction. - patient-centered care and metrics to evaluate its presence or absence.
- media communication and miscommunication, and new standards for medical reporting.
- clinical insights applied to the use of human subjects in biomedical research.
- recommendations for revising medical school curricula and strengthening thepeer-review process in medical journals.
- practical strategies for decreasing the lingering discord between patients, providers, and health plans.
While presenting a diversity of topics and opinions, the authors of this volume agree upon a few principles. The trust famine will have dire consequences if it continues unchecked. Healthcare leaders can take measures to improve trust. Regaining trust requires that entire organizations pay closer attention to the "human factors" of healthcare. And perhaps most critical for change, trust-building is not only good medicine, but good business as well.

This book focuses on ethical issues faced by a variety of healthcare practitioners across the Anglophone African continent. This important resource contains in-depth discussions of the most salient current ethical issues by experts in various healthcare fields. Each profession is described from both an African and a South African perspective, and thus contributes to dialogue and critical thinking around African ethics and decision-making. In this way the book provides readers with an understanding of the ethical issues at hand in various professions, including the practical implications of the ethical issues and how to address those effectively. This is a beneficial resource for all those involved in the various healthcare professions addressed in this book, including undergraduate students, lecturers, researchers and practitioners across the continent. Simply put, with the dynamic changes and challenges in healthcare across the globe and in Africa, this is an indispensable resource for healthcare practitioners.

Andrew Thompson, Norman J. Temple We humans are an extraordinary species. One of our finest achievements is the development of morality, of a sense of right and wrong. We articulate and then impose this sensitivity upon ourselves in the form of ethical guidelines, rules, regulations, and laws. We have, regrettably, also developed marvelously clever ways of justifying our behavior whenever it runs afoul of these prescriptions. We have, for example, developed the concept of objectivity to guide scientific pursuits and subsequently established rights which undermine the possibility of ever coming close to attaining the goal of being objective -- rights which entitle participating scientists to gain personal, tangible profits from scientific discoveries. Formerly, we envisaged gods who kept us in place, who reminded us that we were not all-powerful or especially wise. Now we tend to worship our achievements, especially our technological ones, and ourselves. Mary Midgley' aptly names this phenomenon, "humanolatry." We have lost our respect for nature in our enthusiasm for changing it to that which suits our shortsighted ends. We must, as she says, "unlearn" this way of thinking.

With the success of organ transplantation and the declining number of heart beating cadaver doctors, the number of patients awaiting a transplant continues to rise. This means that alternative sources of donors have been sought, including donors after cardiac death. Such donors sustain rapid damage to their organs due to ischaemia, and as a consequence, some organs do not work initially and some none at all. The proportion of such transplants has increased dramatically in recent years--25% of kidney transplants in the UK were from such donors in 2006, highlighting how much progress has been made.
Written by international experts, this book lays out the moral, legal, and ethical restraints to using such donors for organ transplant together with the techniques that have been adpoted to improve their outcome. The different approaches and results of renal transplant according to country are covered together with the procedures and outcomes adopted to use other organs, notably the liver and lungs.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

The present volume is the result of a conference devoted to the topic of Rationing in Medicine, which was organized by the Europäische Akademie zur Erforschung von Folgen wissenschaftlich-technischer Entwicklungen Bad Neuenahr-Ahrweiler GmbH. One of the purposes of this volume is to contribute to a clarification of the concept of rationing and its possible implementations and thereby to help the participants in the debate to avoid further unnecessary confusion. Authors from the disciplines of medicine, philosophy, economics and law as well as practitioners of health care itself and from the field of health-care financing have contributed to this volume.

Positive conceptions of healthy aging are rightly displacing negative ageist perceptions of older members of our society. Nevertheless, at some stage, most elderly citizens will require some form of assistance from other members of society. When the body or mind begins to fail, a legitimate need for intervention and care will arise. This second volume on Aging discusses this theme.

This fifth edition of Where Medicine Fails, like previous editions, argues for a broader definition of society's responsibilities to the ill than is commonly perceived to be the case. The authors examine the moral and economic implications of medical technology, especially in regard to fetal tissue transplant, cancer survival, childbirth, and dying, and provide a thoughtful assessment of the issues and challenges facing American hospitals. Seventeen chapters are new to this edition. The aim of this volume is to encourage serious examination of the current structure of health services and of the complicated facets of health care reform.

Can medical ethics be legislated? Can a complex bioethical question be definitively answered through legislation? In July 1987 the New York State legislature experimented with legislating medical ethics by amending the state's public health law to regulate Do Not Resuscitate' orders. The consequent law was complex and remains controversial. This volume reviews both the background bioethical debates and the elements of the public policy making process that are essential to understanding New York's experience with the DNR law. It features debates between leading exponents and critics of the law; case studies that examine the impact of New York's DNR law on clinicians, hospitals and patients; and a review of all empirical studies of the law by their lead authors. Appended to the volume is the New York State DNR law and a comprehensive set of background documents. The co-editors, Robert Baker and Martin A. Strosberg, are both professors at Union College, Schenectady, New York. They have collaborated on many projects including, Rationing America's Medical Care: The Oregon Plan and Beyond (Brookings, 1992).

Bioethicists, moral philosophers and social policy analysts have long debated about how we should decide who shall be saved with scarce, lifesaving resources when not all can be saved. It is often claimed that it is fairer to save younger persons and that age is an ethically relevant consideration in such tragic decisions. Medical benefit should be maximized and final selection should aim to minimize the contaminating influence of chance. These claims are challenged by Duff R. Waring in Medical Benefit and the Human Lottery, one of the few books that attempts a sustained defence of random patient selection.

This book combines ethics and political philosophy in its novel and strict egalitarian approach to patient selection for transplantable organs. Waring addresses the question of whether we should choose between lives on the basis of fair chances or best outcomes. He argues that final selection criteria should be based on fair chances that equalize opportunity as opposed to best outcomes. His defence of "hardy" egalitarianism aims to show that random selection by lottery can affirm both a common humanity and the equal value of lives. The notion of patient selection by lottery has not fared well in bioethics and has been regarded by some as a moral affront. Waring argues that a human selection lottery may be neither as crude nor as ethically anomalous as some have supposed. Indeed, it can reflect a familiar conception of equality as a political and moral ideal. This conception abstracts from many undeniable differences between patients and claims that scarce resources should be allocated on the principled assumption that each of their lives is equally worth saving. The book isalso notable for its critiques of some recent utilitarian notions of medical benefit which can have an age-biased impact on elderly patients. Waring then argues against the leading, contemporary age-based approaches to patient selection. He explores the way random selection by lottery can affirm his egalitarian ethos in cases where eligible transplant candidates have each passed a threshold level of prospective medical benefit that has been set by democratic deliberation. Taming chance with a human lottery is defended as the most lucid means of ensuring equal opportunity. In so doing, Waring argues that we give the principle of equal concern and respect a radical expression: above a noncomparative threshold of medical benefit, each candidate can have an equal claim to life.

The question of whether there might be a duty to die was first raised by Margaret Battin in 1987 in her ground-breaking essay, "Age Distribution and the Just Distribution of Health Care: Is There a Duty to-Die?" In 1997 the issue was reprised when two new articles appeared on the topic written by John Hardwig and the other by former Colorado Governor Richard D. Lamm. Given the renewed interest in the topic, as well as its undeniable importance, Biomedical Ethics Re views sought to initiate an in-depth discussion of the issue by soliciting articles and issuing a general call for papers on the topic "Is There a Duty to Die?" The twelve articles in this volume represent the ultimate fruits of those initiatives. The first seven essays in this text are sympathetic to the claim that there is a duty to die. They argue either: (a) that some form of a duty to die exists, or (b) that arguments that might be offered against the existence of such a duty cannot be sustained. By way of contrast, the last five articles in the text are critical of duty-to-die claims: The authors of the first three of these five articles attempt to cast doubt on the existence of a duty to die, and the writers of the last two essays argue that if such a duty did exist, severe problems would arise when ever we attempted to implement it."

In general, the history of virtue theory is well-documented (Sherman, 1997; O'Neill, 1996). Its relationship to medicine is also recorded in our work and in that of others (Pellegrino and Thomasma, 1993b; 1996; Drane, 1994; Ellos, 1990). General publications stress the importance of training the young in virtuous practices. Still, the popularity of education in virtue is widely viewed as part of a conservative backlash to modern liberal society. Given the authorship of some of these works by professional conservatives like William Bennett (1993; 1995), this concern is authentic. One might correspondingly fear that greater adoption of virtue theory in medicine will be accompanied by a corresponding backward-looking social agenda. Worse yet, does reaffirmation of virtue theory lacquer over the many challenges of the postmodern world view as if these were not serious concerns? After all, recreating the past is the "retro" temptation of our times. Searching for greater certitude than we can now obtain preoccupies most thinkers today. One wishes for the old clarity and certitudes (Engelhardt, 1991). On the other hand, the same thinkers who yearn for the past, like Engelhardt sometimes seems to do, might stress the unyielding gulf between past and present that creates the postmodern reaction to all systems of Enlightenment thought (1996).

"The 60% Solution should be required reading for political and industry leaders focused on healthcare reform. Timely, insightful and comprehensible." - Eric Affeldt Chairman, Vail Health The 60% Solution offers a bold new vision of how to radically improve the availability and affordability of healthcare by focusing on five critical components: Emphasizing primary care, Clarifying pricing Standardizing accounting and IT Modifying Health Savings Accounts Changing governance #1 Bestselling author Todd Furniss, an industry insider, offers clear and practical solutions to the complexity of healthcare while examining the historical missteps that landed us facing ongoing systemic dysfunction. The book takes on the task of solving the impersonality of healthcare as well as creating an industry that embraces and manifests a compassionate delivery model, putting the power of choice in the center of the relationship of doctor/care-giver and patient. The 60% Solution makes activists out of the 60% of Americans with private healthcare insurance. Our current system is far too costly, ineffectual, and cold; it violates the ideological and moral tenets of a caring nation. High insurance premiums and insurmountably large bills have left countless citizens under mounds of debt or rolling the dice with their lives. This book is about the actionable measures we as individuals can take to become financially capable, educated, and engaged enough to demand the far-reaching reform necessary. It is an inspiring call to action to have all see the benefit of true healthcare reform that focuses on driving consumerism while vastly improving personal choice and access to affordable care.