This book sheds light on important philosophical assumptions made by professionals working in clinical and research medicine. In doing so, it aims to make explicit how active philosophy is in medicine and shows how this awareness can result in better and more informed medical research and practice. It examines: what features make something a scientific discipline; the inherent tensions between understanding medicine as a research science and as a healing practice; how the "replication crisis" in medical research asks us to rethink the structure of knowledge production in our modern world; whether explanations have any real scientific values; the uncertainties about probabilistic claims; and whether it is possible for evidence-based medicine to truly be value free. The final chapter argues that the most important question we can ask is not, "How can we separate values from science?" but, "In a democratic society, how can we decide in a politically and morally acceptable way what values should drive science?" Key features: introduces complex philosophical issues in a manner accessible to non-professional academics; critically examines philosophical assumptions made in medicine, providing a better understanding of medicine that can lead to better healthcare; integrates medical examples and historic contexts so as to frame the rationale of philosophical views and provide lively illustrations of how philosophy can impact science and our lives; uses inter-connected chapters to demonstrate that disparate philosophical concepts are deeply related (e.g., it shows how the aims of medicine inform how we should understand theoretical reasoning).

In 1841 the American sailing ship William Brown struck an iceberg. About half of the passengers and all of the crew were saved in two small, open boats. The next night, half of the passengers in the larger long-boat were thrown overboard because the boat was overfull. This was the first case of "lifeboat ethics," of hard choices in the face of scarcity. Since then the question has been "who should die so that others, equally needy, might live?" Both the case of the William Brown and the ethics it spawned have been used in recent years to describe the problem of health care rationing generally, and organ transplantation specifically. Koch reexamines and reinterpretes the paradigm case of lifeboat ethics, the story of the William Brown, not as an unavoidable tragedy, but as an avoidable series of errors. Its relation to more general issues of distributive justice are then considered. The lessons learned from both the historical review and its application to distributive principles are then applied to the problem of graft organ distribution in the United States. Through the use of maps, the problem of organ distribution is considered at a range of scales, from the international to the urban. The contextual issues become more evident as one moves from international to hemispheric, fron national to regional, and then local systems. Finally, Koch reviews the lessons in light of other problems of distribution in the face of scarcity. The central lesson-that scarcity is exacerbated where it is not in fact created by our distributive programs-is explored thoroughly. The result is "no good choices" for anyone and the continuation of the scarcity that for most seems inevitable, but, from theevidence provided, is itself an outcome of inequalities of distribution at different scales of society. Of particular interest to students, scholars, and policymakers involved with issues of planning and health care economics, medical geography, and concepts of justice.

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.

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."

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.

The use of human subjects in biomedical research has increased rapidly with scientific discoveries. However, the failure to achieve the highest--or even adequate--standards of professional moral concern and behavior is a serious side effect. Research on Human Subjects is based on four years of intensive research in which two studies were completed--one on a nationally representative sample of biomedical research institutions, the second on a sample of 350 researchers who actually used human subjects. The authors explore prevalent ethical norms, the actual ethical behavior of scientists, and the dilemma between the values of humane therapy and scientific discovery. They document the inadequate training that biomedical researchers receive in the ethics of research on human subjects, not only in medical schools but in post-graduate training as well. This landmark work makes very specific suggestions for policy change and reform for the biomedical research profession and its employment of human subjects.

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

Strive for health equity and surmount institutional oppression when treating marginalized populations with this distinct resource!This unique text provides a framework for delivering culturally safe clinical care to LGBTQIA populations filtered through the lens of racial, economic, and reproductive justice. It focuses strongly on the social context in which we live, one where multiple historical processes of oppression continue to manifest as injustices in the health care setting and beyond. Encompassing the shared experiences of a diverse group of expert health care practitioners, this book offers abundant examples, case studies, recommendations, and the most up-to-date guidelines available for treating LGBTQIA patient populations. Rich in clinical scenarios that describe best practices for safely treating patients, this text features varied healthcare frameworks encompassing patient-centered and community-centered care that considers the intersecting and ongoing processes of oppression that impact LGBTQIA people every day--particularly people of color. This text helps health providers incorporate safe and culturally appropriate language into their care, understand the roots and impact of stigma, address issues of health disparities, and recognize and avoid racial or LGBTQIA microaggressions. Specific approaches to care include chapters on sexual health care, perinatal care, and information about pregnancy and postpartum care for transgender and gender-expansive people. Key Features: Emphasizes patient-centered care incorporating an understanding of patient histories, safety needs, and power imbalances Provides tools for clinician self-reflection to understand and alleviate implicit bias Fosters culturally safe language and communication skills Presents abundant patient scenarios including specific dos and don'ts in patient treatment Includes concrete objectives, conclusions, terminology, and references in each chapter and discussion questions to promote critical thought Offers charts and information boxes to illuminate key information

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.

Common morality has been the touchstone of medical ethics since the publication of Beauchamp and Childress's Principles of Biomedical Ethics in 1979. Rosamond Rhodes challenges this dominant view by presenting an original and novel account of the ethics of medicine, one deeply rooted in the actual experience of medical professionals. She argues that common morality accounts of medical ethics are unsuitable for the profession, and inadequate for responding to the particular issues that arise in medical practice. Instead, Rhodes argues that medicine's distinctive ethics should be explained in terms of the trust that society allows to the profession. Trust is the core and starting point of Rhodes' moral framework, which states that the most basic duty of doctors is to "seek trust and be trustworthy." Building from this foundation, Rhodes explicates the sixteen specific duties that doctors take on when they join the profession, and demonstrates how her view of these duties is largely consistent with the codes of medical ethics of medical societies around the world. She then explains why it is critical for physicians to develop the attitudes or "doctorly" virtues that comprise the character of trustworthy doctors and buttress physicians' efforts to fulfil their professional obligations. Her book's presentation of physicians' duties and the elements that comprise a doctorly character, together add up to a cohesive and comprehensive description of what medical professionalism really entails. Rhodes's analysis provides a clear understanding of medical professionalism as well as a guide for doctors navigating the ethically challenging situations that arise in clinical practice

Many intellectuals today embrace a postmodern view of the social construction of ethical values, which reduces to a form of ethical relativism. It is currently fashionable to avoid rights language, reject the central place of individual autonomy, and focus instead on the importance of community, while many people at the interface of ethics, medicine, and the social sciences in the developing world champion autonomy and individual rights in response to past or present authoritarian governments and paternalistic practices of physicians. Macklin advances this debate by examining the evidence and arguments on either side, and by presenting her view that ethical universals do exist but that they are compatible with a variety of culturally relative interpretations.

A bioethic of obligations and responsibilities, based on the Jewish tradition The Jewish tradition has important perspectives, history, and wisdom that can contribute significantly to crucial contemporary healthcare deliberations. Care and Covenant: A Jewish Bioethic of Responsibility demonstrates how numerous classic Jewish texts can add new ideas to the world of medicine today. Rabbi Jason Weiner draws on fifteen years of experience working in a hospital as a practitioner to develop an “ethic of responsibility.” This book seeks to develop an approach to bioethical dilemmas that is primarily informed by personal and communal obligations as well as social responsibilities. Weiner applies unique and inspiring values found in Judaism to encourage healthcare providers to remain dedicated to preventing harm and providing care to all. Each chapter investigates relevant philosophical questions such as what the expectations of a society or government are and what we should do when our obligations to others violate our own moral principles, safety, or ability to assist. Care and Covenant provides analytical, philosophical, and evidence-based scholarship to guide discussions on ethics in healthcare.

Now includes a brand new introductory chapter, explaining how medical law has developed, highlighting key ethical issues and locating the law within its wider political and sociological contexts. Unique pedagogic approach sets this book apart by helping the student to engage with complex and detailed legal concepts and the modern, attractive layout enhances the visual appeal of the text Numerous citations, quotations and extracts mean that students will be exposed to primary sources of legal language and cases and judgments are highlighted making them easy to find for cross-reference and revision Concepts and terms are explained clearly allowing for maximum accessibility and understanding, making this an ideal textbook for both law and non-law students Supporting website at www.unlockingthelaw.co.uk provides interactive mcqs, podcasts of key recent developments in medical law as well as updates to the cases and legislation discussed within the text

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

In When Medicine Went Mad, one of the nation's leading bioethicists-and an extraordinary panel of experts and concentration camp survivors-examine problems first raised by Nazi medical experimentation that remain difficult and relevant even today. The importance of these issues to contemporary bioethical disputes-particularly in the thorny areas of medical genetics, human experimentation, and euthanasia-are explored in detail and with sensitivity.

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."

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.

The successful achievement of pregnancies following pre-implantation genetic diagnosis (PGD) was first reported in April 1990. The technology is often used for patients who are at substantial risk of conceiving a pregnancy affected by a known genetic disorder, however from this technology other more controversial uses have arisen such as HLA typing to save the life of a sibling, gender selection for social reasons, the prevention of late onset diseases, or the prevention of diseases which may be genetically predisposed to developing such as breast cancer. The technology surrounding PGD is constantly developing, giving rise to new and unexpected consequences that create fresh ethical and legal dilemmas. Featuring internationally recognized experts in the field, this book critically explores the regulation of PGD and the broader legal and ethical issues associated with it. It looks at the regulatory situation in a number of jurisdictions including New Zealand, Australia and the United Kingdom, but it also explores a number of themes of wide significance including a historical consideration of PGD and its part in the creation of the "genetic embryo" as a political tool, the over regulation of PGD and the ethical difficulties in handling additional unexpected medical information yielded by new technologies. This book will be of particular interest to academics and students of law, medicine and ethics.

In Valuing Health Daniel M. Hausman provides a philosophically sophisticated overview of generic health measurement that suggests improvements in standard methods and proposes a radical alternative. He shows how to avoid relying on surveys and instead evaluate health states directly. Hausman goes on to tackle the deep problems of evaluation, offering an account of fundamental evaluation that does not presuppose the assignment of values to the properties and consequences of alternatives. After discussing the purposes of generic health measurement, Hausman defends a naturalistic concept of health and its relations to measures such as quality-adjusted life-years (QALYs) and disability-adjusted life years (DALYs). In examining current health-measurement systems, Valuing Health clarifies their value commitments and the objections to relying on preference surveys to assign values to health states. Relying on an interpretation of liberal political philosophy, Hausman argues that the public value of health states should be understood in terms of the activity limits and suffering that health states impose. Hausman also addresses the moral conundrums that arise when policy-makers attempt to employ the values of health states to estimate the health benefits of alternative policies and to adopt the most cost-effective. He concludes with a general discussion of the difficulties of combining consequentialist and non-consequentialist moral considerations in policy-making.

Patients who are confident of physicians' intellectual and technical abilities are sometimes not convinced of their professional behavior. Systemic and anecdotal cases of physician misconduct, conflict of interest, and self-interest abound. Many have even come to mistrust physicians as patient advocates. How can patients trust the intellectual and technical aspects of medical care, but not the professional? In order to enhance and promote professionalism in medicine, one should expect it, encourage it, and evaluate it. By measuring their own professional behavior, physicians can provide the kind of transparency with which they can regain the trust of patients and society.
Not only patients, but also institutions which accredit organizations have demanded accountability of physicians in their professional behavior. While there has been much lament and a few strong proposals for improving professionalism, no single reliable and valid measure of the success of these proposals exists. This book is a theory-to-practice text focused on ways to evaluate professional behavior written by leaders in the field of medical education and assessment.

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

Doctors in training are exposed to pressures and distractions to which they do not always respond appropriately, and individuals and institutions can struggle to deal effectively with difficulties when they arise. This book exposes the myths surrounding medical professionalism and strips it of pretensions or exclusivity, making a complex subject accessible and easy to comprehend. It promotes best practice for dealing with unprofessional behaviours amongst doctors-in-training. Divided into two main sections, this workbook first explores topics such as what constitutes professionalism, how it might best be taught and assessed, the interactions between professionalism, ethics and legal frameworks, international trends in medical education in relation to professionalism and implications for public policy. The second section presents 29 international case studies based on real life, explores issues and makes practical recommendations. Medical educators and students will appreciate the common format with key discussion points for each case and international health and social care professionals will welcome inspiration from the candid, sincere exploration of the topic.

The field of ethics is expanding and has assumed new significance as a compulsory part of study for psychiatrists and all mental health professionals. Ethics and Mental Health: The Patient, Profession and Community presents a new approach to these ethical dilemmas that have become an increasing part of modern practice. The book begins by exploring current normative theories of psychiatric ethics. It describes how empirical methods can make codes of conduct more representative of professional values. Considering their previous work, concepts of justice, and the moderate communitarian position, the authors outline their methodology, which argues that mental health professionals exist within a perpetual state of tension, caused by conflicts between the Hippocratic Oath, personal values, notions of social justice, and the potentially harmful influences of their social role. Applying their theory to the area of involuntary psychiatric treatment, the authors address the context of psychiatric practice and the moral agency of psychiatrists. They outline the different influences on the craft of psychiatry to better illustrate the diverse forces that impact moral deliberation and the practice of ethics in mental health. In doing so, they cover areas as diverse as cultural, economic, scientific, and political domains. The final section of the book applies the methodology to contemporary problems in mental health ethics, formulating how mental health clinicians can approach these quandaries. The book brings a new perspective to classic dilemmas from the past, to contemporary challenges, and in anticipation, to new concerns that will inevitably arise in a dynamic and complex professional context.

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.