If a pregnant woman refuses medical treatment needed by the fetus - for instance for religious reasons - or conducts some aspect of her life in a way which risks fetal harm, there may arise an instance of "maternal-fetal conflict". This is an unfortunate term, since pregant women are generally renowned for their self-sacrificing behaviour, but it may well reflect the reality of certain maternal choices and actions. Should a pregnant woman have the legal right to refuse medical treatment needed by the fetus, or should she owe it a legal duty of care which precludes her acting in ways which may harm it? Does the debate hinge simply upon the appropriateness, or otherwise, of legally compelling presumed moral obligations, or is it more complex than this? Indeed, what are a pregnant woman't moral obligations towards her fetus? In England and in some US states, courts have held that a pregnant woman has the right to refuse medical treatment needed by the fetus. In similar fashion, the idea of a general maternal legal duty of care toward the fetus has been rejected, most recently in Canada. The cases, however, leave the impression of an uncomfortable split between the ethics and the law, as if the problem were entirely one of not legally enforcing presumed moral duties. The effect is both puzzling and polarising: puzzling in that the cases leave unanswered - as largely they must - the huge question of a pregnant woman's moral rights and duties; polarising in that the cases leave troubling tensions about a pregnant woman's rights in the face of fetal harm or death. The tendency is to deny these by ever more strongly asserting a woman's rights. In turn this encourages a reaction in favour of fetal rights, one which is unlikely to attend to a woman's interests and difficulties in pregnancy. This could have serious legal repercussions for various instances of maternal-fetal conflict, including in those US states or other jurisdictions which have yet to address these issues. It might also increase the pressures on the issue of abortion. This book, which seeks a way between these polarised positions, tries to explain and justify a woman's moral and legal rights in pregnancy and, at the same time, to explore the extent of her moral duties toward the fetus. The aim is to resolve, as far as possible, the ethical, legal and social tensions which undoubtedly surround this area. Innovatively in work on this issue (and unusually in the field of medical law and ethics) the author adopts a joint philosophical and legal approach directed to issues both of principle and policy, revealing strong conceptual links between the ethics and the law. In addition to an ethical exploration of the maternal-fetal relationship, the author explores and analyses the relevant English, American, Canadian (and sometimes Australian) arguments from the law of treatment refusal, abortion, tort and rescue, as well as relevant jurisprudence from the European Court of Human Rights. This important book breaks new ground and will be of great interest to academics in law and philosophy, lawyers, health professionals, policy-makers and students of medical law and ethics. "It is rare to find a book which so skilfully combines legal and moral analysis of a controversial medical issue. Rosamund Scott has produced what is undoubtedly one of the finest pieces of medico-legal writing of recent years. This is a clever, human and immensely readable work." Alexander McCall Smith, Professor of Medical Law, University of Edinburgh "This book concerns one of the most personally agonizing and morally complex issues in medical ethics. It is a work of great philosophical sophistication, combining breadth of vision with acute sensitivity to the nuances of women's experiences. It will soon become the standard work in philosophical, legal and political debate on maternal-fetal conflicts." Roger Crisp, Uehiro Fellow and Tutor in Philosophy, St Anne's College, Oxford

Fire, flood, earthquake, famine, pestilence, and warfare are no strangers to our experience. Once, we sought to placate the gods who brought these evils upon us. Today, clinicians, engineers, and politicians replace priests, prophets, seers, and shamans, and we Americans in particular think to impose our will upon the world. In times of catastrophe, issues of good and evil surrender to rapid, nearly automatic, operational response. Yet the catastrophic event poses unavoidable moral choices, ones that are more politically and emotionally complex since 9/11 and our "War on Terrorism." This book benefits from the emergence of bioethics as it has evolved from its clinical roots to address policy, politics, and social practice far removed from that origin. At the same time, the clinical focus on narratives and cases provides a tangible center for ethical reflection. It reminds us that ethics is about persons and their choices, a perspective often lost to abstraction when ethics is left to the ministrations of academe. By treating the catastrophic event as both a category and a genre, Bioethics connects to aesthetics and so enables us to enrich ethical inquiry by ranging from pandemic, hurricane, and flood to terrorist attack."

The growth of evidence-based medicine has occurred against a backdrop of health care reform, managed care, cost containment, and quality improvement. Clinicians have been urged to adopt the rigors of science while remaining true to their 'clinical judgment'. This incisive book reviews the history and conceptual origins of evidence-based practice and discusses key ethical issues that arise in clinical practice, public health, and health policy. It is essential reading for all physicians, and practitioners in epidemiology and public health.

Medical ethics is a vitally important subject, and currently a highly controversial one. Recent cases have highlighted both the intellectual and moral challenges posed by the dilemmas of modern medicine, and their significance for us all. John Harris gives a fully up-to-date survey of the issues in this crucial field of applied ethics, including in vitro fertilization and experimentation on human embryos.
Professor Harris explores the principal ethical dilemmas that arise in medical practice and research, and by challenging our basic assumptions and familiar ideas, shows how the most diffficult problems may be approached and resolved. He presents a clear discussion of the major issues, and argues for a radical re-appraisal of our way of thinking about these problems and of the traditional solutions to them.
The book is intended both to introdduce the general reader to the problems of medical ethics, and as a text for the study and discussion of medical ethics in medical schools and in the training of health professionals. It will also be of value as a text for applied and practical ethics courses in philosophy departments and departments of social policy and administration, politics, sociology and liberal studies.

eBook available with sample pages: 0203005600

This book encompasses the theoretical and practical aspects of surgical ethics, with a focus on the application of ethical standards to everyday surgical practice and the resolution of ethical conflicts in the surgical arena. It provides surgeons (both prospective and practicing) in the different surgical fields with deep, practical insights into the topic. A 21st century surgeon requires complete competence (superb clinical skills, expert surgical decision-making and outstanding performance and technical skills) as well as solid ethical values. Ethics are placed at the core of surgical professionalism, so surgeons must be not only proficient and expert but also ethically and morally reliable. Surgical decision-making can be considered as a two-step process: the "how to treat" aspect is a matter of surgical science, while "why to treat" issues are a matter of surgical ethics and are based on ethical principles. As such, every surgeon should have a moral compass to guide his or her actions, always placing the welfare and rights of the patients above their own. The book provides invaluable background and insights for solving the ethical conflicts surgeons around the globe encounter in their daily practice. Each chapter will also include features such as key point summaries in the beginning of the chapters, explanatory boxes, a glossary and suggested readings. Surgical Ethics - Principles and Practice is an authoritative work in the field designed for experienced surgeons, surgical residents, and fellows, all of whom are confronted with ethics issues and conflicts in practice.

Fast-moving and ever-changing, stem cell science and research presents ongoing ethical and legal challenges in many countries. Each development and innovation throws up new challenges. This is the case even where new developments initially seem to solve old dilemmas. Sometimes it becomes evident that new science does not in fact solve old problems and, for that reason, the ethical issues remain. In recognition of this, this book presents innovative and creative analyses of a range of ethical and legal challenges raised by stem cell research and its potential and actual application. The editors of this collection have brought together experts from ethics and law to bring fresh perspectives on the use of and research on stem cells. The chapters in this collection range across a number of different issues in the debate on stem cells, from the ethical dilemmas of conducting stem cell research to those of the clinical application of stem cell technology. Each chapter gives an in-depth and comprehensive analysis of the ethical or legal issues at stake. The early chapters give engaging new expositions on the permissibility of using embryos in stem cell research, in particular challenging our views about how we view and construct' the embryo in debates regarding stem cells. Later chapters move on to actual and potential clinical uses of stem cells and present novel arguments about these.

'This book gives plenty of examples of ad hominem attacks, intimidation, slander, threats of litigation, deception, dishonesty, lies and other violations of good scientific practice. For some years I kept a folder labeled Dishonesty in breast cancer screening on top of my filing cabinet, storing articles and letters to the editor that contained statements I knew were dishonest. Eventually I gave up on the idea of writing a paper about this collection, as the number of examples quickly exceeded what could be contained in a single article.' From the Introduction The most effective way to decrease women's risk of becoming a breast cancer patient is to avoid attending screening. Mammography screening is one of the greatest controversies in healthcare, and the extent to which some scientists have sacrificed sound scientific principles in order to arrive at politically acceptable results in their research is extraordinary. In contrast, neutral observers increasingly find that the benefit has been much oversold and that the harms are much greater than previously believed. This groundbreaking book takes an evidence-based, critical look at the scientific disputes and the information provided to women by governments and cancer charities. It also explains why mammography screening is unlikely to be effective today. All health professionals and members of the public will find these revelations disturbingly illuminating. It will radically transform the way healthcare policy makers view mammography screening in the future. 'If Peter Gotzsche did not exist, there would be a need to invent him ...It may still take time for the limitations and harms of screening to be properly acknowledged and for women to be enabled to make adequately informed decisions. When this happens, it will be almost entirely due to the intellectual rigour and determination of Peter Gotzsche.' From the Foreword by Iona Heath, President, RCGP 'If you care about breast cancer, and we all should, you must read this book. Breast cancer is complex and we cannot afford to rely on the popular media, or on information from marketing campaigns from those who are invested in screening. We need to question and to understand. The story that Peter tells matters very much.' From the Foreword by Fran Visco, President, National Breast Cancer Coalition

With much of the world's population facing restricted access to adequate medical care, how to allocate scarce health-care resources is a pressing question for governments, hospitals, and individuals. How do we decide where funding for health-care programs should go? Tannsjo here approaches the subject from a philosophical perspective, balancing theoretical treatments of distributive ethics with real-world examples of how health-care is administered around the world today. Tannsjo begins by laying out several popular ethical theories-utilitarianism, which recommends maximizing the best overall outcome; egalitarianism, which recommends smoothing out the differences between people as much as possible; and the maximin/leximin theory, which urges people to give absolute priority to those who are worst off. Tannsjo shows how, in abstract thought experiments, these theories come into conflict with each other and reveal puzzling implications. He goes on to argue, however, that when we consider health-care in the real-world, these theories all agree on a central point: in a well-ordered welfare state, more resources should be directed to the care and cure of people suffering from mental illness, and less to the marginal life extension of elderly patients. Tannsjo's book thus recommends a shift in spending to increase fairness and overall utility-while also recognizing that this kind of dispassionate suggestion, with its purely economic foundation, is unlikely to take hold in policy. Tannsjo's analysis is a case study in how ethical theories can sometimes lead to rational conclusions and recommendations that we are not prepared to accept.

A Practical Guide to Clinical Ethics Consulting reasserts the philosophical method as foundational to ethics consulting. It does so in response to extensive attacks from social scientists, lawyers, theologians, and especially practitioners, all of whom disparage philosophy's reliance on abstract theory and conceptual analysis. Using clinical ethics consulting as an exemplar, Christopher Meyers argues that while many of the attacks are well founded, they are only partly so and not in the most important respects. Ethics consulting that relies too heavily on abstract analysis is of little use to practitioners; consultants must have adequate grounding in, and appreciation of, the concrete reality of working professionals. They must also be experienced enough to have the practical wisdom necessary to assist with real-world problems. Skills of philosophical analysis, when combined with instruction in empirical investigation, political awareness and appropriate character traits, are vital to ethics consulting. Ethicists need the theoretical and conceptual analysis skills that are a standard part of a philosophical education and mindset. The book provides both a defense of this central thesis and a detailed description of the empirical tools and of the critical independence necessary to effective consulting.

The ethic of care has developed to become a body of theory that has expanded from its roots in social psychology to many other disciplines in the social sciences as well as the humanities. This work on care has informed both theory and practice by generating complex accounts of care ethics for multiple and intersecting kinds of relationships, and for a variety of domains and contexts. Its application now extends from the moral to the political realm, from personal to public relationships, from the local to the global, from feminine to feminist virtues and values, and from issues of gender to issues of power and oppression. The developments in the theories and applications of care ethics over the past few decades make this book an appropriate and timely publication. It includes chapters by authors who are developing or expanding theories of care ethics and also by those who work on applying and extending insights from care ethics to practices and policies in personal and institutional settings. Care Ethics provides readers from different disciplines and professional groups with a substantial number of new theories and applications from both new and established authors. This book was originally published as two special issues of Ethics and Social Welfare.

What if a lifesaving medical device causes loss of life along its supply chain? That's the question Katherine E. Standefer finds herself asking one night after being suddenly shocked by her implanted cardiac defibrillator. In this gripping, intimate memoir about health, illness, and the invisible reverberating effects of our medical system, Standefer recounts the astonishing true story of the rare diagnosis that upended her rugged life in the mountains of Wyoming and sent her tumbling into a fraught maze of cardiology units, dramatic surgeries, and slow, painful recoveries. As her life increasingly comes to revolve around the internal defibrillator freshly wired into her heart, she becomes consumed with questions about the supply chain that allows such an ostensibly miraculous device to exist. So she sets out to trace its materials back to their roots. From the sterile labs of a medical device manufacturer in southern California to the tantalum and tin mines seized by armed groups in the Democratic Republic of the Congo to a nickel and cobalt mine carved out of endemic Madagascar jungle, Lightning Flowers takes us on a global reckoning with the social and environmental costs of a technology that promises to be lifesaving but is, in fact, much more complicated. Deeply personal and sharply reported, Lightning Flowers takes a hard look at technological mythos, healthcare, and our cultural relationship to medical technology, raising important questions about our obligations to one another, and the cost of saving one life.

Medical care and biomedical research are rapidly becoming global. Ethical questions that once arose only in the narrow context of the physician-patient relationship in relatively prosperous societies are now being raised across societies, cultures, and continents. For example, what should be the "standard of care" for clinical trials of medical innovations in poorer countries? Are researchers obligated to compare new therapies or drugs with the best known ones available, or can they use as a benchmark the actual treatments (or lack of treatments) available to poor people? Should pharmaceutical companies seeking to lower the costs of new drug trials be allowed to enroll citizens of less developed countries in them even when those individuals cannot afford and will not be eligible for the resulting drugs? More generally, should the norms of medicine and research be the same across cultures or can they adapt to local social, economic, or religious conditions? Global Bioethics gathers some of the world's leading bioethicists to explore many of the new questions raised by the globalization of medical care and biomedical research. Among the topics covered are the impact of globalization on the norms of medical ethics, the conduct of international research, the ethics of international collaborations, challenges to medical professionalism in the international setting, and the relation of religion to global bioethics.

In this important collection of essays Dennis Thompson argues for a more robust conception of responsibility in public life than prevails in contemporary democracies. He suggests that we should stop thinking so much about public ethics in terms of individual vices (such as selfishness or sexual misconduct) and start thinking about it more in terms of institutional vices (such as abuse of power and lack of accountability). Combining theory and practice with many concrete examples and proposals for reform, these essays could be used in courses in applied ethics or political theory and will be read by professionals and graduate students in schools of political science, public policy, law, public health, journalism and business.

The majority of patients in need of organ transplants do not survive long enough for a suitable human organ to become available. Xenotransplantation, the transplant of animal organs into humans, has attracted substantial media attention. If, as appears likely, it proves possible to "humanize" animal organs and evade the problems of rejection, in the coming few years there will be a tremendous increase in this procedure, mostly using organs from animals specifically for their harvestable organs. This book will lay out the potential and promise of the technique, the history of organ transplantation, the technical problems and breakthroughs in overcoming immune rejection, and typing and humanizing donor organs for transplantation. The ethical question of growing animals specifically for organ harvest, and the substantial public health concern from the certainty that animal viruses will pass into humans with the donated organs, will be fully discussed. The authors are among the leaders in the field of Xenotransplantation.

This study deals with an underexplored area of the emerging technologies debate: robotics in the healthcare setting. The author explores the role of care and develops a value-sensitive ethical framework for the eventual employment of care robots. Highlighting the range of positive and negative aspects associated with the initiative to design and use care robots, it draws out essential content as a guide to future design both reinforcing this study's contemporary relevance, and giving weight to its prescriptions. The book speaks to, and is meant to be read by, a range of disciplines from science and engineering to philosophers and ethicists.

Contemporary debates over issues as wide-ranging as the protection of wildernesses and endangered species, the spread of genetically modified organisms, the emergence of synthetic biology, and the advance of human enhancement, all of which seem to spin into deeper and more baffling questions with every change in the news cycle, often circle back to the same fundamental question: should there be limits to the human alteration of the natural world? A growing number of people view the human capacity to alter natural states of affairs - from formerly wild spaces and things around us to crops and livestock to our own human nature - as cause for moral alarm. That reaction raises a number of perplexing philosophical questions, however: Can we identify "natural" states of affairs at all? Does the idea of being morally concerned about the human relationship to nature make any sense? Should such a concern influence public policy and politics, or should government stay strenuously neutral on such matters? Through a study of moral debates about the environment, agricultural biotechnology, synthetic biology, and human enhancement, Gregory E. Kaebnick, a research scholar at The Hastings Center and editor of the Hastings Center Report, argues that concerns about the human alteration of nature can be legitimate and serious, but also that they are complex, contestable, and of limited political force. Kaebnick defends attempts to identify "natural" states of affairs by disentangling the nature/artifact distinction from metaphysical hoariness. Drawing on David Hume, he also defends moral standards for the human relationship to nature, arguing that they, and moral standards generally, should be understood as grounded in what Hume called the "passions." Yet what counts as "natural" can be delineated only roughly, he concludes, and moral standards for interaction with nature are less a matter of obligation than of ideals. Kaebnick also concludes, drawing on an interpretation of the liberal principle of neutrality, that government may support those standards but must be careful not to enforce them. Thus Kaebnick looks for a middle way on debates that have tended toward polarization. "As differences between nature and artifact become steadily less substantial, problems about preservation run to the core of how people can make sense of themselves, of each other, and of our shared world. Kaebnick's solutions are creative and compelling, theoretically elegant and politically practical. Providing distinctive ways forward, when much academic and policy discussion seems exhausted, his book demands wide attention. In return, it inspires hope." - James Nelson, Michigan State University

All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms.

This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested.

A Practical Guide to Clinical Ethics Consulting reasserts the philosophical method as foundational to ethics consulting. It does so in response to extensive attacks from social scientists, lawyers, theologians, and especially practitioners, all of whom disparage philosophy's reliance on abstract theory and conceptual analysis. Using clinical ethics consulting as an exemplar, Christopher Meyers argues that while many of the attacks are well founded, they are only partly so and not in the most important respects. Ethics consulting that relies too heavily on abstract analysis is of little use to practitioners; consultants must have adequate grounding in, and appreciation of, the concrete reality of working professionals. They must also be experienced enough to have the practical wisdom necessary to assist with real-world problems. Skills of philosophical analysis, when combined with instruction in empirical investigation, political awareness and appropriate character traits, are vital to ethics consulting. Ethicists need the theoretical and conceptual analysis skills that are a standard part of a philosophical education and mindset. The book provides both a defense of this central thesis and a detailed description of the empirical tools and of the critical independence necessary to effective consulting."

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

Each year, roughly a million new cases of cancer appear in the US, and more than 500,000 Americans die annually of premature death. Although medical progress has slowed cancer mortality, its incidence is increasing roughly six times faster than cancer mortality is decreasing. Breast cancer, in particular, has been increasing about one percent each year since 1973. At least two of the factors responsible for this surge in breast cancer are women's use of medically-prescribed synthetic hormones and the exposure of the entire population to chemicals such as dioxin. Both exposures increase the likelihood of breast cancer. Although many ethicists worry about involuntary societal imposition of chemicals such as dioxin, through industrial and agricultural processes, allegedly voluntary exposures also constitute both, a public-health problem and a biomedical-ethics difficulty. Physicians recommend synthetic hormones, for example, to women who apparently take them voluntarily. In the case of in vitro fertilization, doctors prescribe hormones to induce egg production and to increase the chances of reproduction for couples who are unable to have children. Despite the benefits of medical technologies such as hormone stimulation and in vitro fertilization, they also carry great risks. The price that childless women pay, for their opportunity to have children through in vitro fertilization, may be their own increased risk of diseases - such as breast cancer - that are hormone dependent.

The distinguished contributors to Confidentiality probe the ethical, legal, and clinical implications of a deceptively simple proposition: Psychoanalytic treatment requires a confidential relationship between analyst and analysand. But how, they ask, should we understand confidentiality in a psychoanalytically meaningful way? Is confidentiality a therapeutic requisite of psychoanalysis, an ethical precept independent of psychoanalytic principles, or simply a legal accommodation with the powers that be? In wrestling with these questions, the contributors to Confidentiality are responding to a professional, ethical, and political crisis in the field of mental health. Psychotherapy - especially long-term psychotherapy in its psychoanalytic variants - has been undermined by an erosion of personal privacy that has become part of our cultural zeitgeist. The heightened demand for public transparency has forced caregivers from all walks of professional life to submit to increasing bureaucratic regulation. For the contributors to this collection, the need for confidentiality is centrally involved in the relationship of the psychotherapeutic professions both to society and to the law. No less importantly, the requirement of confidentiality brings a clarifying perspective to debates within the psychotherapeutic literature about the relationship of theory to practice. It thereby provides a framework for shaping a set of ethical principles specifically adapted to the psychotherapeutic, and especially to the psychoanalytic, relationship. Linking general issues of privacy to the intimate details of psychotherapeutic encounter, Confidentiality will serve as a basic guide to a wide range of professionals, including lawyers, social scientists, philosophers, and, of course, psychotherapists. Therapy patients, policy makers, and the wider public will also find it instructive to know more about the special protected conditions under which one can better come to "know thyself."

With advances in personalised medicine, the field of medical law is being challenged and transformed. The nature of the doctor-patient relationship is shifting as patients simultaneously become consumers. The regulation of emerging technologies is being thrown into question, and we face new challenges in the context of global pandemics. This volume identifies significant questions and issues underlying the philosophy of medical law. It brings together leading philosophers, legal theorists, and medical specialists to discuss these questions in two parts. The first part deals with key foundational theories, and the second addresses a variety of topical issues, including euthanasia, abortion, and medical privacy. The wide range of perspectives and topics on offer provide a vital introduction to the philosophical underpinnings of medical law.

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 Limits of Medical Paternalism defines and morally assesses paternalistic interventions, especially in the context of modern medicine and health care, particular emphasis is given to the analysis of the conceptual background of the paternalism issue. In this book an anti-paternalistic view is presented and defended.

Commodified Bodies examines the social practice of organ transplantation and trafficking and scrutinises the increasingly neoliberal tendencies in the medical system. It analyses phenomena such as the denomination of human body parts as "raw materials" and "commodities," or the arguments used by the proponents for a free market solution. Moreover, it argues that modern medicine is still linked with its religious roots. The commodification of body parts is seen not as an imperialistic act of the market, but as the end of a historical process as the notion of "fetishism" links the market with the body. Marx s concept of commodity fetishism and Sigmund Freud s theory of the perverted use of objects are modified and adapted to the reconstruction of the joint beginnings of market and medicine."