In ancient Rome parents would consult the priestess Carmentis shortly after birth to obtain prophecies of the future of their newborn infant. Today, parents and doctors of critically ill children consult a different oracle. Neuroimaging provides a vision of the child's future, particularly of the nature and severity of any disability. Based on the results of brain scans and other tests doctors and parents face heart-breaking decisions about whether or not to continue intensive treatment or to allow the child to die. Paediatrician and ethicist Dominic Wilkinson looks at the profound and contentious ethical issues facing those who work in intensive care caring for critically ill children and infants. When should infants or children be allowed to die? How accurate are predictions of future quality of life? How much say should parents have in these decisions? How should they deal with uncertainty about the future? He combines philosophy, medicine and science to shed light on current and future dilemmas.

Modern medicine has put a new twist on one of our most fundamental values . . . self-determination. A patient's right to self-determination becomes a poignant and volatile issue in the context of modern life-sustaining technologies. When the benefit of medical treatment is overshadowed by the resulting burdens, treatment may ethically be withdrawn. Patients have the right to make this decision, assuming they still have the capacity to make it. Through advance directives a competent patient can extend his right to consent to or refuse medical treatment indefinitely into the future. Whether in the form of informal oral instructions or formal written documents, advance directives insure patients that their treatment wishes will be carried out. They also alleviate the uncertainty, guilt, and/or fear of legal consequences facing the family and caregivers. This volume is a collection of fourteen essays investigating the advantages and disadvantages of different kinds of directives, the role of professionals in making and honoring them, policy issues that need to be addressed, and future directions which directives may take. Although such documents may be used to request treatment, this volume limits its focus to their more common function . . . the refusal of treatment. Timely and comprehensive, Advance Directives in Medicine provides a stimulating overview of this relevant topic. The papers in this volume were originally presented at a multidisciplinary conference on advance directives. Revised and edited for this text, they address a variety of questions and issues, for instance: What are the individual and societal benefits of advance directives? Does an advance directive tamper with thesanctity of life? Will normalizing directives have an adverse effect on the practice of medicine? Should a patient specify treatments to be withheld within a directive, such as the use of CPR, nutrition, or hydration? What legal sanctions should apply against those who ignore directives? Should directives be used to reduce health care expenditures by insurance companies, Medicare, and Medicaid? What is a physician's role in helping his patient formulate an appropriate directive and when is a patient ready to confront his own mortality?

Drawing on a wide range of primary historical and sociological sources and employing sharp philosophical analysis, this book investigates medical ethics from a Chinese-Western comparative perspective. In doing so, it offers a fascinating exploration of both cultural differences and commonalities exhibited by China and the West in medicine and medical ethics. The book carefully examines a number of key bioethical issues in the Chinese socio-cultural context including: attitudes toward foetuses; disclosure of information by medical professionals; informed consent; professional medical ethics; health promotion; feminist bioethics; and human rights. It not only provides insights into Chinese perspectives, but also sheds light on the appropriate methods for comparative cultural and ethical studies. Through his pioneering study, Jing-Bao Nie has put forward a theory of "trans-cultural bioethics," an ethical paradigm which upholds the primacy of morality whilst resisting cultural stereotypes, and appreciating the internal plurality, richness, dynamism and openness of medical ethics in any culture. Medical Ethics in China will be of particular interest to students and academics in the fields of Medical Law, Bioethics, Medical Ethics, Cross-Cultural Ethics as well as Chinese/Asian Studies and Comparative Cross-Cultural Studies.

This is the first book in healthcare ethics addressing the moral issues regarding ownership of the human body. Modern medicine increasingly transforms the body and makes use of body parts for diagnostic, therapeutic and preventive purposes. The book analyzes the concept of body ownership. It also reviews the ownership issues arising in clinical care (for example, donation policies, autopsy) and biomedical research. Societies and legal systems also have to deal with issues of body ownership. A comparison is made between specific legal arrangements in The Netherlands and France, as examples of legal approaches. In the final section of the book, different theoretical perspectives on the human body are analyzed: libertarian, personalist, deontological and utilitarian theories of body ownership.

The past decades have seen a rapid development and increasing development of genetic tests. This development will have a major social, political and ethical impact on society.
"Genetics from Laboratory to Society" details practices of genetic testing and discusses its future role for insurance and the workplace. By tracing the work of medical professionals, but also clients, their family-members, insurance companies, employers, unions and government involved, the book shows how due to the introduction of genetic testing responsibilities are redistributed.

This book examines core issues related to legal insanity, integrating perspectives from psychiatry, law, and ethics. Various criteria for insanity are analyzed and recommendations for forensic psychiatric and legal practice are offered. Many legal systems have an insanity defense, in one form or another. Still, it remains unclear exactly when and why mental disorders affect a person's moral or criminal responsibility. Questions addressed in this book include: Why should insanity be a component of our legal system? What should be the criteria for an insanity defense? What would be the reasons for abolishing it? Who should bear the burden of proof? Furthermore, the book discusses the impact neurosciences may have on psychiatric and psychological evaluations of defendants as well as on legal decisions about insanity.

principles. A second solution to this problem is to develop a scale for weighing the significance of the conflicting principles in a given case and for concluding which action should be adopted because it is supported by the weightier considerations in that case. Such a solution seems more realistic than the lexical ordering approach, but the development of such a scale is a problematic task. Still other, more complex solutions are possible. Which is the best solution to this problem of conflicting principles of bioethics? We need a moral theory to answer that question. This is the first reason for concluding that the principles of bioethics are not the true foundations of justified judgment in bioethics. What is the problem of the unclear scope and implications of the principles of bioethics and how can an appeal to moral theory help deal with that problem? The scope of a bioethical principle is the range of cases in which it applies. The implications of a bioethical principle are the conclusions to be derived from that principle in those cases in which it applies. It is clear from a review of the discussions in bioethics that there are major unclarities about the scope and implications of each of the principles. Consider, for example, the principle of autonomy.

in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferer, and at the same time instructs the invalid to the best of his power. He does not give his prescriptions until he has won the patient's support, and when he has done so, he steadilY aims at producing complete restoration to health by persuading the sufferer in to compliance (Laws 4. 720 b-e, [28]). This passage shows the perennial nature of the problems of treating the patient as a person. It shows as well the historical'depth of philosophical interest in medicine. The history of philosophy includes more reflections upon medical ethics than the casual reader might suspect. Many of these reflections are pertinent to contemporary issues such as abortion and population control. Plato, for example, recommends abortion in cases of incest (Republic 5. 461c); and Aristotle argues for letting seriously deformed children die, while forbidding infanticide as a means of popUlation control, suggesting instead the use of early abortions. 'As to the exposure in rearing of children, let there be a law that no deformed child shall live, but that on the ground of an excess in the number of children . . . let abortion be procured before sense and life have begun; what mayor may not be lawfully done in these cases depends on the question of life and sensation' (Politics VII, 16,335 b20-26, [4]).

One: An Evolutionary View of Ethics, Rights and the Doctor-Patient Relationship.- 1. Ethical Theory.- 1. Introduction.- 2. Philosophical Considerations.- 3. Biological Considerations.- 4. Discussion.- 5. Conclusions.- 2. Dual Evolution: Ethics, The Law, Rights.- 1. Ethics and the Law.- 2. The Concept of Rights.- 3. Conclusions.- 3. Bases for Medical Ethics.- 1. Origin of Medical Ethics and the Doctor-Patient Relationship.- 2. Rights and the Practice of Medicine.- 2.1 Autonomy and Beneficence.- 2.2 Non-Maleficence.- 2.3 Justice.- 2.4 Confidentiality.- 2.5 Patients' Right to Medical Care.- 2.6 Patients' Right to Know.- 3. Summary and Conclusions.- Summary and Conclusion to Part One.- Two: A Physician's Perspective on Problems In Medical Ethics (From an Evolutionary Ethical Point of View).- 4. Public Health Policy and Rights (AIDS).- 1. Introduction to the Problem.- 2. Testing for HIV.- 3. Problems in AIDS Control.- 4. Conclusions.- 5. Public Health Policy and Individual Rights (DRUGS).- 1. Drug Addictions (and Alcoholism).- 1.1 Introduction.- 1.2 Alcoholism.- 1.3 Testing for Drugs.- 1.4 Controlling the Use of Drugs.- 1.5 Summary and Discussion.- 2. Drugs in Sports.- 6. Public Health Policy and Individual Rights (Continued).- 1. Rights and Psychiatry.- 2. Rights of the Handicapped and Disabled.- 3. Testing for Genetic Disease.- 7. Experimentation and Research.- 1. Research on Humans.- 2. Animal Experimentation.- 3. Biotechnology (Genetic Engineering).- 4. The Human Genome.- 8. Problems of Reproduction - Abortion (with notes on contraception).- 1. Discussion and Conclusions.- 9. Problems of Reproduction - Artificial Conception.- 1. Artificial Reproduction.- 1.1 Artificial Insemination.- 1.2In VitroFertilization.- 1.3 Surrogacy.- 2. Population Problems.- 3. Discussion and Conclusions (abortion, artificial conception and population problems).- 10. Dying.- 1. Introduction.- 2. Infanticide.- 3. Euthanasia.- 4. Discussion and Conclusions.- 11. Transplantation (with additional notes on the rationing of medical care).- 1. Transplantations.- 2. Discussion.- 3. Rationing.- Summary and Conclusions to Part Two.- References.

An introduction to the ethical and legal dilemmas in nursing practice, this text is designed to provoke the nurse to reflect on the nature of his or her professional obligations and future practice. The authors firstly familiarise the reader with the basic principles of ethical debate and the overall structure of the legal system as it effects nurses. They then address the fundamental dilemmas of nursing practice, such as whether or not paternalism can ever be justified, if patients have the right to die, and what a nurse's response should be to poor professional practice by colleagues. The book aims to enhance the reader's understanding of the issues, and to educate nurses to develop their own skills of reasoning and judgement. -- .

Advances in genetics, such as the Human Genome Project's successful mapping of the human genome and the discovery of ever more sites of disease-related mutations, invite re-examination of basic concepts underlying our fundamental social practices and institutions. Having children, assigning responsibility, identifying causes, using social and scientific resources to improve human well-being, among other concepts, will never be the same. Our concepts of moral and legal responsibility, cause and effect, disease prevention, health, disability, enhancement, personal identity, and reproductive autonomy and responsibility are all subtly changing in response to developments in genetics. Biology, law, medicine, and other disciplines are also evolving in response to mutating concepts in genetics itself-for example, dominance, causation, behavior, gene expression, and gene. The selections in this volume employ philosophical and historical perspectives to shed light on classic social, ethical, and philosophical issues raised with renewed urgency against the backdrop of the mapping of the human genome.

Narrative Medicine: A Rhetorical Rx rests on the principles that storytelling is central to medical encounters between caregivers and patients and that narrative competence enhances medical competence. Thus, the book's goal is to develop the narrative competence of its reader. Grounded in the rhetorical theory of narrative that Phelan has been constructing over the course of his career, this volume utilizes a three-step method: Offering a jargon-free explication of core concepts of narrative such as character, progression, perspective, time, and space. Demonstrating how to use those concepts to interpret a diverse group of medical narratives, including two graphic memoirs. Pointing to the relevance of those demonstrations for caregiver-patient interactions. Narrative Medicine: A Rhetorical Rx is the ideal volume for undergraduate students interested in pursuing careers in healthcare, students in medical and allied health professional schools, and graduate students in the health humanities and social sciences.

The place of drugs in American society is a problem more apt to evoke diatribe than dialog. With the support of the Na tional Science Foundation's program on Ethics and Values in Science and Technology, and the National Endowment for the Humanities' program on Science, Technology, and Human Values, * The Hastings Center was able to sponsor such dialog as part of a major research into the ethics of drug use that spanned two years. We assembled a Research Group from leaders in the scientific, medical, legal, and policy com munities, leavened with experts in applied ethics, and brought them together several times a year to discuss the moral, legal and social issues posed by nontherapeutic drug use. At times we also called on other experts when we needed certain issues clarified. We did not try to reach a consensus, yet several broad areas of agreement emerged: That our society's response to nontherapeutic drug use has been irrational and inconsistent; that our attempts at control have been clumsy and ill-informed; that many complex moral values are entwined in the debate and cannot be reduced to a simple conflict between individual liberty and state paternalism. Of course each paper should be read as the statement of that particular author or authors. The views expressed in this book do not necessarily represent the views of The Hastings Center, the National Science Foundation, or the National En dowment for the Humanities."

Religious beliefs and attitudes have long been recognized as playing an important role in sexual functioning, but the relationship between religion and sexual behavior has rarely been studied in a comprehensive way. The essays in this volume bring the views of sex counsellors, therapists. theologians, and bioethicists to bear on the relationship between religion and sexuality. A major theme emerging from these essays is that religion and counselling need to learn from one another. Religious traditions, at the popular or theological levels, are often marked by ignorance and misinformation about sexuality and can benefit by the insights of those who work closely with patients in medical and counselling settings. Counsellors, in turn, need to develop a sensitivity to past and present religious attitudes toward sexuality in order to assist their patients achieve sexual health.

Medical ethics in Imperial Germany were entangled with professional, legal and social issues. This book shows how doctors' ethical decision-making was led by their notions of male honour, professional politics and a paternalistic doctor-patient relationship rather than concern for patients' interests or the right of the sick to self-determination.

The book aims to establish a critical dialogue between sports ethicists and bioethicists across the range of sporting disciplines at elite level. It will address questions such as:

• are the increasingly intrusive testing methods of elite sports compatible with the right to autonomy and privacy granted to patients in general medicine?
• could there be a moral obligation to correct injustices produced by the genetic lottery?
• how should the goals of sports medicine be viewed from the perspective of rationing scarce health care resources?

This book was published as a special issue in Sport, Ethics and Philosophy.

The question of whether a young woman should be allowed to terminate a pregnancy without her parents' knowledge has been one of the most contentious issues of the post Roe v. Wade era. Parental involvement laws reach to the core of the parent-teen relationship in the highly contested realm of adolescent sexuality. This is the first book to examine in thorough detail the decision-making experiences of teens considering abortion. Shoshanna Ehrlich evaluates the Supreme Court's efforts to reconcile the historically based understanding of teens as dependent persons in need of protection with a more contemporary understanding of them as autonomous individuals with adult-like claims to constitutional recognition. Arriving at a compromise, the Court has made clear that, like adult women, teens have a protected right of choice, but that states may impose a parental involvement requirement. However, so that parents are not vested with veto power over their daughters' decisions, young women must be allowed to seek a waiver of the requirement. Integrating a wealth of social science literature, including in-depth interviews with 26 young women from Massachusetts who obtained court authorization for an abortion, the book raises important questions about the logic of a legal approach that requires young women to involve adults when they seek to terminate a pregnancy, but that allows them to make a decision to become mothers on their own.

Issues in reproductive ethics, such as the capacity of parents to 'choose children', present challenges to philosophical ideas of freedom, responsibility and harm. This book responds to these challenges by proposing a new framework for thinking about the ethics of reproduction that emphasizes the ways that social norms affect decisions about who is born. The book provides clear and thorough discussions of some of the dominant problems in reproductive ethics - human enhancement and the notion of the normal, reproductive liberty and procreative beneficence, the principle of harm and discrimination against disability - while also proposing new ways of addressing these. The author draws upon the work of Michel Foucault, especially his discussions of biopolitics and norms, and later work on ethics, alongside feminist theorists of embodiment to argue for a new bioethics that is responsive to social norms, human vulnerability and the relational context of freedom and responsibility. This is done through compelling discussions of new technologies and practices, including the debate on liberal eugenics and human enhancement, the deliberate selection of disabilities, PGD and obstetric ultrasound.

For caregivers of deeply forgetful people: a book that combines new ethics guidelines with an innovative program on how to communicate and connect with people with Alzheimer's. How do we approach a "deeply forgetful" loved one so as to notice and affirm their continuing self-identity? For three decades, Stephen G. Post has worked around the world encouraging caregivers to become more aware of-and find renewed hope in-surprising expressions of selfhood despite the challenges of cognitive decline. In this book, Post offers new perspectives on the worth and dignity of people with Alzheimer's and related disorders despite the negative influence of "hypercognitive" values that place an ethically unacceptable emphasis on human dignity as based on linear rationality and strength of memory. This bias, Post argues, is responsible for the abusive exclusion of this population from our shared humanity. With vignettes and narratives, he argues for a deeper dignity grounded in consciousness, emotional presence, creativity, interdependence, music, and a self that is not "gone" but "differently abled." Post covers key practical topics such as: * understanding the experience of dementia * noticing subtle expressions of continuing selfhood, including "paradoxical lucidity" * perspectives on ethical quandaries from diagnosis to terminal care and everything in between, as gleaned from the voices of caregivers * how to communicate optimally and use language effectively * the value of art, poetry, symbols, personalized music, and nature in revealing self-identity * the value of trained "dementia companion" dogs At a time when medical advances to cure these conditions are still out of reach and the most recent drugs have shown limited effectiveness, Post argues that focusing discussion and resources on the relational dignity of these individuals and the respite needs of their caregivers is vital. Grounding ethics on the equal worth of all conscious human beings, he provides a cautionary perspective on preemptive assisted suicide based on cases that he has witnessed. He affirms vulnerability and interdependence as the core of the human condition and celebrates caregivers as advocates seeking social and economic justice in an American system where they and their loved ones receive only leftover scraps. Racially inclusive and grounded in diversity, Dignity for Deeply Forgetful People also includes a workshop appendix focused on communication and connection, "A Caregiver Resilience Program," by Rev. Dr. Jade C. Angelica.

debating (and possibly ratifying) the Convention at the national level 13]. The Convention identified basic principles necessary for the applica tion of medicine and the life sciences. It set out to protect the dignity and identity of all human beings: ''The interests and welfare of the human being shall prevail over the sole interest of society or science" (art. 2). It also requests that appropriate measures be taken to provide equitable access to healthcare of appropriate quality. The principle of respecting the free and informed consent of the person is clearly stressed. The issue of interventions on persons unable to provide an informed consent has been controversial for a long time; in the first draft, the exact formulation of the relevant article remained open. Now it states that interventions may be carried out on persons with impaired decision-making capacities, but only for their benefit, and only if minimal risks and minimal burdens are imposed. Consensus apparently exists over a broad range of issues. Privacy and free access to information are defined as rights, in article 10. Discrimination against a person on the basis of his or her genetic heritage is prohibited. Sex selection in medically assisted procreation is prohibited (except to avoid serious hereditary, sex-related diseases). Financial gain from using the human body and its parts is explicitly prohibited. The more controversial issues in bioethics are not addressed in this Convention, however. An exception is research on embryos in vitro."

The National Science Foundation, The National Institute of Occupational Safety and Health, and the Center for Technology and Humanities at Georgia State University sponsored a two-day national conference on Moral Issues and Public Policy Issues in the Use of the Method of Quantitative Risk Assessment ( QRA) on September 26 and 27, 1985, in Atlanta, Georgia. The purpose of the conference was to promote discussion among practicing risk assessors, senior government health officials extensively involved in the practice of QRA, and moral philosophers familiar with the method. The conference was motivated by the disturbing fact that distinguished scientists ostensibly employing the same method of quantitative risk assessment to the same substances conclude to widely varying and mutually exclusive assessments of safety, depending on which of the various assumptions they employ when using the method. In short, the conference was motivated by widespread concern over the fact that QRA often yields results that are quite controversial and frequently contested by some who, in professedly using the same method, manage to arrive at significantly different estimates of risk.

This volume is designed to provide a framework for studying the public policy implications of a broad range of biomedical technologies. Each chapter focuses on the policy issues and political activities surrounding a single technology. Contributors address such issues as new reproductive technologies, animal experimentation, contraceptive drugs, genetic markers and technology and the aging society.

Biomedical Ethics Reviews is an annual publication designed to review and update the literature on issues of central importance in bioethics today. Ordinarily, more than one topic is discussed in each volume of Biomedical Ethics Reviews. This year, however, we have decided to devote the entire volume of Biomedical Ethics Reviews: 1988 to disussion of one topic, namely, AIDS. The ra tionale for this decision should be clear: AIDS is arguably the most serious public health threat facing our nation today, and the char acter of the disease is such that it creates special problems for ethicists, philosophers, theologians, educators, jurists, health care professionals, and politicians. Indeed, the questions that AIDS gives rise to are so numerous and complex that no one text could hope to treat them exhaustively. Still, if it is impossible, in anyone text, to deal with all of the perplexing difficulties that AIDS generates, it nevertheless remains true that each addition to the AIDS literature contributes to our collective knowledge, and in so doing, brings us one step closer to resolving at least some of the problems associated with the disease. We believe that the articles included in the present volume of Biomedical Ethics Reviews serve this purpose admirably, and we hope the reader will agree. James M. Humber Robert F. Almeder vii Contributors Ronald Carson * Medical Humanities Institute, University of Texas Medical Branch, Galveston, Texas David J.