In Righting Health Policy: Bioethics, Political Philosophy, and the Normative Justification of Health Law and Policy, D. Robert MacDougall argues that bioethics does not have adequate tools for justifying its normative recommendations for law and policy. Bioethics' tools are mostly theories about what we owe each other. But justifying laws and policies requires more; at a minimum, it requires explaining the basis on which we may control or influence others to do what they are supposed to do, which lies within the realm of political and not moral philosophy. MacDougall develops an interpretation of Kant's moral and political philosophy and uses this account to show the importance of political philosophy for bioethics. He argues that a theory of political legitimacy is necessary for distinguishing between what is morally required and what is legally enforceable. MacDougall also argues that in some cases, an account of political authority is necessary for settling the content of not only our legal rights and duties but also our moral ones. The Kantian account shows why the content of physicians' duties-legal and moral-to inform patients prior to treatment remain indeterminate outside of a state with authority to conclusively settle what counts as valid consent.

As a society, we have learned to value diversity. But can some strategies to achieve diversity mask deeper problems, ones that might require a different approach and different solutions? With "Inclusion," Steven Epstein argues that in the field of medical research, the answer is an emphatic yes.
Formal concern with diversity in American medical research, Epstein shows, is a fairly recent phenomenon. Until the mid-1980s, few paid close attention to who was included in research subject pools. Not uncommonly, scientists studied groups of mostly white, middle-aged men--and assumed that conclusions drawn from studying them would apply to the rest of the population. But struggles involving advocacy groups, experts, and Congress led to reforms that forced researchers and pharmaceutical companies to diversify the population from which they drew for clinical research. That change has gone hand in hand with bold assertions that group differences in society are encoded in our biology--for example, that there are important biological differences in the ways that people of different races and sexes respond to drugs and other treatments.
While the prominence of these inclusive practices has offered hope to traditionally underserved groups, Epstein argues forcefully that it has drawn attention away from the tremendous inequalities in health that are rooted not in biology but in society. There is, for instance, a direct relationship between social class and health status--and Epstein believes that a focus on bodily differences can obscure the importance of this factor. Only when connected to a broad-based effort to address health disparities, Epstein explains, can a medical policy of inclusionachieve its intended effects.
A fascinating history, powerful analysis, and call to action, "Inclusion" will be essential reading for medical professionals, policymakers, and any concerned citizen.

Ce document a pour objectif de faire prendre conscience de la necessite d elaborer et de mettre en oeuvre, dans le contexte d un plan sanitaire national, des politiques relatives aux technologies de la sante comprenant trois volets: reglementation, gestion et evaluation des technologies. L accent est mis en particulier sur les politiques visant l utilisation sure et adaptee des dispositifs medicaux, qui sont un sous-ensemble des technologies de la sante. Ces politiques comprennent des recommandations axees sur le choix de technologies medicales repondant au mieux aux besoins de la population cible et sur l identification des ressources financieres et humaines. De plus, ces politiques peuvent promouvoir l utilisation sure et adaptee des dispositifs tout au long de leur cycle de vie. Elles devraient ainsi permettre l amelioration du systeme de sante."

En el presente informe se explica el diseno de un programa de mejora del acceso a unos dispositivos medicos idoneos aplicando los cuatro componentes cruciales, la disponibilidad, la accesibilidad, la idoneidad y la asequibilidad, a las 15 enfermedades con mayor morbilidad mundial y algunas cuestiones transversales. Se sugieren, como resultado de este ejercicio, varios ambitos de investigacion necesarios para ayudar a aumentar la disponibilidad, la accesibilidad, la idoneidad y la asequibilidad de los dispositivos medicos.Pueden citarse los ejemplos siguientes: el desarrollo de un kit de tecnologias sencillas y asequibles para medir la tension arterial, la glucemia y los niveles de colesterol, que permitiria evaluar el riesgo cardiovascular; el desarrollo de equipos de espirometria portatiles y asequibles para el diagnostico y pronostico correctos de la neumopatia obstructiva cronica (NOC) o asma en entornos con pocos recursos, y el desarrollo de audifonos mas adecuados adaptables a personas con defectos de audicion de todas las edades y entornos. Un ejemplo de cuestion transversal clave es la necesidad de desarrollar pruebas de sensibilidad a antigenos bacterianos y viricos que sean sencillas, asequibles y confiables. Estas pruebas podrian sustituir a los sistemas de cultivo para la deteccion de la presencia de agentes patogenos y ayudar a diagnosticar de forma eficaz y eficiente muchas infecciones con morbilidad alta y enfermedades tropicales desatendidas.El Proyecto sobre DMP aplico las cuatro preguntas clave (relativas a la disponibilidad, la accesibilidad, la idoneidad y la asequibilidad de los dispositivos medicos) a algunos ejemplos de dispositivos medicos clave para explorar en mayor profundidad las cuestiones relativas a la demanda asociadas con el acceso deficiente a unos dispositivos medicos idoneos"

Health Care and the Charter explores the systematic use of Charter litigation in the area of health care and the policy impact of the resulting judicial decisions. Christopher P. Manfredi and Antonia Maioni examine three of the most controversial Supreme Court decisions in recent years. Eldridge (1997) and Auton (2004) invited the Court to extend the scope of publicly funded services, while Chaouilli (2005) asked the Court to allow private health services. This book explores the paths that brought litigants to the Court, the arguments that supported their positions, and the substance of the victory or defeat the Court provided.

Post-mortem computed tomography (PMCT) is increasingly used in forensic pathology practice in many jurisdictions. Such imaging has expanded the capacity to evaluate skeletal trauma improving the visualisation, documentation and presentation of forensic findings. Typically when deceased persons are located and exhibit evidence of trauma, forensic pathologist, anthropologists and radiologists base their interpretations of the mechanism of trauma on their experience and understanding of the biomechanics of fractures as well as recognisable patterns of injury. In order to augment this process, An Atlas of Forensic Skeletal Trauma presents a range of de-identified adult and child skeletal trauma cases that occur in medico-legal contexts where the cause of death and mechanism of trauma are recorded. An Atlas of Forensic Skeletal Trauma includes comprehensive photographs and PMCT images as well as descriptive text.

Beim Organtransplantationswesen handelt es sich - auch rechtlich - um eine besonders anspruchsvolle Materie. Die 1997 erlassenen Rechtsvorschriften sind seit jeher aus vielerlei Grunden stark umstritten. Dominierend ist dabei die Kritik, die der Gesetzgeber dafur erfahren hat, dass er in einem weiten Mass gesellschaftliche Akteure in die Aufgabenerfullung eingebunden hat. Der Autor greift dieses Phanomen am Beispiel der Koordinierungsstelle auf. Er geht der Frage nach, ob sich die hier auftretenden Strukturen staatlich-gesellschaftlichen Zusammenwirkens den bereits bekannten Kooperationsformen zuordnen lassen und worin ihre Besonderheiten liegen. Im Fokus der Untersuchung steht die Frage, ob - und inwieweit - sich solche Konzepte uberhaupt in ausreichend effektiver, verfassungsrechtlich gebotener Weise rechtsstaatlich-demokratisch ruckbinden lassen.

In this age of increasing headlines about drug addiction and prescription drug abuse, this book is a timely revelation of how the nursing profession is also impacted by substance abuse. It allows nurses, who are the most trusted profession in society, who have been hidden within their profession and living with substance use disorders, to openly voice their personal experiences with addiction. Seven nurses detail their journey through family dynamics, early use as nursing students and later career nurses as they traveled deeper and deeper into their addiction. They discuss their shame, humiliation and dejection under the throes of the compelling forces of drugs and alcohol. They also describe how their family, other nurses, the healthcare system, and society assisted them in perpetuating their deception and denial about their disease. They explain how they lied, stole and cheated those around them to maintain their addiction. Each explains in detail the confrontations and the "jolt" and "wake up call" it took for them to awaken, become sober and truly enter recovery. They are all candid and forthright in order to help others that are impacted by this horrific and complex disease. They each share how recovery is possible when appropriate attitudes and tools are put in place to support nurses suffering from the devastation of addiction. Their stories bring attention to the importance of intervention, treatment, and recovery communities within the nursing profession. Recovery is emphasized as a "gift" by each of these nurses. The nurses and the researcher provide suggestions and recommendations to assist the healthcare community in addressing addiction in nursing. This book reveals how recovery for nurses is a major public health benefit.

When the United Nations announced the Millennium Development Goals (MDGs) in 2000, approximately half a million women worldwide died each year from complications associated with pregnancy and childbirth. The fifth MDG aimed to reduce the maternal mortality rate by 75 per cent between 1990 and 2015, but by the target date, the goal had not been reached. In The Limits of Trust Lisa Nicole Mills investigates the reasons why Mexico in particular did not meet its objective. Focusing on the states of Guerrero, Chiapas, and Oaxaca, where maternal mortality rates are the highest in the country, Mills looks into how MDG 5 has been implemented in Mexico, how it has been experienced by individuals and groups, what obstacles have been encountered, and what factors have facilitated improvements in maternal health. Using data gathered from interviews with NGOs, government officials, and health care workers, the book argues that government and feminist NGO efforts to build trust in the health care system have fallen short because of systemic failures to protect women's rights and enhance the quality of health care. In Mexico a woman's risk of dying from a pregnancy-related complication is five times higher than in developed countries. The Limits of Trust explores the realities of implementing maternal health initiatives on the ground in rural, remote, and impoverished areas, and the steps that can be taken to successfully combat maternal mortality.

As neuroscience continues to reveal the biological basis of human thought and behavior, what impact will this have on legal theory and practice? The emerging field of neurolaw seeks to address this question, but doing so adequately requires confronting difficult philosophical issues surrounding the nature of mind, free will, rationality, and responsibility. In The Philosophical Foundations of Neurolaw, Martin Roth claims that the central philosophical issue facing neurolaw is whether we can reconcile the conception of ourselves as free, rational, and responsible agents with the conception of ourselves as complex bio-chemical machines. Roth argues that we can reconcile these conceptions. To show this, Roth develops and defends an account of free will that identifies free will with the capacity to respond to rational demands, and he argues that this capacity is at the foundation of our thinking about responsibility. Roth also shows how the mind sciences can explain this capacity, thus revealing that a purely physical system can have the kind of free will that is relevant to responsible agency. Along the way, Roth critiques a number of arguments that purport to show that the kind of reconciliation provided is not possible. Roth concludes that though we should rethink our legal system in important ways, both in light of his account of free will and what neuroscience is poised to reveal, neuroscience does not threaten the law's core commitment to responsible agency.

This book critically examines the moral soundness of the two definitions of death used in organ donation-transplantation: "brain death" (heart-beating) and "controlled cardiac/circulatory death" (non-heart-beating). The author carries out a multidisciplinary study of the crucial moral issues surrounding these new definitions to answer the question: are the donors truly dead at the time of organ removal? The book probes the history of these protocols, and the rationales of pro-"brain death" Catholic scholars who assert that brain-dead individuals are dead because, without a functioning brain, they have undergone a substantial change. The author's arguments, firmly grounded in both classical metaphysics and contemporary biophilosophy, demonstrate that the new definitions of death are unsound because they contradict both Aristotelian-Thomistic anthropology and holistic biophilosophy. The book also looks at the new definitions in terms of Christian ethics. It provides a detailed critical analysis of John Paul II's 2000 Address to the Transplantation Society, showing that, contrary to popular belief, the Catholic Church has not given any formal approval to the "brain death" protocol.

Provoking urgent questions about the politics of health in the twenty-first century, this collection interrogates how neoliberal approaches to governance frame health and risk in ways that promote individual responsibility and the implications of such framings for the well-being of the collective. The essays examine a range of important issues, including childhood obesity, genetic testing, HPV vaccination, Aboriginal health, pandemic preparedness, environmental health, disability policy, aging, contingent work, and women's access to social services. With specific attention to the Canadian context, contributors reveal how neoliberal practices and policies shape the health experiences of individuals, disadvantaged groups, and communities by cultivating self-discipline while further exposing to harm the lives and bodies of those already marginalized in consumer society. Building on the theoretical conceptualizations of power and government of French philosopher Michel Foucault, the case studies extend our understanding of the effects of neoliberal practices and policies in relation to social class, gender, racialized identity, colonization, and ability, and provide insight into how health-related discourse creates new requirements for citizenship and forms of social stratification. A timely intervention in the field of health studies, Neoliberal Governance and Health establishes the need for critical interdisciplinary scholarship to counter the individualizing and marginalizing tendencies of health-related policy, practice and research.

For decades, manufacturers from around the world relied on asbestos from the town of Asbestos, Quebec, to produce fire-retardant products. Then, over time, people learned about the mineral's devastating effects on human health. Dependent on this deadly industry for their community's survival, the residents of Asbestos developed a unique, place-based understanding of their local environment; the risks they faced living next to the giant opencast mine; and their place within the global resource trade. This book unearths the local-global tensions that defined Asbestos's proud and painful history to reveal the challenges similar resource communities have faced - and continue to face today.

Academic global health programs are proliferating, and global health partnerships between North American academic institutions and institutions in low- and middle-income countries are steadily increasing. This study employs surveys and key informant interviews to examine global health partnerships, and it presents a framework for success to guide the development of sustainable global health programs and partnerships with measurable, defined impact. Eighty-two North American academic institutions and 46 international partnering institutions participated in the survey. Key informant interviews were conducted with global health leaders at 15 North American academic institutions and 11 partnering international institutions. Quantitative data were analyzed using linear regression, and qualitative data were used in thematic analyses. The surveys and interviews provide evidence of mutual benefits resulting from these global health partnerships, as well as areas for further development and improvement.

Health Care Disparities and the LGBT Population addresses a people whose lack of health care access, including mistreatment and refusal of services, are often omitted from discussions about health care and insurance reform. Research suggests that LGBT people experience worse health outcomes than their heterosexual counterparts. Low rates of health insurance coverage, high rates of stress due to systematic harassment, stigma, discrimination, and lack of cultural competency in the health care system frequently manifest in negative health-related behaviors. The dearth of data collection on sexual orientation and identity in state and federal health care surveys has led to inadequate information about LGBT populations, and has impeded the establishment of health programs and public policies that benefit them. With its diverse perspectives, this book will not only benefit LGBT people, but will also more broadly improve the lives of entire communities, medical care, and prevention programs and services. This research provides a better understanding of the social and structural inequalities that LGBT populations experience. Improvements to our country's health care system should go beyond just providing universal insurance and should ensure equitable health care for all.

Effective palliative care that rests on a sound ethical foundation requires ongoing discussions about patient and family values and preferences. This is especially important when addressing care at end-of-life including artificial nutrition and hydration, withdrawal of life-sustaining therapies and palliative sedation as well as requests for assistance in hastening death. The eighth volume in the HPNA Palliative Nursing Manuals series, Legal and Ethical Aspects of Palliative Care, provides an overview of critical communication skills and formal organizational mechanisms, such as ethics committees and interdisciplinary rounds, required for decisions in ethical dilemmas which respect diversity in the views of colleagues, as well as patients. The content of the concise, clinically focused volumes in the HPNA Palliative Nursing Manuals series is one resource for nurses preparing for specialty certification exams and provides a quick-reference in daily practice.

The pervasiveness of global tuberculosis (TB) poses a particular set of challenges to policymakers. In order to make the necessary strategic decisions, it is essential to understand how the disease works and its impact on individuals, families, communities, and broader global health goals. This primer is intended to lay out the basics for a nontechnical audience to give policymakers the information they need to make informed and accurate decisions about the future of U.S. TB control efforts.

Malaria is an infectious disease like no other: it is a dynamic force of nature and Africa’s most deadly and debilitating malady. James C. McCann tells the story of malaria in human, narrative terms and explains the history and ecology of the disease through the science of landscape change. All malaria is local. Instead of examining the disease at global or continental scale, McCann investigates malaria’s adaptation and persistence in a single region, Ethiopia, over time and at several contrasting sites. Malaria has evolved along with humankind and has adapted to even modern-day technological efforts to eradicate it or to control its movement. Insecticides, such as DDT, drug prophylaxis, development of experimental vaccines, and even molecular-level genetic manipulation have proven to be only temporary fixes. The failure of each stand-alone solution suggests the necessity of a comprehensive ecological understanding of malaria, its transmission, and its persistence, one that accepts its complexity and its local dynamism as fundamental features. The story of this disease in Ethiopia includes heroes, heroines, witches, spirits—and a very clever insect—as well as the efforts of scientists in entomology, agroecology, parasitology, and epidemiology. Ethiopia is an ideal case for studying the historical human culture of illness, the dynamism of nature’s disease ecology, and its complexity within malaria.

Over the last quarter of a century, the fields of medical ethics and of legal issues related to medical practice have rapidly developed for a number of reasons. Firstly, the provision of healthcare nowadays is based on a complicated partnership between healthcare providers, patients, administrators and organizations responsible for providing finance; this complicated partnership frequently results in clashes of views, opinions, and priorities, which have a major ethical and legal dimension. Secondly, a major event of the 21st century is the development of multicultural societies; healthcare-related decisions thus have to be made on the background of so many different ethnicities, religions, cultures and languages, resulting in a great spectrum of ethical and legal implications. Thirdly, in the modern world, people are more mobile and can easily and cost-effectively seek treatment outside of their country of origin or residence, which raises many ethical and legal issues. Lastly, the development of new medical specialties, modern and advanced treatments for very challenging patients, and the introduction of new technologies in medical practice have dramatically broadened the spectrum of ethical and legal issues related to medical practice. This book will therefore aim to cover in detail general principles and specific issues related to the ethical and legal dimensions of modern surgical practice.

Courts recognize that those who are involved in medico-legal proceedings have a stake in the outcome of their psychological assessment, regardless of whether they are high- or low-functioning individuals. Accounting for the validity of the evaluation in low-functioning examinees is frequently made more difficult by impairment; when evaluating testimony from people with intellectual disability (ID), neuropsychologists and psychologists must acknowledge the differences between the medico-legal evaluation and the clinical evaluation. This book provides helpful guidelines for assessing validity in low-functioning claimants. It charts recent advances in psychological and neuropsychological assessment pertaining to civil and criminal proceedings while examining issues such as validity and motivation, assessments of disability, criminal and civil capacities, capital cases, Miranda waiver cases, and others. In disability cases, the Social Security Administration has had a long-standing policy that prevents neuropsychologists and psychologists from using validity instruments-yet, using this book, an accurate and valid assessment can still be obtained. Evaluators who perform assessments in capital cases will find up-to-date discussions of the Flynn Effect, measurement of intellectual functioning, problems associated with the assessment of adaptive functioning, and the challenge of validity assessment. Miranda waiver evaluations for those with low IQ are discussed concerning issues of capacity measurement, including reading and language analysis for the Miranda advisement in the particular jurisdiction in question. Testamentary capacity is discussed at length, showing how understanding of the legal standard is helpful in guiding the examination. Competency to stand trial, or adjudicative competence, is the main topic in the area of criminal competencies, with exploration of the Dusky standard and the various tests used to evaluate this competence, focusing on individuals with ID.

Daniel Callahan---whose cofounding of The Hastings Center in 1969 was one of the most important milestones in the history of bioethics--has written on an uncommonly wide range of issues over a long career. They have moved back and forth between clinical care of individual patients and the ethical problems of health care research and delivery. Through his many writings, four core problems have recurred in all of his work, and influence each of the others. What is health and how has its understanding been shaped by medical progress and the culture of medicine and society? What is progress, a deep value in modern health care and how should we judge it? What kinds of technological innovations that come out of the drive for progress are really good for us-and what do we do when there is a clash between individual good and social good in the use of expensive technologies, a problem now evident in the unsustainable high costs of health care? How should our understanding of the place of an inevitable death in all our lives, and its place in medicine, help us to better think of the goals of medicine and the goals of our life in seeking a good death? Those four questions have been with bioethics from its beginning and will remain with it for the indefinite future. They are the roots of bioethics.

The use of human beings as research subjects poses distinctive ethical issues. Subjects of medical research are exposed to risks of harm for the sake of generating scientific knowledge that can benefit future patients and society. Ethical analysis of the challenges posed by research involving human subjects requires careful attention to the contextual details of scientific experimentation. This book contains 22 essays by Franklin G. Miller on research ethics written over a 15-year period. With the exception of the first essay, all have been previously published in bioethics and medical journals. The book is arranged into four parts. Part One addresses a general ethical perspective on the protection of human subjects in clinical research, including paternalism in research regulation and acceptable limits to research risks. The essays in Part Two examine ethical issues in study design. It includes ethical analyses of controversial types of medical experimentation-studies that provoke psychiatric symptoms, induce infections, provide patients with placebos that withhold proven effective treatments or administer fake invasive procedures, test experimental treatments in cancer patients who have exhausted all standard treatment options, and employ the use of deception to generate scientifically valid data. Part Three offers a systematic critique of "the therapeutic orientation" to clinical trials and the principle of clinical equipoise, which is widely regarded as a fundamental norm for randomized treatment studies. Part Four takes up a range of ethical issues relating to informed consent for research participation, including examination of "the therapeutic misconception" and presentation of a novel approach to the validity of consent: "the fair transaction model." An abiding theme, developed in many of the essays is that the ethics of clinical research is importantly different from the ethics of medical care.

Two towering figures in the field of health care policy analysis, Theodore R. Marmor and Rudolf Klein, reflect on a lifetime of thought in this wide-ranging collection of essays published in the wake of President Obama's health care reform. Presented as a kind of dialogue between the two, the book offers their recent writings on the future of Medicare; universal health insurance; conflicts of interest among physicians, regulators, and patients; and many other topics.