In Intimations of Mortality, Barbara Reich offers an empirically-based critique of the failures of end-of-life communication and decision-making in the United States. Using England and Canada as occasional foils, Reich explores why U.S. physicians, patients, and families struggle to have the conversations necessary to provide seriously ill and dying patients with medical care consistent with their preferences. Reich also shows how a number of different factors -including payment mechanisms, liability fears, cultural phenomena, communication avoidance, death denial, and clinical uncertainty -impact physician-patient communication and medical decision-making, leave patients and families without the tools they need to make informed choices, and instead leave the default practices in place. Ultimately, this groundbreaking analysis unveils the interconnectedness of the many obstacles to better communication and decision-making in end-of-life communications and offers much-needed suggestions for improvement.

In this eye-opening look at the doctor-patient decision-making process, physician and law professor Jay Katz examines the time-honored belief in the virtue of silent care and patient compliance. Historically, the doctor-patient relationship has been based on a one-way trust--despite recent judicial attempts to give patients a greater voice through the doctrine of informed consent. Katz criticizes doctors for encouraging patients to relinquish their autonomy, and demonstrates the detrimental effect their silence has on good patient care. Seeing a growing need in this age of medical science and sophisticated technology for more honest and complete communication between physician and patients, he advocates a new, informed dialogue that respects the rights and needs of both sides.

In a new foreword to this edition of "The Silent World of Doctor and Patient," Alexander Morgan Capron outlines the changes in medical ethics practice that have occurred since the book was first published in 1984, paying particular attention to the hotly debated issues of physician-assisted suicide and informed consent in managed care.

This book provides a clear and comprehensive introduction to contemporary bioethics. It also presents provocative, philosophically informed arguments on current bioethical issues. Holland engages with debates ranging from the more familiar such as euthanasia, advance decisions to refuse treatment, and new reproductive technologies to the philosophical implications of recent developments in genetics, including prenatal genetic therapy, genetic enhancement and human cloning. The book is built around four crucial themes. The first is moral status: what are the implications of the moral status of human embryos or animals for our biomedical practices? The second theme life, death and killing looks at the ethics of ending, or failing to lengthen, human life. Holland then explores various questions of personal identity raised in contemporary bioethical debates. Finally, he presents and develops a version of the argument from nature which continues to be influential in bioethics in order to make sense of the objection that some biomedical innovations are 'unnatural'. Structuring the discussions in this way creates an engaging introduction to bioethics that is an ideal textbook for students, whilst offering much to stimulate colleagues in the field. This second edition has been thoroughly and comprehensively updated to reflect the most recent advances in bioethics, and includes an entirely new chapter on the ethical treatment of patients in the minimally conscious state.

What roles do different kinds of knowledge play in medicine? What roles should they play? What standards (epistemic, ethical, practical) should be met before knowledge is used to develop policy or practice? Medical decision-making, whether in the clinic or at the policy level, can have serious and far-reaching consequences. It is therefore important to base decisions on the best available knowledge. Yet deciding what should count as the best available knowledge is not easy. This important book addresses philosophical questions about what kinds of knowledge should be taken into account, and how knowledge should inform practice and policy. The chapters in this volume examine the relationship between knowledge and action in medical research, practice, and policy. "Knowledge" is broadly construed to include knowledge from clinical, laboratory, or social science research, and from the clinical encounter, as well as broader background assumptions prevalent in society that inform both the kinds of knowledge that are taken to be relevant to medicine and how that knowledge is interpreted in decision-making. Such knowledge may be relevant not only to clinical decision-making with regard to the care of individual patients, but also to the practice of scientific research, the development of policy and practice guidelines, and decisions made by patients or by patient advocacy groups.

Here is an overview of many of the ethical challenges facing health care practitioners today. Health providers striving for the appropriate balance between human rights and values and the objectives within their professions confront many ethical dilemmas. This helpful book explores such dilemmas from practical and philosophical perspectives and helps practitioners successfully navigate through the maze of concerns they face on a daily basis. With Ethics and Values in Long Term Health Care, readers can develop new modes of ethical thinking that will enhance their practice as they improve the quality of life of the elderly they serve. The book presents information that can be used as a catalyst for innovative thinking and a guide for positive action. Readers are encouraged to apply the lessons contained in this book to practical decisionmaking in their respective health professions. Chapters assist health practitioners and others in thinking more in-depth about the impact of their personal ethics and values on service delivery, and help them to broaden their views and enhance their decisionmaking skills. The book has a broad scope and is divided into four sections which address: Practitioner Knowledge Caregiving End of Life Choices Health Care ReformEthics and Values in Long Term Health Care helps prepare health care professionals to confront some of the major ethics and values challenges of the 1990s and beyond. This book can be used as a guide to ethical awareness, as well as a tool for teaching ethics and values or for developing programs and workshops.

Much has been written about whether end-of-life law should change and what that law should be. However, the barriers and facilitators of such changes - law reform perspectives - have been virtually ignored. Why do so many attempts to change the law fail but others are successful? International Perspectives on End-of-Life Law Reform aims to address this question by drawing on ten case studies of end-of-life law reform from the United Kingdom, the United States, Canada, the Netherlands, Belgium and Australia. Written by leading end-of-life scholars, the book's chapters blend perspectives from law, medicine, bioethics and sociology to examine sustained reform efforts to permit assisted dying and change the law about withholding and withdrawing life-sustaining treatment. Findings from this book shed light not only on changing end-of-life law, but provide insight more generally into how and why law reform succeeds in complex and controversial social policy areas.

We live at a time when the human lifespan has increased like never before. As average lifespans stretch to new lengths, what impact should this have on our values? Should our values change over the course of our ever-increasing lifespans? Nancy S. Jecker coins the term, the life stage relativity of values, to capture the idea that at different stages of our lives, different ethical concerns shift to the foreground. During early life, infants and small children hold dear the value of being cared for and nurtured by someone they trust-and their vulnerability and dependency make these the right values for them. By early adulthood and continuing into midlife, the capacity for greater physical and emotional independence gives people reason to place more emphasis on autonomy and the ability to freely choose and carry out their plan of life. During old age, heightened risk for chronic disease and disability gives us a reason to shift our focus again, emphasizing safeguarding our central capabilities and keeping our dignity and self-respect intact. Despite different values becoming central at different stages of life, we often assume the standpoint of someone in midlife, who is in the midst of planning a future adulthood that stretches out before them. Jecker coins the term, midlife bias, to refer to the privileging of midlife. Midlife bias occurs when we assume that autonomy should be our central aim at all life stages and give it priority in a wide range of ethical decisions. The privileging of midlife raises fundamental problems of fairness. It also suggests the possibility of large gaps in the ethical principles and theories at hand. Ending Midlife Bias: New Values for Old Age addresses these concerns in a step-wise fashion, focusing on later life. Jecker first introduces a philosophical framework that extends moral theorizing to older adults, addressing midlife bias, the life stage relativity of values, human capabilities and dignity, time's passage, the narrative self, and justice between old and young. She then turns to policy and practice and explores ethical issues in bioethics, long term care, personal robotic assistants, care of the dying and newly dead, ageism in medical research, the allocation of healthcare, mandatory retirement, and the future of population aging.

Baruch A. Brody has been one of the most important voices in bioethics over the last several decades, asking new and challenging questions about a range of problems, examining recalcitrant issues in novel ways, always with the goal of offering practical solutions to complex problems. This volume presents a sustained philosophical analysis of Brody's contributions to biomedical ethics. Done well, philosophical work can clarify complex issues, facilitate creative problem solving, and lead to real-world solutions to difficult situations. Each contributor carefully and critically explores Brody's writings in biomedical ethics and the philosophy of medicine, illustrating his appreciation that thorough and critical scientific research and philosophical analysis are central to reining in the untutored human desire to ameliorate pain and suffering so that medical treatments and health care policy do more good than harm.

How is modern medicine failing? Why is a more human approach required? This book challenges the dogma of modern technological medicine that ignores both the therapeutic effect of the doctors and the self-healing powers of the patient. It reviews the vast weight of evidence on the effectiveness of this 'human effect', and uses the evidence to describe how to use the human effect in everyday practice. This book is about a vision. A vision that practitioners and patients will recognise and regain their therapeutic potential. It provides a shift in perspective on what doctors can achieve. Thoroughly referenced, it is vital for general practitioners, and also very relevant to all doctors, nurses, health managers, policy makers and indeed patients. 'Pendulums swing in most fields of life, and medicine and general practice are no exceptions. At the mid-point of the twentieth century the human side of medicine was well understood and implicitly accepted by most working practitioners. As the century progressed, the personal aspects came second (but now) the pendulum of thought has started to swing back again towards the personal.

For the average person, genetic testing has two very different faces. The rise of genetic testing is often promoted as the democratization of genetics by enabling individuals to gain insights into their unique makeup. At the same time, many have raised concerns that genetic testing and sequencing reveal intensely personal and private information. As these technologies become increasingly available as consumer products, the ethical, legal, and regulatory challenges presented by genomics are ever looming. Assembling multidisciplinary experts, this volume evaluates the different models used to deliver consumer genetics and considers a number of key questions: How should we mediate privacy and other ethical concerns around genetic databases? Does aggregating data from genetic testing turn people into products by commercializing their data? How might this data reduce or exacerbate existing healthcare disparities? Contributing authors also provide guidance on protecting consumer privacy and safety while promoting innovation.

For the average person, genetic testing has two very different faces. The rise of genetic testing is often promoted as the democratization of genetics by enabling individuals to gain insights into their unique makeup. At the same time, many have raised concerns that genetic testing and sequencing reveal intensely personal and private information. As these technologies become increasingly available as consumer products, the ethical, legal, and regulatory challenges presented by genomics are ever looming. Assembling multidisciplinary experts, this volume evaluates the different models used to deliver consumer genetics and considers a number of key questions: How should we mediate privacy and other ethical concerns around genetic databases? Does aggregating data from genetic testing turn people into products by commercializing their data? How might this data reduce or exacerbate existing healthcare disparities? Contributing authors also provide guidance on protecting consumer privacy and safety while promoting innovation.

In Suffering Presence, ethicist Stanley Hauerwas delivers a well-formed theological perspective that illuminates the moral life, particularly medical care and the care of children and the handicapped.

Narrative Medicine: A Rhetorical Rx rests on the principles that storytelling is central to medical encounters between caregivers and patients and that narrative competence enhances medical competence. Thus, the book's goal is to develop the narrative competence of its reader. Grounded in the rhetorical theory of narrative that Phelan has been constructing over the course of his career, this volume utilizes a three-step method: Offering a jargon-free explication of core concepts of narrative such as character, progression, perspective, time, and space. Demonstrating how to use those concepts to interpret a diverse group of medical narratives, including two graphic memoirs. Pointing to the relevance of those demonstrations for caregiver-patient interactions. Narrative Medicine: A Rhetorical Rx is the ideal volume for undergraduate students interested in pursuing careers in healthcare, students in medical and allied health professional schools, and graduate students in the health humanities and social sciences.

Ethics in Community Mental Health Care: Commonplace Concerns examines everyday ethical issues that clinicians encounter as they go about their work caring for people who have severe and persistent mental disorders. Individuals (psychiatrists, social workers, case managers, nurses, psychologists, peer counselors, primary care physicians) who serve on the front line of community mental health clinical and social services find that they must deal, on a daily basis, with significant ethical dilemmas that involve personal, social, and policy matters: overstepping personal boundaries and coercive practices, dealing with violence in the home and in the workplace, breaching confidentiality, and ensuring the rights and welfare of vulnerable individuals.

This book prompts and provokes readers to recognize, to analyze, to reflect upon, and to respond to the range of commonplace ethical concerns that arise in community mental health care practice with persons who have mental disorders that may impede their ability to protect their own interests.

Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical duties to patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparities when allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

Over the past decades, public trust in medical professionals has steadily declined. This decline of trust and its replacement by ever tighter regulations is increasingly frustrating physicians. However, most discussions of trust are either abstract philosophical discussions or social science investigations not easily accessible to clinicians. The authors, one a surgeon-turned-philosopher, the other an analytical philosopher working in medical ethics, joined their expertise to write a book which straddles the gap between the practical and theoretical. Using an approach grounded in the methods of conceptual analysis found in analytical philosophy which also draws from approaches to medical diagnosis, the authors have conceived an internally coherent and comprehensive definition of trust to help elucidate the concept and explain its decline in the medical context. This book should appeal to all interested in the ongoing debate about the decline of trust - be it as medical professionals, medical ethicists, medical lawyers, or philosophers.

Respect for autonomy has become a fundamental principle in human research ethics. Nonetheless, this principle and the associated process of obtaining informed consent do have limitations. This can lead to some groups, many of them vulnerable, being left understudied. This book considers these limitations and contributes through legal and philosophical analyses to the search for viable approaches to human research ethics. It explores the limitations of respect for autonomy and informed consent both in law and through the examination of cases where autonomy is lacking (infants), diminished (addicts), and compromised (low socio-economic status). It examines alternative and complementary concepts to overcome the limits of respect for autonomy, including beneficence, dignity, virtue, solidarity, non-exploitation, vulnerability and self-ownership. It takes seriously the importance of human relationality and community in qualifying, tempering and complementing autonomy to achieve the ultimate end of human research - the good of humankind.

History will mark the twenty-first century as the dawn of the age of precise genetic manipulation. Breakthroughs in genome editing are poised to enable humankind to fundamentally transform life on Earth. Those familiar with genome editing understand its potential to revolutionize civilization in ways that surpass the impact of the discovery of electricity and the development of gunpowder, the atomic bomb, or the Internet. Significant questions regarding how society should promote or hinder genome editing loom large in the horizon. And it is up to humans to decide the fate of this powerful technology. Rewriting Nature is a compelling, thought-provoking interdisciplinary exploration of the law, science, and policy of genome editing. The book guides readers through complex legal, scientific, ethical, political, economic, and social issues concerning this emerging technology, and challenges the conventional false dichotomy often associated with science and law, which contributes to a growing divide between both fields.

History will mark the twenty-first century as the dawn of the age of precise genetic manipulation. Breakthroughs in genome editing are poised to enable humankind to fundamentally transform life on Earth. Those familiar with genome editing understand its potential to revolutionize civilization in ways that surpass the impact of the discovery of electricity and the development of gunpowder, the atomic bomb, or the Internet. Significant questions regarding how society should promote or hinder genome editing loom large in the horizon. And it is up to humans to decide the fate of this powerful technology. Rewriting Nature is a compelling, thought-provoking interdisciplinary exploration of the law, science, and policy of genome editing. The book guides readers through complex legal, scientific, ethical, political, economic, and social issues concerning this emerging technology, and challenges the conventional false dichotomy often associated with science and law, which contributes to a growing divide between both fields.

Key Features * Discusses the various aspects of cheating in publications: spin, protocol changes; failure to publish negative studies, including current data on the publishing industry and its issues, like the menace of predatory journals, poor peer review, coupled with lack of early education in ethics, and its significant impact on rational prescribing. * Assesses the impact of misconduct and fraud on clinicians and healthcare professionals as they attempt to balance the risk-benefit ratio which is supported by multiple contemporary studies. * Presents shocking data on bribes to physicians, journal editors and other key opinion leaders, exposing the ultimate root of the problem which lies in the economics of the healthcare system, badly in need of repair.

Res Ipsa Loquitur and Medical Negligence: A Comparative Survey analyses the application of the doctrine of res ipsa loquitur ('it speaks for itself') to medical negligence cases. The book aims to establish conclusively that the approach of the South African courts, that the doctrine should never find application in medical negligence cases, is untenable and out of touch with modern approaches adopted in other countries. Constitutional principles such as procedural equality, access to courts, access to health care, access to information, post-constitutional legislation, medical ethics and policy considerations are also discussed.

The book further provides a theoretical and practical legal framework for the application of the doctrine to medical negligence cases in South Africa in future. The authors argue for the application of the doctrine, not only in medical negligence cases, but also to related legal procedures that follow a medical accident such as medical inquests, criminal prosecutions and disciplinary inquiries instituted by the Health Professions Council of South Africa.

Res Ipsa Loquitur and Medical Negligence includes a comprehensive comparison of the practical application of the doctrine to medical negligence cases in South Africa, England and the United States of America.

Reproductive health care professionals in fields such as Obstetrics and Gynecology, Family Medicine, and Pediatrics face difficult ethical issues because they work at the crossroads of patient decision-making, scientific advancement, political controversy, legal regulation, and profound moral considerations. The dilemmas these professionals face expose big-picture bioethics questions of interest to everyone. Yet for clinicians striving to deliver excellent patient care, the ethical questions that make daily practice challenging can be just as nuanced. This volume presents a carefully curated compilation of essays written by leading experts in the fields of medicine, ethics, and law, who address key issues at the forefront of reproductive ethics. It is organized into three main sections: I. Contraception and Abortion Ethics - Preventing Pregnancy and Birth, II. Assisted Reproduction Ethics - Initiating Pregnancy, and III. Obstetric Ethics - Managing Pregnancy and Delivery. Each section begins with a short introduction by the editors providing an overview of the area and contextualizing the essays that follow. This volume's primary aim is to be useful to practicing clinicians, students, and trainees by providing short and practical essays covering urgent topics-from race, religion and abortion, to legal liability, violations of confidentiality and maternal choices that risk future children's health. This collection provides clinicians at all levels of training with frameworks they need to approach the intimate and high-stakes encounters central to their profession.

The Human Embryo in vitro explores the ways in which UK law engages with embryonic processes under the Human Fertilisation and Embryology Act 1990 (as amended), the intellectual basis of which has not been reconsidered for almost thirty years. McMillan argues that in regulating 'the embryo' - that is, a processual liminal entity in itself - the law is regulating for uncertainty. This book offers a fuller understanding of how complex biological processes of development and growth can be better aligned with a legal framework that purports to pay respect to the embryo while also allowing its destruction. To do so it employs an anthropological concept, liminality, which is itself concerned with revealing the dynamics of process. The implications of this for contemporary regulation of artificial reproduction are fully explored, and recommendations are offered for international regimes on how they can better align biological reality with social policy and law.

In 1978, the World Health Organization (WHO) designated the year 2000 as the "due date" for world health. The Alma Ata declaration set the turn of the century as the target for a level of health that would permit all people of the world to lead a socially and economically productive life. ' At that (magic but arbitrary) date most infectious diseases and many chronic conditions, including diabetes and cancer, were expected to have been eradicated or at least controlled. Such predictions were based on solid foundations. In the 1 20 h century, and particularly since the 1970's, Western science and technology based (or "modern") medicine has made quantum leaps in numerous areas as diverse as pharmacology, genetic and molecular biology, surgical techniques, infertility treatments, and pre- and neo-natal care. This impressive trajectory of progress, which continues unabatedly, gave every reason to assume that come the year 2000 humanity would finally be free from many of its ancient scourges. However, as we are all too well aware, the new millennium witnesses also ever more terrifying threats to our health as a result of the emergence of 2 AIDS in the early 80's, the resurgence of infectious diseases such as 3 tuberculosis and malaria, now drug resistant, the absence of significant breakthroughs in the treatment of cancer and cardiovascular diseases, and the continuing dramatic gap in health care between industrialized and developing countries, to mention but a few examples.

Written by four internationally renowned bioethicists, From Chance to Choice is the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late 19th and early 20th centuries. In addition, appendices explain the nature of genetic causation, gene-environment interaction, and expose widespread misconceptions of genetic determinism, as well as outlining the nature of the ethical analysis used in the book. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science.