As more and more people survive into old age, the burden of caring for them becomes greater and greater. Although it is now possible to alleviate many of the afflictions that beset mankind, no society can afford to pay for all the healthcare that is now available or technically possible. People working in healthcare increasingly have to do more with less. Rationing takes many forms, mostly covert, and the less privileged in most societies end up struggling to get their proper share of the available healthcare resources. All too often, those in the front-line have to deal with the consequences of this 'rationing by default': healthcare professionals find themselves rushed off their feet simply doing the basic tasks and completing all the paperwork; placing frail, sick people in ever lengthening queues, sometimes asking them to wait for hours in the middle of the night under uncomfortable and even unsafe conditions; and, worst of all, working under conditions they would rather avoid in which the safety margin for those they are caring for has been greatly diminished. We are all aware that under these conditions the chance of making a mistake which can seriously harm or even lead to the death of a patient is greatly increased. But what can be done about this? How can you be sure that you are doing the right thing when faced with having to practise an uncertain science on vulnerable patients in a complex system under ever-changing conditions? At what point could you cross the invisible line from reasonable to irresponsible or unethical behaviour by tolerating conditions or tacitly accepting practices which may be regarded as unacceptable, even though you may have little immediate control over them? This book is a guide to getting it right for healthcare professionals. It is about doing the right thing, in the right way, at the right time, for the right people. These are the dimensions of quality in healthcare, and although some are in conflict (equitable access and efficiency, for example), adherence to ethical practice and professional behaviour will help lead healthcare practitioners through the minefield of responsibilities and priorities. Real-life situations are integral to the book, with over 500 clinical examples referred to within the text.

As more and more people survive into old age, the burden of caring for them becomes greater and greater. Although it is now possible to alleviate many of the afflictions that beset mankind, no society can afford to pay for all the healthcare that is now available or technically possible. People working in healthcare increasingly have to do more with less. Rationing takes many forms, mostly covert, and the less privileged in most societies end up struggling to get their proper share of the available healthcare resources. All too often, those in the front-line have to deal with the consequences of this 'rationing by default': healthcare professionals find themselves rushed off their feet simply doing the basic tasks and completing all the paperwork; placing frail, sick people in ever lengthening queues, sometimes asking them to wait for hours in the middle of the night under uncomfortable and even unsafe conditions; and, worst of all, working under conditions they would rather avoid in which the safety margin for those they are caring for has been greatly diminished. We are all aware that under these conditions the chance of making a mistake which can seriously harm or even lead to the death of a patient is greatly increased. But what can be done about this? How can you be sure that you are doing the right thing when faced with having to practise an uncertain science on vulnerable patients in a complex system under ever-changing conditions? At what point could you cross the invisible line from reasonable to irresponsible or unethical behaviour by tolerating conditions or tacitly accepting practices which may be regarded as unacceptable, even though you may have little immediate control over them? This book is a guide to getting it right for healthcare professionals. It is about doing the right thing, in the right way, at the right time, for the right people. These are the dimensions of quality in healthcare, and although some are in conflict (equitable access and efficiency, for example), adherence to ethical practice and professional behaviour will help lead healthcare practitioners through the minefield of responsibilities and priorities. Real-life situations are integral to the book, with over 500 clinical examples referred to within the text.

Cloning, embryo research and genetic modification are three of the most controversial issues of our time. Is it ethical to use cloning as a means of reproduction? Are embryos people? Is there a difference between removing genetic disease and creating « designer babies? This book will attempt to show that these and other problems are ultimately resolvable, given careful and unbiased application of established ethical principles, many of which underlie common morality. These principles, when applied to the problems of the new genetic technologies, form the basis of a new genetic morality. This book applies established principles of biomedical ethics to the new genetic technologies and examines the ethical implications of reproductive and therapeutic cloning, genetic modification and stem cell research from a deontological and a rule-utilitarian perspective. Finally, it seeks to establish what, if anything, is wrong with each of these practices, and why.

Why has Egypt, a pioneer of organ transplantation, been reluctant to pass a national organ transplant law for more than three decades? This book analyzes the national debate over organ transplantation in Egypt as it has unfolded during a time of major social and political transformation - including mounting dissent against a brutal regime, the privatization of health care, advances in science, the growing gap between rich and poor, and the Islamic revival. Sherine Hamdy recasts bioethics as a necessarily political project as she traces the moral positions of patients in need of new tissues and organs, doctors uncertain about whether transplantation is a "good" medical or religious practice, and Islamic scholars. Her richly narrated study delves into topics including current definitions of brain death, the authority of Islamic fatwas, reports about the mismanagement of toxic waste predisposing the poor to organ failure, the Egyptian black market in organs, and more. Incorporating insights from a range of disciplines, "Our Bodies Belong to God" sheds new light on contemporary Islamic thought, while challenging the presumed divide between religion and science, and between ethics and politics.

This book explores the ethical dilemma clinicians may face when disclosing a diagnosis of atypical sex. The moment of disclosure reveals an epistemic incompatibility between scientific fact and social meaning in relation to sex. Attempting to assess the bio-psychosocial implications of this dilemma highlights a complex historic antagonism between fact and meaning making satisfactory resolution of this dilemma difficult. Drawing on David Hume, WVO Quine and Michel Foucault the author presents an integrative model, which views scientific fact and social meaning as codetermining threads in one fabric of knowledge. From this epistemic perspective, the ethical dilemma is understood as a tear in the fabric signifying a rupturing of ontological integrity. To mend this tear and resolve the ethical dilemma three metaphysical perspectives are considered: essentialism, naturalism and emergentism. The book's unique features include: an exploration of the impact of diagnostic disclosure on people with atypical sex (intersex); a synthesis of the epistemic perspectives of social and natural science facilitating interdisciplinary collaboration; a critical evaluation of three metaphysical perspectives on atypical sex (intersex); the application of Hume's epistemological and moral distinctions to contemporary biomedicine and bioethics. The book's target audience includes academics, students and professionals whose work intersects the natural and social sciences, and individuals interested in the metaphysics, epistemology and meta-ethics of sex.

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.

Each year, tens of thousands of children are conceived with donated gametes (sperm or eggs). By some estimates, there are over one million donor-conceived people in the United States and, of course, many more the world over. Some know they are donor-conceived. Some do not. Some know the identity of their donors. Others never will. Questions about what donor-conceived people should know about their genetic progenitors are hugely significant for literally millions of people, including donor-conceived people, their parents, and donors. But the practice of gamete donation also provides a vivid occasion for thinking about questions that matter to everyone. What is the value of knowing who your genetic progenitors are? How are our identities bound up with knowing where we come from? What obligations do parents have to their children? And what makes someone a parent in the first place? In Conceiving People: Identity, Genetics and Gamete Donation, Daniel Groll argues that people who plan to create a child with donated gametes should choose a donor whose identity will be made available to the resulting child. This is not, Groll argues, because having genetic knowledge is fundamentally important. Rather, it is because donor-conceived people are likely to develop a significant interest in having genetic knowledge and parents must help satisfy their children's significant interests. In other words, because a donor-conceived person is likely to care about having genetic knowledge, their parents should care too.

Offering a format that is significantly different than that offered by other books, Ethical Health Care beings by asking what is meant by health and how it is achieved. The book then proceeds to explore with care and context the nature of the relationship between patients and clinicians, health care providers and the societies in which they inhabit, and finally the relationship between the health care enterprise and the international community. By emphasizing the ethical issues that arise in the broad quest to foster human health, and appreciating that health is not primarily a function of medical interventions, Ethical Health Care introduces students to problems such as the international distribution of pharmaceuticals and the dangers of reemerging infections. To a far greater extent than is done traditionally, Ethical Health Care provides an interdisciplinary perspective to bioethics, relying heavily upon the teachings of economics, law, and public health.

At the turn of the twentieth century, medicine's imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, "The Inevitable Hour" demonstrates that professional attention and resources gradually were diverted from dying patients.

Emily K. Abel challenges three myths about health care and dying in America. First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become dehumanized. Abel shows that hospitals resisted accepting dying patients and often worked hard to move them elsewhere. Poor, terminally ill patients, for example, were shipped from Bellevue Hospital in open boats across the East River to Blackwell's Island, where they died in hovels, mostly without medical care. Some terminal patients were not forced to leave, yet long before the advent of feeding tubes and respirators, dying in a hospital was a profoundly dehumanizing experience.

With technological advances, passage of the Social Security Act, and enactment of Medicare and Medicaid, almshouses slowly disappeared and conditions for dying patients improved--though, as Abel argues, the prejudices and approaches of the past are still with us. The problems that plagued nineteenth-century almshouses can be found in many nursing homes today, where residents often receive substandard treatment. A frank portrayal of the medical care of dying people past and present, "The Inevitable Hour" helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.

Originally published in 1985, this book examines the concept of death against the background of dramatic changes in medical technology. The book argues that 'brain death' can be precisely defined and that a biological concept of death such as 'brain death' can be philosophically well-grounded. It examines traditional criteria for death and various formulations of the concept of death in both medical literature and philosophical texts. Definitions of 'brain death' - some of which have become statute law - are critically examined. The author also examines ethical and social policy questions which arise out of attempts to redefine the boundaries of life.

Originally published in 1990, this study of the moral problems bound up with transplant therapy addresses a finely balanced distinction between ethical issues relating to its experimental nature on the one hand and those which arise when transplantation is routine on the other. Among the issues examined are proposals for routine cadaveric harvesting, criteria for organ and tissue procurement from living donors, foetuses, non-human animals and current ethical problems with artificial implants. Written as a contribution to practical philosophy, this book will interest ethicists and health care professionals.

This book is Open Access under a CC BY license. It is the first monograph-length study of the force-feeding of hunger strikers in English, Irish and Northern Irish prisons. It examines ethical debates that arose throughout the twentieth century when governments authorised the force-feeding of imprisoned suffragettes, Irish republicans and convict prisoners. It also explores the fraught role of prison doctors called upon to perform the procedure. Since the Home Office first authorised force-feeding in 1909, a number of questions have been raised about the procedure. Is force-feeding safe? Can it kill? Are doctors who feed prisoners against their will abandoning the medical ethical norms of their profession? And do state bodies use prison doctors to help tackle political dissidence at times of political crisis?

According to a recent Institute of Medicine report, as many as 98,000 Americans die each year as a result of medical error--a figure higher than deaths from automobile accidents, breast cancer, or AIDS. That astounding number of fatalities does not include the number of those serious mistakes that are grievous and damaging but not fatal. Who can forget the tragic case of 17-year-old Jesica Santillan, who died after receiving a heart-lung transplant with an incompatible blood type? What can be done about this? What should be done? How can patients and their families regain a sense of trust in the hospitals and clinicians that care for them? Where do we even begin the discussion? Accountability: Patient Safety and Policy Reform brings the issue to the table in response to the demand for patient safety and increased accountability regarding medical errors. In an interdisciplinary approach, Virginia Sharpe draws together the insights of patients and families who have suffered harm, institutional leaders galvanized to reform by tragic events in their own hospitals, philosophers, historians, and legal theorists. Many errors can be traced to flaws in complex systems of health care delivery, not flaws in individual performance. How then should we structure responsibility for medical mistakes so that justice for the injured can be achieved alongside the collection of information that can improve systems and prevent future error? Bringing together authoritative voices of family members, health care providers, and scholars--from such disciplines as medical history, economics, health policy, law, philosophy, and theology--this book examines how conventional structures of accountability in law andmedical structure (structures paradoxically at odds with justice and safety) should be replaced by more ethically informed federal, state, and institutional policies. Accountability calls for public policy that creates not only systems capable of openness concerning safety and error-but policy that also delivers just compensation and honest and humane treatment to those patients and families who have suffered from harmful medical error.

This book examines the issue of ethics in the context of the provision of military health care in an epidemic. Outbreaks of epidemics like Ebola trigger difficult ethical challenges for civilian and military health care personnel. This book offers theoretical reflections combined with reports from recent military and NGO missions in the field. The authors of this volume focus on military medical ethics adding a distinct voice to the topic of epidemics and infectious diseases. While military health care personnel are always crucially involved during disaster relief operations and large-scale public health emergencies, most of the current literature treats ethical issues during epidemics from a more general perspective without taking into account the specifics of the military context. The contributions in this volume provide first-hand insights into some of the ethical issues encountered by military health care personnel in missions during the Ebola outbreak in 2014/2015. This practical perspective is complimented by academic analyses and theoretical reflections on ethical issues associated with epidemics. This book will be of much interest to students of military studies, ethics and African politics.

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."

Since the therapeutic value of umbilical cord blood (UCB) stem cells was first recognised in the late 1980s, there has been a proliferation of both public and private UCB banks worldwide. However, the ability to utilise such a potentially valuable resource has provoked a number of controversies. In a distinctly accessible style, this book unpacks the socio-legal implications of the UCB collection process and constructs a detailed analysis of the law and ethics that surrounds UCB banking in the UK, including ownership of the cells. Its enquiry is located within the theoretical framework of altruism versus self-interest and explores the notions of risk and choice associated with this distinctive blend of public/private healthcare provision. The book evaluates the impact of the Human Tissue Act 2004 and the European Union Tissues and Cells Directive (2004/23/EC) on the UCB industry and provides a unique insight into the effect that the law may have on the NHS whose maternity staff and premises are used to collect UCB. This book would be of interest primarily to a UK readership in addition to expectant families, health professionals, students, academics, practitioners and the UCB industry elsewhere in the world.

This book explores patient safety themes in developed, developing and transitioning countries. A foundation premise is the concept of 'reverse innovation' as mutual learning from the chapters challenges traditional assumptions about the construction and location of knowledge. This edited collection can be seen to facilitate global learning. This book will, hopefully, form a bridge for those countries seeking to enhance their patient safety policies. Contributors to this book challenge many supposed generalisations about human societies, including consideration of how medical care is mediated within those societies and how patient safety is assured or compromised. By introducing major theories from the developing world in the book, readers are encouraged to reflect on their impact on the patient safety and the health quality debate. The development of practical patient safety policies for wider use is also encouraged. The volume presents a ground-breaking perspective by exploring fundamental issues relating to patient safety through different academic disciplines. It develops the possibility of a new patient safety and health quality synthesis and discourse relevant to all concerned with patient safety and health quality in a global context.

This text focuses on areas of public health practice in which the systematic application of epidemiologic methods can have a large and positive impact. It describes how best to apply traditional epidemiologic methods for determining disease etiology to "real-life" problems in public health and health services research. Brownson and Petitti's much-needed book bridges the gap between theoretical epidemiology and public health practice, and covers a number of topics not addressed by other epidemiology texts with a focus on methods. This second edition contains a new chapter on the development and use of systematic reviews and one on epidemiology and the law. Each chapter includes one or more case studies intended to illustrate major points from the chapter and to provide a basis for teaching exercises. All of the chapters are authored by leading experts in the fields of epidemiology and public health, and all are fully revised and updated.
The book is intended for practitioners in epidemiology as well as for students in epidemiology and related disciplines that rely on epidemiologic methods and reasoning. It is a practical and informative book for use in academic institutions, federal agencies which have significant educational missions, state and local public health agencies, and health care organizations. By providing a resource of immense accessibility to several key audiences, this edition of Applied Epidemiology: Theory to Practice further extends the fields ability to make a real difference on behalf of better health for all.

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.

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

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

Topics covered include:

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

• The concept of informed consent

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

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

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

• The ethical responsibility to the patient

This 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.

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.

"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.

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.