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."

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.

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.

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.

This book illuminates issues in medical ethics revolving around the complex bond between healer and patient, focusing on friendship and other important values in the healing relationship. Embracing medicine, philosophy, theology, and bioethics, it considers whether bioethical issues in medicine, nursing, and dentistry can be examined from the perspective of the healing relationship rather than external moral principles.

Distinguished contributors explore the role of the health professional, the moral basis of health care, greater emphasis on the humanities in medical education, and some of the current challenges facing healers today.

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.

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.

Tom L. Beauchamp of Georgetown is one of the founding fathers of contemporary bioethics, and is particularly influential as one of the co-authors (with James Childress) of PRINCIPLES OF BIOMEDICAL ETHICS, first published by OUP over 25 years ago and a true cornerstone of contemporary bioethics. This volume is both an introductory textbook as well as a definitive expression of what is known as the dominant "principlist" approach which views bioethical reasoning developing out of four key principles: respect for autonomy, nonmaleficence, beneficence, and justice. This view has been highly influential over the last two decades and has set the agenda for the field.
This volume will collect Tom Beauchamp's 15 most important published articles in bioethics, most of which were published over the last 25 years, and most of which have a strong connection to the principlist approach. Most of the essays included here augment, develop, or defend various themes, positions and arguments in that earlier book, both adding depth as well as taking off in new directions. Among the topic discussed are the historical origins of modern research ethics, to moral principles and methodological concerns. Beauchamp will include a new introduction to explain the history of the essays and their relationship to the principlist theory.

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.

Modern medicine and healthcare systems are in crisis. In the last fifty years, medicine has gained deep, scientific insights into the biological basis of health and disease, and while this has led to many successes, it has brought about a dramatic change of medical focus. The patient is seen as a carrier of disease rather than as a person with a unique experience of the effects of disease or illness. This book seeks to correct that, but showing how a person-centred medical consultation might overcome this crisis of modern medicine. The systemic, solution-oriented approach, outlined here in this new title, is good for both the patient and the doctor, and is a counter-model to doctor's consultations that can seem automated and impersonal. In a systemic, solution-oriented consultation, doctor and patient approach the symptom or problem and the patient's solutions. With active listening and a doctor who can ask the right questions, they create a common reality as a starting point for a targeted therapeutic process, which is tailored to the needs and possibilities of the patient. The consultation thus structured involves the patient as a person in all of his being with his own, personal resources. It initiates an individual, comprehensive and efficient healing process. In addition, the doctor feels satisfaction and joy in his work, which contributes significantly to his own well-being. The consultation process is ideally divided into seven steps, which are described in detail and justified with reference to the literature.

During the past few decades, high-profile cases like that of Terry Schiavo have fueled the public debate over forgoing or withdrawing artificial nutrition and hydration from patients in a persistent vegetative state (PVS). These cases, whether involving adults or young children, have forced many to begin thinking in a measured and careful way about the moral legitimacy of allowing patients to die. Can families forgo or withdraw artificial hydration and nutrition from their loved ones when no hope of recovery seems possible? Many Catholics know that Catholic moral theology has formulated a well-developed and well-reasoned position on this and other end-of-life issues, one that distinguishes between "ordinary" and "extraordinary" treatment. But recent events have caused uncertainty and confusion and even acrimony among the faithful. In his 2004 allocution, Pope John Paul II proposed that artificial nutrition and hydration is a form of basic care, thus suggesting that the provision of such care to patients neurologically incapable of feeding themselves should be considered a moral obligation. The pope's address, which seemed to have offered a new development to decades of Catholic health care ethics, sparked a contentious debate among the faithful over how best to treat permanently unconscious patients within the tenets of Catholic morality. In this comprehensive and balanced volume, Ronald Hamel and James Walter present twenty-one essays and articles, contributed by physicians, clergy, theologians, and ethicists, to reflect the spectrum of perspectives on the issues that define the Catholic debate. Organized into six parts, each with its own introduction, the essays offer clinical information on PVS and feeding tubes; discussions on the Catholic moral tradition and how it might be changing; ecclesiastical and pastoral statements on forgoing or withdrawing nutrition and hydration; theological and ethical analyses on the issue; commentary on Pope John Paul II's 2004 allocution; and the theological commentary, court decisions, and public policy resulting from the Clarence Herbert and Claire Conroy legal cases. A valuable resource for students and scholars, this teachable volume invites theological dialogue and ethical discussion on one of the most contested issues in the church today.

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

A unique, pathbreaking collection that provides the first, detailed and comprehensive analysis of the implications of new health technologies for society, the delivery of health care, and the very meaning of health itself. It is based on new, critical social science research integrated according to core themes, making it accessible and engaging. It will be of especial value to students and researchers in Social Science, Health Studies and medical schools.

"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.

Voluntariness is a necessary condition of valid consent. But determining whether a person consented voluntarily can be difficult, especially when people are subjected to coercion or manipulation, placed in a situation with no acceptable alternative other than to consent to something, or find themselves in an abusive relationship.

Relevant for the entire primary care team, this book provides a diverse range of perspectives on current topical issues. Healthcare ethics is a subject of increasing interest, especially when it related to some of the challenging themes regularly discussed in the media. Until now there has been little useful literature for those in primary care, where ethical problems are often experienced with a unique set of issues. Primary Care Ethics is rigorous and academic, while remaining highly accessible for the full range of practitioners. Moral and legal aspects are clearly distinguished throughout, and the theme-based approach is stimulating and original. In providing greater depth and breadth in this subject than has been available previously, the book is both practical and thought-provoking, and essential reading for everyone, whether in academic, training or practice-based primary care.

Embodiment, Morality and Medicine deals with the relevance of `embodiment' to bioethics, considering both the historical development and contemporary perspectives on the mind--body relation. The emphasis of all authors is on the importance of the body in defining personal identity as well as on the role of social context in shaping experience of the body. Among the perspectives considered are Christian, Jewish, Islamic, Buddhist, and African-American. Feminist concerns are important throughout.

Today we have more control over how we live and how we die than we ever had before. This fact has produced many ethical problems. While much about life is biologically determined, much else is determined by the social circumstances surrounding it. Unfortunately, little energy is spent dealing with the social and psychological factors within which the medical/biological factors are imbedded. In this volume the authors examine some of the medical social and psychological conditions which affect the way we die.
Important topics covered include attitudes toward death; suicide, assisted suicide and euthanasia; hospice and pain management. This volume will be of interest to all who work with terminally ill patients.

Sanctity of life' and human dignity' are two bioethical concepts that play an important role in bioethical discussions. Despite their separate history and content, they have similar functions in these discussions. In many cases they are used to bring a difficult or controversial debate to an end. They serve as unquestionable cornerstones of morality, as rocks able to weather the storms of moral pluralism. This book provides the reader with analyses of these two concepts from different philosophical, professional and cultural points of view. Sanctity of Life and Human Dignity presents a comparative analysis of both concepts.

Stay up-to-date on the ethical and legal issues that affect your clinical and professional decisions! Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards details the ethical and legal issues that involve mental health professionals. Respected authorities with diverse backgrounds, expertise, and professional experience discuss contemporary theories emphasizing professional ethics, the ramifications of professional actions and decisions, and ethical standards on teaching, training, research, and publication. This informative handbook provides invaluable up-to-date information and guidelines vital for every mental health professional. This book is a thorough examination of ethical behavior which can be used as a reference source for the professional or a textbook for graduate students. The handbook itself is divided into five sections. The first section is a detailed introduction of ethics, law, and licensing. The second section presents general ethical principles like competence, integrity, and respect for individual rights and dignity. The third section examines confidentiality, privilege, consent, and protection. The fourth section focuses on general ethical standards in practice, including sexual contact, multiple relationships, and bartering. The fifth section presents the ethical principles and standards in teaching, training, and research. Appendices include the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002) and the Code of Ethics of the National Association of Social Workers (National Association of Social Workers, 1999). Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards discusses: the history of basic approaches and issues in ethical philosophy five fundamental areas in the process of developing competence the necessary ingredients for the mental health professional's practice of integrity aspirational versus enforceable standards of ethics concern for the welfare of others as a core ethical principle the notion of social responsibility in the ethics codes of psychologists and social workers ethical principles, statutes, and case law protecting privacy and confidentiality issues involving the therapist-patient privilege the "duty to protect" doctrine and relevant legal issues the dynamics of multiple relationships and boundary violations sexualized dual relationships between psychologists and patients possible conflict of interest in bartering for services the requirements and implementation of maintaining patient records to avoid ethical and legal problems possible ethical dilemmas involving referrals and fees much, much more This Handbook is an essential resource for all mental health professionals, including psychologists, psychiatrists, social workers, counselors, therapists, and graduate students in mental health and the related fields. Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards is the first of three volumes under this title. The following volumes will focus on forensic settings and special populations/special treatment modalities.

It is possible to increase cost-effectiveness and lower the risk of lawsuits while improving patient care and office morale. In this revolutionary work, the authors, a seasoned primary care physician and an experienced defense attorney, detail risk management techniques and introduce the concept of co-active medicine. Their book will provide practical guidance for all primary care physicians, and will serve as an invaluable resource for risk management consultants and malpractice attorneys.