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

Narrative medicine, an interdisciplinary field that brings together the study of literature and medicine, offers both a way of understanding patient identity and a method for developing a clinician's responsiveness to patients. Scholars in narrative medicine maintain that the ability to be a close reader of texts, particularly literature, correlates with the ability to attend closely to one's patients, an ability referred to as narrative competence. While recognizing the genuine value of narrative competence in clinical encounters, and the value of narrative medicine in patient-centered care, Tara Flanagan examine the limits of self-narration for patients with cognitive and verbal deficits. In Narrative Medicine in Hospice Care: Identity, Practice, and Ethics though the Lens of Paul Ricoeur, Flanagan argues that the models of selfhood and care found in the work of Paul Ricoeur can offer a framework for clinicians, caregivers, and end-of-life patients regardless of their verbal and cognitive capabilities. In particular, Ricoeur's concept of the life-plan connects with the narrative method of life review in hospice and palliative care, and patient identity is a way to discuss religious and spiritual dimensions of patient experience.

Patient-centered care for chronic illness is founded upon the informed and activated patient, but we are not clear what this means. We must understand patients as subjects who know things and as agents who do things. Bioethics has urged us to respect patient autonomy, but it has understood this autonomy narrowly in terms of informed consent for treatment choice. In chronic illness care, the ethical and clinical challenge is to not just respect, but to promote patient autonomy, understood broadly as the patients' overall agency or capacity for action. The primary barrier to patient action in chronic illness is not clinicians dictating treatment choice, but clinicians dictating the nature of the clinical problem. The patient's perspective on clinical problems is now often added to the objective-disease perspective of clinicians as health-related quality of life (HRQL). But HRQL is merely a hybrid transitional concept between disease-focused and health-focused goals for clinical care. Truly patient-centered care requires a sense of patient-centered health that is perceived by the patient and defined in terms of the patient's vital goals. Patient action is an essential means to this patient-centered health, as well as an essential component of this health. This action is not extrinsically motivated adherence, but intrinsically motivated striving for vital goals. Modern pathophysiological medicine has trouble understanding both patient action and health. The self-moving and self-healing capacities of patients can be understood only if we understand their roots in the biological autonomy of organisms. Taking the patient as the primary perceiver and producer of health has the following policy implications: 1] Care will become patient-centered only when the patient is the primary customer of care. 2] Professional health services are not the principal source of population health, and may lead to clinical, social and cultural iatrogenic injury. 3] Social justice demands equity in health capability more than equal access to health services.

Since the turn of the millennium, the potential for patients' knowledge to contribute to medical knowledge has been increasingly recognized by medical sociologists and anthropologists. Where previously such knowledge may have been written off as 'beliefs' and assumed to be inaccurate when it contradicted established medical science, it is increasingly recognized that patients-especially those with chronic conditions-can add a valuable perspective to the clinical knowledge of medical professionals. Sometimes this means working together to reassess treatment priorities, and at other times it may mean a patient-led movement to influence the direction of new research, based on patients' experiences. Ushiyama takes the case of eczema (atopic dermatitis)-a chronic condition with a history of patient-led controversy over treatment methods - as a case study in how patient knowledge has come to affect change in medical practice. Comparing ethnographic fieldwork from Japan and the UK, she builds a complex picture of the differences in approach to treatment in light of attitudes to patients' knowledge.

There is the world of ideas and the world of practice; the French are often for sup pressing the one and the English the other; but neither is to be suppressed. -Matthew Arnold The Function of Criticism at the Present Time From its inception, bioethics has confronted the need to reconcile theory and practice. At first the confrontation was purely intellectual, as writers on ethical theory (within phi losophy, theology, or other humanistic disciplines) turned their attention to topics from the world of medical practice. Recently the confrontation has grown more intense. The ap pointment of clinical ethicists in hospitals and other health care settings is an accelerating trend in North America. Concomitantly, those institutions involved in training peo ple in clinical ethics have added organized exposure to the world of practice, in the form of placement requirements, to the normal academic course load. In common with other dis ciplines, bioethics has begun to see clinical training as a con dition of didactic theory and apprenticeship."

A host of ethical questions has arisen recently in response to the development of new reproductive technologies. This text helps students of theology, philosophy, and health studies, as well as lay readers, to find answers to these questions.

In order to facilitate an informed discussion of the many delicate ethical issues, the book first provides readers with relevant medical and scientific information. It explains in a clear and simple way, for example, what is involved in human embryo and embryonic cell stem research, infertility and its treatments, and prenatal screening and diagnosis. It also explains how the metaphysical framework, in which both Christian and secular philosophers think, relates to the scientific facts and affects the ways in which they solve ethical problems.

Throughout, the author takes a balanced approach, acknowledging his loyalty to Catholicism, yet freely exploring new options indicated by advancing biological science.

Midwives increasingly have faced challenging ethical issues that have clinical and legal implications, they have not always been adequately prepared to deal with them. This book adopts a multi-disciplinary approach to guide the student and practitioner through dilemmas that commonly occur in clinical practice and to highlight the changing face of the midwifery profession.Provides a multi-disciplinary approach to guide midwives through dilemmas which occur in clinical practice Anexcellent team of contributors from the field of midwifery and ethics make this an essential purchase for every midwifery student and practitioner

This U.K. book is written by Faye Thompson, who has thirty years experience as a midwife and educator. She studied philosophy and the humanities as an undergraduate in Australia, and now lectures on health care ethics. As a feminist, she seeks to reunite morality and personal interest so that the woman is not subordinated in women's health and childbirth practices.
From this experience, she offers a framework of ethics specific to midwifery and derived from midwifery practice that takes ethical discourse beyond current literature, proposing strategies for ethical practice based on findings arising out of the profession itself.

Misadventures in Health Care: Inside Stories presents an alternative approach to attributing the cause of medical error solely to the health care provider. That alternative, the systems approach, pursues why an incident occurs in terms of factors in the context of care that affect the care provider to induce an error. The basis for this approach is the fact that an error is an act, an act is behavior, and behavior is a function of the person interacting with the environment. Eleven vignettes illustrate the importance of the systems approach by describing health care incidents from the perspective of the care providers--the perspective that can identify the factors that actually affect the provider. These stories provide general readers with opportunities to apply their knowledge in analyzing incidents to identify error-inducing factors. This book is important reading for policymakers, researchers and practitioners in law and in all medical specialties, and professionals in the social sciences, human factors, and engineering. In addition to sensitizing the reader to the importance of contextual factors in error, Misadventures in Health Care is a case study reference to supplement texts in professional schools such as law and medicine, as well as the full range of academic disciplines. It also is important reading for the general public because it presents an approach for addressing a very pressing social problem-- that of misadventures in health care.

Health Care Ethics examines the way ethical dilemmas are played out in everyday clinical practice and argues for an approach to ethical decision-making which focuses more on patient needs than competing professional interests.

While advances in medical science and technology have improved the ability to save and prolong lives, they have also given rise to fundamental questions about what constitutes life and personhood, especially in the context of what are termed 'persistent vegetative state' and 'brain death'. Drawing on the example of intensive care where such questions feature strongly in everyday practice, Kath M Melia examines how decisions are taken within the context of multiprofessional teamworking, including

- whether to admit a patient and commence treatment

- what the aim of treatment should be (i.e. palliation, care or cure)

- when to limit, withhold or withdraw treatment

- when to donate organs.

As an area in which different professional groups work closely together, the author argues that there are lessons to be learnt from intensive care which can be applied to ethical decision making in all areas of health care for the greater good of patients.

The book makes a significant contribution to the literature on ethics in health care and to the development of ethical decision making which prioritises the needs of patients. It is essential reading for ethicists, sociologists and health care professionals.

"Misadventures in Health Care: Inside Stories" presents an alternative approach to attributing the cause of medical error solely to the health care provider. That alternative, the systems approach, pursues why an incident occurs in terms of factors in the context of care that affect the care provider to induce an error. The basis for this approach is the fact that an error is an act, an act is behavior, and behavior is a function of the person interacting with the environment. Eleven vignettes illustrate the importance of the systems approach by describing health care incidents from the perspective of the care providers--the perspective that can identify the factors that actually affect the provider. These stories provide general readers with opportunities to apply their knowledge in analyzing incidents to identify error-inducing factors.
This book is important reading for policymakers, researchers and practitioners in law and in all medical specialties, and professionals in the social sciences, human factors, and engineering. In addition to sensitizing the reader to the importance of contextual factors in error, "Misadventures in Health Care" is a case study reference to supplement texts in professional schools such as law and medicine, as well as the full range of academic disciplines. It also is important reading for the general public because it presents an approach for addressing a very pressing social problem-- that of misadventures in health care.

Complementary and Alternative Medicine: Ethics, the Patient, and the
Physician is the first comprehensive, multidisciplinary book to focus
on the ethical challenges of complementary and alternative medicine
(CAM), examining the ethical considerations and challenges that
increasingly face patients, physicians and complementary and
alternative medicine practitioners today. In one recent year, it was
estimated that 42% of Americans spent $27 billion out of pocket on CAM
therapies; in particular, CAM therapies are becoming more popular with
baby boomers, who are taking an increasingly active interest in their
health and health care as they age. Most people do not tell their
physicians about their CAM use - what implications does this have for
traditional patient-physician relationships? This volume examines what
should be the center of the dialogue between conventional medicine and
CAM. With big issues and big money at stake, how are patients,
physicians, the health care system and policymakers handling the
explosion in CAM interest and use? What are the physicians' ethical
obligations in this area? These topics and more are examined in this
timely book.

Chapters 1 and 2 of Complementary and Alternative Medicine: Ethics, the
Patient, and the Physician provide a context for thinking about CAM and
introduce its history and definitions. Chapters 3, 4, 5, and 6 examine
the ethical responsibilities of physicians, as well as communications
issues, patient education, legal concerns, and risk management.
Chapter 7 presents a framework for examining CAM using the scientific
method. As we enter the 21st century, and CAMuse becomes more
frequent, often as a companion to conventional medicine, this volume is
timely, thought-provoking and practical reading.

In this book, Carl Elliott draws on philosophy and psychiatry to develop a conceptual framework for judging the moral responsibility of mentally ill offenders.

This volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organized around the main stages of the clinical encounter from the patient's perspective. They run from staying well and "first contact" through to either recovery or long-term illness, death, and dying.

An introductory section opens up crucial issues of methodology and of practical application in this highly innovative approach to the role of ethics in healthcare. The contributions include selections from literature and poetry, canonical and newly commissioned articles, and first-hand narrative by patients, care givers, and professionals. The readings speak volumes to the diversity of human values operative in healthcare.

The volume as a whole conveys the message that these values are far more diverse than any of us normally recognize. Raising awareness of this diversity is the first step to developing a practically effective healthcare ethics.

Bodies for Sale: Ethics and Exploitation in the Human Body Trade explores the philosophical and practical issues raised by activities such as surrogacy and organ trafficking. Stephen Wilkinson asks what is it that makes some commercial uses of the body controversial, whether the arguments against commercial exploitation stand up, and whether legislation outlawing such practices is really justified.

In Part One Wilkinson explains and analyses some of the notoriously slippery concepts used in the body commodification debate, including exploitation, harm and consent. In Part Two he focuses on three controversial issues (the buying and selling of human kidneys, commercial surrogacy, and DNA patenting) outlining contemporary regulation and investigating both the moral issues and the arguments for legal prohibition.

Do people have a moral right to sell their kidneys, or other body parts? Is it wrong to receive money for being a surrogate mother? Can we - and should we - patent DNA? How ethical is the 'commodification' of the human body?

Bodies for Sale: Ethics and Exploitation in the Human Body Trade explores the philosophical and practical issues raised by activities such as surrogacy and organ trafficking. Stephen Wilkinson asks what is it that makes some commercial uses of the body controversial, whether the arguments against commercial exploitation stand up, and whether legislation outlawing such practices is really justified.

In Part One Wilkinson explains and analyses some of the notoriously slippery concepts used in the body commodification debate, including exploitation, harm and consent. In Part Two he focuses on three controversial issues (the buying and selling of human kidneys, commercial surrogacy, and DNA patenting) outlining contemporary regulation and investigating both the moral issues and the arguments for legal prohibition.

Combining philosophical analysis with a detailed examination of current practice, Bodies for Sale is a comprehensive introduction to the ethics of body commodification and will be of interest to students of philosophy, politics and law as well as anyone with a serious interest in healthcare ethics and policy.

In Ethical Dilemmas in Pediatrics, Forman and Ladd clarify, conceptualize, and guide reasoning toward defensible conclusions relating to ethical decisions in medicine. Brief and challenging clinical cases are followed by key discussion questions. The discussions introduce vocabulary, distinctions, concepts, and analysis designed to deepen understanding. Developed as a teaching tool, the book may be used for class discussions and case conferences. Deciding when not to treat, volunteering children for research, achieving the best doctor-patient relationship, and treating adolescents are among the major topics addressed. Originally published in 1991 by Springer-Verlag.

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

For over two decades, Bloch et al's Psychiatric Ethics has been the leading text on ethical issues in psychiatry and mental health. This anthology will serve as an invaluable companion volume, providing ready access to foundational writings, previously published articles and excerpts of book chapters of significance to psychiatric ethics.

Regional Perspectives in Bioethics" illustrates the ways in which the national and international political landscape encompasses persons from diverse and often fragmented moral communities with widely varying moral intuitions, premises, evaluations and commitments.

The essential book on how not to be a doctor - and how to be a better one. Drawn from his popular medical columns over the years, John Launer shares fifty of his best-loved essays, covering topics from essentials skills they don't teach you in medical school to his poignant account of being a patient himself as he received treatment for a life-threatening illness. Taken together, the stories make the case that being a doctor should mean drawing on every aspect of yourself, your interests and your experiences no matter how remote they seem from the medical task at hand. How Not to Be a Doctor combines humour, candour and the human touch to inform and entertain readers on both ends of the stethoscope. ***PRAISE FOR HOW NOT TO BE A DOCTOR*** 'An essential read... It is a gem.' Dr. Fiona Moss, CBE, Dean of the Royal Society of Medicine 'This collection is warm, wise, generous, thoughtful and thought-provoking... imbued with a moving humanity which offers inspiration and reassurance in equal measure.' Dr. Deborah Bowman, MBE, BBC Broadcaster and Professor of Medical Ethics and Law 'Witty and wise. Shows how important it is that doctors are allowed to be human.' Kit Wharton, author of Emergency Admissions: Memoirs of an Ambulance Driver 'An all-round excellent book, which would appeal to a wide range of healthcare professionals and students... a light-hearted way of looking at serious subjects.' BMA Panel of Judges 'I raced through this book, laughing, nodding, highlighting and then read some favourite bits again. Every chapter has a gem of wisdom as well as being so very elegantly written and entertaining.' Jenny Rogers, Co-Author of Coaching for Health 'Bursting with wonder and wisdom, this seductively readable book imparts courage and joy in equal measure.' Dr. Iona Heath, CBE. Former President, Royal College of General Practitioners and author of The Mystery of General Practice 'Gets to the heart and soul of current medical practice. Written by a doctor, but incorporates life experience and wisdom, making it an easy, thought provoking read.' Professor Jane Dacre, President of the Royal College of Physicians

The purpose of medical humanities is to improve the delivery of effective health care through a better understanding of disease - in society, and in the individual. The interfaces between the science of medicine and the arts, philosophy, sociology and law interpret causes and effects of disease. The field of medical ethics is the most prominent offspring of this wider debate, yet the context of disease in the life of the individual and of society is profound and far-reaching. The influences of medicine on the humanities and vice versa are all around, yet only recently have they been recognized in the wider world of health care.

Revolutionary advances in biomedical research and information systems technology pose new and difficult issues for American health care policy, especially in the context of managed care. Health Care Policy in an Age of New Technologies takes on this challenging array of issues, where the dignity of individual life meets the imperatives of the national-level health care system: the right to die, rationing of care, organ transplants, experiments with human embryos, genetic research, confidentiality of medical records, and other ethical dilemmas.

Chapters on a patient's bill of rights, and on medical education and physician training, link the book to policy issues of direct concern to the public and practitioners. Throughout the book, the authors place critical questions in their political, legal, social, economic, and ethical context. Each chapter ends with discussion points, and a multimedia bibliography directs readers to relevant films, documentaries, and case studies.

Revolutionary advances in biomedical research and information systems technology pose new and difficult issues for American health care policy, especially in the context of managed care. Health Care Policy in an Age of New Technologies takes on this challenging array of issues, where the dignity of individual life meets the imperatives of the national-level health care system: the right to die, rationing of care, organ transplants, experiments with human embryos, genetic research, confidentiality of medical records, and other ethical dilemmas.

Chapters on a patient's bill of rights, and on medical education and physician training, link the book to policy issues of direct concern to the public and practitioners. Throughout the book, the authors place critical questions in their political, legal, social, economic, and ethical context. Each chapter ends with discussion points, and a multimedia bibliography directs readers to relevant films, documentaries, and case studies.

From 1932 to 1972, the United States Public Health Service conducted a non-therapeutic experiment involving over 400 black male sharecroppers infected with syphilis. The Tuskegee Study had nothing to do with treatment. It purpose was to trace the spontaneous evolution of the disease in order to learn how syphilis affected black subjects. The men were not told they had syphilis; they were not warned about what the disease might do to them; and, with the exception of a smattering of medication during the first few months, they were not given health care. Instead of the powerful drugs they required, they were given aspirin for their aches and pains. Health officials systematically deceived the men into believing they were patients in a government study of "bad blood", a catch-all phrase black sharecroppers used to describe a host of illnesses. At the end of this 40 year deathwatch, more than 100 men had died from syphilis or related complications. "Bad Blood" provides compelling answers to the question of how such a tragedy could have been allowed to occur. Tracing the evolution of medical ethics and the nature of decision making in bureaucracies, Jones attempted to show that the Tuskegee Study was not, in fact, an aberration, but a logical outgrowth of race relations and medical practice in the United States. Now, in this revised edition of "Bad Blood", Jones traces the tragic consequences of the Tuskegee Study over the last decade. A new introduction explains why the Tuskegee Study has become a symbol of black oppression and a metaphor for medical neglect, inspiring a prize-winning play, a Nova special, and a motion picture. A new concluding chapter shows how the black community's wide-spread anger and distrust caused by the Tuskegee Study has hampered efforts by health officials to combat AIDS in the black community. "Bad Blood" was nominated for the Pulitzer Prize and was one of the "N.Y. Times" 12 best books of the year.