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Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin."
Modern medicine has put a new twist on one of our most fundamental values . . . self-determination. A patient's right to self-determination becomes a poignant and volatile issue in the context of modern life-sustaining technologies. When the benefit of medical treatment is overshadowed by the resulting burdens, treatment may ethically be withdrawn. Patients have the right to make this decision, assuming they still have the capacity to make it. Through advance directives a competent patient can extend his right to consent to or refuse medical treatment indefinitely into the future. Whether in the form of informal oral instructions or formal written documents, advance directives insure patients that their treatment wishes will be carried out. They also alleviate the uncertainty, guilt, and/or fear of legal consequences facing the family and caregivers. This volume is a collection of fourteen essays investigating the advantages and disadvantages of different kinds of directives, the role of professionals in making and honoring them, policy issues that need to be addressed, and future directions which directives may take. Although such documents may be used to request treatment, this volume limits its focus to their more common function . . . the refusal of treatment. Timely and comprehensive, Advance Directives in Medicine provides a stimulating overview of this relevant topic. The papers in this volume were originally presented at a multidisciplinary conference on advance directives. Revised and edited for this text, they address a variety of questions and issues, for instance: What are the individual and societal benefits of advance directives? Does an advance directive tamper with thesanctity of life? Will normalizing directives have an adverse effect on the practice of medicine? Should a patient specify treatments to be withheld within a directive, such as the use of CPR, nutrition, or hydration? What legal sanctions should apply against those who ignore directives? Should directives be used to reduce health care expenditures by insurance companies, Medicare, and Medicaid? What is a physician's role in helping his patient formulate an appropriate directive and when is a patient ready to confront his own mortality?
Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin.
"Healing by Heart" is a book of stories--stories of people's search
for culturally responsive health care from U.S. providers. It
offers resources to providers and institutions committed to
delivering culturally responsive health care, paying special
attention to building successful relationships with traditional
Hmong patients and families. It makes available extensive
information about the health-related beliefs, practices, and values
of the Hmong people, including photographs of traditional healing
methods.
"Healing by Heart" is a book of stories--stories of people's search
for culturally responsive health care from U.S. providers. It
offers resources to providers and institutions committed to
delivering culturally responsive health care, paying special
attention to building successful relationships with traditional
Hmong patients and families. It makes available extensive
information about the health-related beliefs, practices, and values
of the Hmong people, including photographs of traditional healing
methods.
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