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Prominent bioethicists whose work is rooted in philosophy,
religion, medicine, nursing, literature, history, and policy
analysis join together to discuss their methods and professional
insights, as well as to better define the field and its future
development. Writing from the perspective of their own specialties,
the authors: review just how their personal disciplines have
contributed to bioethics, debate the current and future bioethical
issues they face, and identify the most significant strengths and
weaknesses in the current practice of bioethics. Seeking a sound
foundation for the discipline, they also consider what basic
knowledge and skills are necessary to be competent in bioethics,
what methods and theoretical approaches are most promising for its
future development, and what issues or perspectives have been
neglected.
Prominent bioethicists whose work is rooted in philosophy,
religion, medicine, nursing, literature, history, and policy
analysis join together to discuss their methods and professional
insights, as well as to better define the field and its future
development. Writing from the perspective of their own specialties,
the authors: review just how their personal disciplines have
contributed to bioethics, debate the current and future bioethical
issues they face, and identify the most significant strengths and
weaknesses in the current practice of bioethics. Seeking a sound
foundation for the discipline, they also consider what basic
knowledge and skills are necessary to be competent in bioethics,
what methods and theoretical approaches are most promising for its
future development, and what issues or perspectives have been
neglected.
Hospice is the premiere end of life program in the United States,
but its requirement that patients forgo disease-directed therapies
and that they have a prognosis of 6 months or less means that it
serves less than half of dying patients and often for very short
periods of time. Palliative care offers careful attention to pain
and symptom management, added support for patients and families,
and assistance with difficult medical decision making alongside any
and all desired medical treatments, but it does not include a
comprehensive system of care as is provided by hospice. The
practice of palliative care and hospice is filled with sometimes
overt (requests for hastened death in an environment where such
acts are legally prohibited) and other times covert (the delay in
palliative care referral because the health care team believes it
will undermine disease directed treatment) ethical issues. The
contributors to this volume use a series of case presentations
within each chapter to illustrate some of the palliative care and
hospice challenges with significant ethical dimensions across the
three overarching domains: 1) care delivery systems; 2) addressing
the many dimensions of suffering; and 3) difficult decisions near
the end of life. The contributors are among the most experienced
palliative care, hospice and ethics scholars in North America and
Western Europe. Each has been given relatively free reign to
address what they feel are the most pressing ethical challenges
within their domain, so a wide range of positions and vantage
points are represented. As a result, the volume provides a very
diverse ethical exploration of this relatively young field that can
deepen, stretch, and at times confront any simple notion of the
challenges facing patients, their families, professional
caregivers, and policy makers.
In Death, Dying, and Organ Transplantation: Reconstructing Medical
Ethics at the End of Life, Miller and Truog challenge fundamental
doctrines of established medical ethics. They argue that the
routine practice of stopping life support technology in hospitals
causes the death of patients and that donors of vital organs
(hearts, lungs, liver, and both kidneys) are not really dead at the
time that their organs are removed for life-saving transplantation.
These practices are ethically legitimate but are not compatible
with traditional rules of medical ethics that doctors must not
intentionally cause the death of their patients and that vital
organs can be obtained for transplantation only from dead donors.
In this book Miller and Truog undertake an ethical examination that
aims to honestly face the reality of medical practices at the end
of life. They expose the misconception that stopping life support
merely allows patients to die from their medical conditions, and
they dispute the accuracy of determining death of hospitalized
patients on the basis of a diagnosis of "brain death" prior to
vital organ donation. After detailing the factual and conceptual
errors surrounding current practices of determining death for the
purpose of organ donation, the authors develop a novel ethical
account of procuring vital organs. In the context of reasonable
plans to withdraw life support, still-living patients are not
harmed or wronged by organ donation prior to their death, provided
that valid consent has been obtained for stopping treatment and for
organ donation. Recognizing practical difficulties in facing the
truth regarding organ donation, the authors also develop a
pragmatic alternative account based on the concept of transparent
legal fictions. In sum, Miller and Truog argue that in order to
preserve the legitimacy of end-of-life practices, we need to
reconstruct medical ethics.
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.
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