Telling the Truth about Cancer and Its Treatment
In the United States attitudes toward truth telling in cancer care have changed markedly in the last few decades. In 1946 Charles Lund wrote that a patient diagnosed with cancer should not be told the whole truth. He advised physicians to use a loosely descriptive word such as cyst or lesion in place of the word cancer and to give patients only some rough idea of the extent of treatment. That was sufficient information, Lund felt, on which to base a diagnostic discussion and consent to...
Mentally Disabled And Mentally Ill Persons
I. HEALTHCARE ISSUES Miriam Shuchman 1995 Revised by author II. RESEARCH ISSUES Carl Elliott 1995 MERGERS AND ACQUISITIONS James B. Tubbs, Jr. METAPHOR AND ANALOGY James F. Childress 1995 MILITARY PERSONNEL AS RESEARCH SUBJECTS Susan E. Lederer 1995 Revised by author MINORITIES AS RESEARCH SUBJECTS Todd L. Savitt 1995 Revised by author MISTAKES, MEDICAL Joel E. Frader Charles L. Bosk MORMONISM CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS , BIOETHICS IN Courtney S. Campbell
The Total Artificial Heart
Constructing an artificial heart requires materials such as metals, ceramics, plastics, and polymers that are lightweight and durable. At the same time, these materials must be biologically inert. They must work synergistically with other body systems and not trigger attacks by the body's natural system of immune defenses that would lead to the disruption of the circulatory system and, ultimately, death. An artificial heart also requires sufficiently smooth surfaces so as not to disrupt blood...
Defining Disability Conceptual Issues
The idea of disability and these related concepts are tricky to define. The conditions that often are referred to as disabilities are varied, including sensory losses, learning difficulties, chronic systemic illnesses and their effects such as constant fatigue and pulmonary insufficiency , mental illnesses, lack of limbs, and lack of mobility. Do all these conditions have a common feature Does every biological abnormality qualify as a disability Does the availability of technological aids play...
Issues and Themes in Dental Ethics
The specific requirements of a dentist's ethical commitments in any aspect of professional practice depend on the specific facts and circumstances of the situation. However, the principal categories of dentists' professional obligations can be surveyed under nine headings 1. Who are dentistry's chief clients 2. What is the ideal relationship between a dentist and a patient 3. What are the central values of dental practice 4. What are the norms of competence for dental practice 5. What...
What Is Coercion
In their 4th edition of Principles of Biomedical Ethics, published in 1994, Tom L. Beauchamp and James F. Childress provided a definition of coercion that is consistent with common usage Coercion occurs if and only if one person intentionally uses a credible and severe threat of harm or force to control another Beauchamp and Childress, p. 164 . This definition has three critical elements a person acting intentionally, a threat of harm, and an effort to control another. Perhaps the prototype of...
Instrumental Activism
Parsons drew on German sociologist Max Weber's 1864-1920 characterization of the Puritan religious ethic as an inner-worldly asceticism that sought to engage the harsher realities of life to transform them into elements of the kingdom of God on earth Weber, 1930 . While agreeing with Weber's analysis, he preferred the term instrumental activism to characterize the basic values and worldview of American society. This term underscored that American civilization had secularized the Puritan...
Theravada Buddhist Bioethics
Precepts for both monastics and laypersons provide a starting point for investigating Theravada bioethics. Although the number of precepts and issues addressed differs depending on individual religious status, there is nevertheless a core set ofvalues applied to all Theravada practitioners. Buddha's moral conduct serves as a behavioral model for those who wish to pursue nirvana. The sangha, or monastic community, is bound by a code of moral conduct inscribed in monastic rules vinaya that were...
Extracorporeal Embryos
Science fiction fantasies about the artificial uterus notwithstanding, only the very first stages of human development can occur outside the female body. Since 1978, in vitro fertilization followed by embryo transfer has been a common treatment of fertility problems. The growth of ovarian follicles is stimulated by the administration of gonadotropins. Oocytes are then collected by laparoscopy and placed in an appropriate culture medium. Sperm is added and cleavage occurs in culture until the...
Approaches to Buddhist Bioethics
Buddhist ethical perspectives, unlike some Western views, seldom characterize morality in absolute terms. For Buddhists, ethical behavior is a necessary component of successful adherence to the Dharma rather than an end in itself. Once enlightenment is attained, dualities expressed in ethical problems cease to exist. Action is judged not against an absolute moral standard such as the Ten Commandments , but rather on the basis of its relative merit in leading toward or away from enlightenment....
biology philosophy of
While it may seem that the philosophy of biology, a field known for its focus on metaphysical, epistemological, and conceptual issues in biology, is far removed from the concerns of bioethics, there is a trend in philosophy of biology towards descriptivism that paradoxically allows for significant bridges with the predominantly normative concerns of bioethics. About the same time that bioethics was born the 1960s , the field of philosophy of biology took its first steps. Initially, it looked a...
Bibliography Any
Aulisio, Mark P. 1995. The Intention Foresight Distinction. American Philosophical Quarterly 32 4 341-354. Aulisio, Mark P. 1996. On the Importance of the Intention Foresight Distinction. American Catholic Philosophical Quarterly LXX 2 189-205. Aulisio, Mark P. 1997. One Person's Modus Ponens Boyle, Absolutist Catholicism, and the Doctrine of Double Effect. Barry, Robert. 1997. The Roman Catholic Position on Abortion. Advances in Bioethics 2 151-82. Beauchamp, Thomas L., ed. 1996. Intending...
Bibliography Dhp
Alcoholics Anonymous. 1955. Alcoholics Anonymous, 2nd edition. New York Author. Astin, J. A. 1998. Why Patients Use Alternative Medicine Results of a National Study Journal of American Medical Association 279 19 1548-1553. Bynum, William Frederick, and Porter, Roy, eds. 1987. Medical Fringe and Medical Orthodoxy, 1750-1850. Wolfeboro, NH Croon Helm. Callahan, Daniel, ed. 2002. The Role of Complementary and Alternative Medicine Accommodating Pluralism. Washington, D.C. Georgetown University...
V Death In The Western World
This entry, by the late Talcott Parsons, is reprinted from the first edition. It is followed immediately by a Postscript, prepared by Victor Lidz for the purposes of updating the original entry. That the death of every known human individual has been one of the central facts of life so long as there has been any human awareness of the human condition does not mean that, being so well known, it is not problematical. On the contrary, like history, it has needed to be redefined and newly analyzed,...
Michael Shaffer-volume 23. 370-374
Cravalho, Ernest G., and McNeil, Barbara J., eds. 1982. Critical Issues in Medical Technology. Boston Auburn House. Lewis, Steven M. 1988. A Sense of Sin. Biomedical Engineering Society Bulletin 12 1 1-2. Luthy, David A. Syn, Kirkwood K. van Belle, Gerald et al. 1987. A Randomized Trial of Electronic Fetal Monitoring in Preterm Labor. Obstetrics and Gynecology 69 5 687-695. Mann, Robert W. 1985. Biomedical Engineering A Cornucopia of Challenging Engineering Tasks All of Direct Human...
Obligations and Options in Artificial Nutrition and Hydration
A wealth of experience and a burgeoning literature, supported by sound ethical and legal principles, are questioning the appropriateness of artificial nutrition and hydration in clinical settings like the ones discussed here. Among these are Finucane Cillick Lynn Post Slomka Steinbrook and Winter. Yet many providers and laypersons are unaware, or because of personal views rooted in their own moral background, do not accept these concepts. It is important, therefore, to first educate patients...
Bibliography Ffe
Aevarsson, O Skoog I. 1996. A Population-Based Study on the Incidence of Dementia Disorders Between 85 and 88 Years of Age. Journal of the American Geriatrics .Society 44 1455-1460. Alzheimer Canada. 1997. Tough Issues Ethical Guidelines of the Alzheimer .Society of Canada. Toronto Alzheimer Canada. Alzheimer's Disease Association. 2001. Ethical Issues in Alzheimer's Disease. Chicago Alzheimer Disease Association. Binstock, Robert H. Post, Stephen G. and Whitehouse, Peter J. eds. 1992. Dementia...
Ethical Dilemmas
Because dentists rarely make life-or-death decisions, some people are unaware that the professional obligations of dentists require careful study. Important human values are at stake in dental care relieving and preventing intense pain as well as less intense pain and discomfort preserving and restoring patients' oral function, on which both nutrition and speech depend preserving and restoring patients' physical appearance and preserving and restoring patients' control over their bodies. These...
Coercion and Autonomy
The view in Western culture that coercion is a bad thing reflects a deep commitment to the principle of autonomy. Starting with the German philosopher Immanuel Kant 1724-1804 and his 1785 work, Groundwork of the Metaphysics of Morals, secular ethics has taken the respect for the autonomous actions of others as a primary point of orientation. In this context, coercion is wrong because it interferes with autonomy. Thus the nineteenth-century English philosopher and economist John Stuart Mill...
Health Professional Codes
While beneficence is important to many philosophical and religious systems of ethics, it is central to the health professions. The Hippocratic Oath clearly states that the physician's actions are for the benefit of the sick see Appendix for this and other codes and oaths . The Declaration of Geneva begins with a pledge to consecrate one's life to the service of humanity. The 1980 Principles of the American Medical Association AMA opens with the declaration that these principles are established...
Withholding Food and Water The Patient Experience
Not surprisingly, there is little information that precisely defines the patient experience when food and water are withheld. Two aspects of this issue are worth noting, however. First, while a decision might be made to forego supplemental nutrition, oral intake will often continue. Examples are advanced dementia and terminal cancer. Either the patient will choose to eat or drink as desired, or family or providers will assist oral feeding in this situation, a patient need is being met. The...
Beneficence and Autonomy
How beneficence is put into practice depends on how it is modified by other principles. Especially important in this regard is respect for autonomy or self-determination. Another way to put this is to ask whose notion of good will be definitive. Respect for autonomy means that good will be defined by the recipient of the action rather than the agent. Beneficence not so defined leads to paternalism, in which the beneficent actor overrides or ignores the recipient's ideas of good and imposes his...
Modern Society
In the century roughly between 1870 and 1970, the social transition to adulthood end of school, first job, first marriage became more abrupt and uniform for a growing segment of the population. At the same time, the spread of universal, age-homogeneous public school and chronologically triggered public pension systems divided the life course into three boxes education, work, and retirement. In the modern life course, old age was transformed from a cultural category and a negotiated phase of...
Bibliography Oid
Adams, Carol J. 1990. The Sexual Politics of Meat A Feminist-Vegetarian Critical Theory. New York Continuum. Barr, James. 1974. Man and Nature The Ecological Controversy over the Old Testament. In Ecology and Religion in History, pp. 58-72, ed. D. Spring and E. Spring. New York Harper amp Row. Beauchamp, Tom L. 1997. Opposing Views on Animal Experimentation Do Animals Have Rights Ethics and Behavior 7 2 113-121. Brandt, R. B. 1979. A Theory of the Good and the Right. Oxford Clarendon Press....
The Experiment on Barney Clark
Barney B. Clark, a retired dentist who had been admitted to the University of Utah Medical Center on November 29, 1982, with cardiomyopathy, was deemed to be an ideal candidate for the first implant of the Jarvik heart Fox and Swazey as he was educated, enthusiastic, and had a very supportive family. He signed the eighteen-page consent form the night he was admitted to the hospital. When his heart began to fail on December 1, he was taken to the operating room, and after a nine-hour operation...
Bibliography Wxy
Barnhart, Michael G. 1998. Buddhism and the Morality of Abortion. Journal of Buddhist Ethics 5 276-297. Barnhart, Michael G. 2000. Nature, Nurture, and No-Self Bioengineering and Buddhist Values. Journal of Buddhist Ethics 7 126-144. Becker, Carl B. 1990. Buddhist Views of Suicide and Euthanasia. Philosophy East and West 40 543-556. Becker, Carl B. 1993. Breaking the Circle Death and Afterlife in Buddhism. Carbondale Southern Illinois University Press. Feldman, Eric A. 2000. The Ritual of...
Is Pet Keeping Immoral
Despite the emergence of a strong animal-rights movement since the mid-1970s, the ethics of pet keeping is seldom questioned. The major works in animal ethics Singer Clark, 1977 Regan Rodd largely or entirely bypass this question, and only lone voices are raised in critical opposition Linzey, 1976 Bryant . Animal-rights philosophy has evolved without offering any critical analysis of the pet trade, though some argue that abuse of pet animals is a human breach of contract Rollin, p. 219 . Since...
Milton Mayeroff A Personalist Vision
The 1971 book On Caring by American philosopher Milton Mayeroff 1925-1979 provides a detailed description and explanation of the experiences of caring and being cared for. Although he drew on several major themes from the history of the notion of care, he took the idea of care in new, personalist directions. Mayeroff s book is a philosophical essay that at the same time shares some of the characteristics of the care of souls tradition, inasmuch as Mayeroffs purpose was to show how care could...
Kantianism
A final example of an indirect duty view is provided by the great Prussian philosopher Immanuel Kant 1724-1804 . In some respects Kant's moral philosophy regarding the treatment of nonhuman animals is an amalgam of Aristotle's and, stripped of its appeals to God, Aquinas's. In concert with both, Kant emphasizes rationality as the defining characteristic of being human and, echoing Saint Thomas, objects to cruelty to animals because of the deleterious effect this has on how humans are treated....
Harms of Confinement
But there are hidden costs offsetting these benefits, the most important of which is the cost to the animals. The animals being produced in confinement are still essentially the animals that were genetically adapted to extensive conditions. Their fundamental biological interests are systematically violated in confinement. Thus animals that are built to move about are unable to do so. Social animals may be deprived of companionship. Air laden with dust and ammonia in confinement chicken, egg,...
Bioethics Perspective V The Colorblindness of Bioethics
Bioethicists, in efforts to be colorblind, white out the experience of color as a bioethical issue, as well as the harmful effects of racism on health. A colorblind bioethics has the unfortunate potential of increasing health inequalities if it recognizes only the larger ethical issue in a policy or practice, and not also how that policy might affect less dominant populations. When ethicists ignore race, they remove racism and its effects on health from ethical debate. In a sense, a colorblind...
Ongoing Ethical Concerns in the Practice of Behavior Therapy
Ethical practice has been a priority among behavior therapists. Nonetheless, concerns continue to arise. Particularly in cases where, at least potentially, the application of a technique can inflict pain, or where clients are relatively powerless or are involuntarily the subject of treatment, areas of ethical concern still remain. USE OF AVERSION PROCEDURES. The use of aversion procedures the application of subjectively unpleasant stimulation contingent upon performance of an undesirable...
Contractarianism
Among the most influential nontheological political and moral theories, contractarianism has a legacy that reaches at least as far back as Thomas Hobbes 1588 1679 and, among our contemporaries, includes such notable philosophers as John Rawls 1971 and Jan Narveson 1988 . Like other theorists united by a common outlook, contractarians often disagree on many of the most fundamental points. It will not be possible to do justice to the rich fabric of disagreement that characterizes proponents of...
Bibliography Pqb
Bostok, Stephen. 1993. Zoos and Animal Rights The Ethics of Keeping Animals. New York Routledge. Chiszar, David Murphy, James B. and Iliff, Warren. 1990. For Zoos. Psychological Record 40 1 3-13. Clifton, Merritt. 1988. Chucking Zoo Animals Overboard How and Why Noah Culls the Ark. Animals Agenda 8 2 14-22, 53-54. Cohen, Carl, and Regan, Tom. 2001. The Animal Rights Debate. Lanham, MD Rowman amp Littlefield Publishing. Cohn, Jeffrey P. 1992. Decisions at the Zoo. BioScience 42 9 654-659. Fox,...
Autonomy of Actions
In a clinical setting, it is often important to determine whether a patient's decision regarding treatment, or the decision of a proxy in the case of an incompetent patient, is autonomous. A person who has the capacity for autonomy may, for a variety of reasons, not act autonomously on a particular occasion. Determining whether a particular action or decision is autonomous is a matter of how the three elements of the capacity for autonomy agency, independence, and rationality are involved in...
Ontological and Moral Status of the Fetus
The question of the ontological status of the fetus can be teased apart from the question of moral status, but in the abortion debate, fetal personhood and the possession of moral rights are often assumed to go hand in hand. The term person, however, is ambiguous, having a legal, a descriptive, and a normative sense. To be a legal person is simply to possess legal rights. In Roe v. Wade 1973 , the Supreme Court held that fetuses are not persons as defined by the 14th Amendment of the...
Culture Morality and the Problem of Relativism
The landscape of bioethics in particular the bedside practices of clinical ethics and research procedures is informed by the intellectual and ideological orientations of the analytic philosophers who were key figures in shaping the development of the field. Much work in bioethics reinforces and sustains an Enlightenment preoccupation with the primacy of the individual, rational man. Although theoretically it need not, the field's emphasis on rational decision making and individual autonomy...
Bibliography
Adler, Nancy E. David, Henry P. and Major, Brenda N. et al. 1990. Psychological Responses After Abortion. Science 248 41-44. Almeling, Rene Tews, Laureen and Dudley, Susan. 2000. Abortion Training in U.S. Obstetrics and Gynecology Residency Programs, 1998. Family Planning Perspectives 32 6 268-271. American College of Obstetricians and Gynecologists. 1997. Statement on Intact D amp X. Washington, D.C. The American College of Obstetricians and Gynecologists. American College of Obstetricians and...
The Selective Abortion Controversy
The development of tests to prenatally diagnose genetic diseases and disorders has greatly outpaced the development of effective treatments and therapies. The Human Genome Project promises to accelerate the development of prenatal diagnostic tests. Through procedures like chorionic villus sampling CVS , which can be performed at ten weeks gestation, and amniocentesis, available at fourteen to sixteen weeks, numerous genetic abnormalities in the fetus can be detected in utero. The tests are...
Open versus Closed Adoption
Since the early 1980s there has been a trend toward openness in adoption. In the placement of older children, good adoption practice dictates providing each child with a life book that has information and photographs about their history. Often these children are encouraged to maintain contact with the previous foster mother and with relatives, such as grandparents, in the extended birth family. In infant adoption, a birth mother may choose the parents for her baby, but completely open...
V Zoos And Zoological Parks
Wild animals have been displayed in captivity for millennia Luoma . The first known large collections were assembled in Egypt around 2500 b.c.e. Early rulers displayed their exotic menageries, captured during campaigns or expeditions, for personal amusement and as symbols of wealth and political power. Romans later maintained menageries for bloody public spectacles, sending elephants, lions, bears, and other wildlife into battle in arenas throughout Europe. Urban zoos appeared in...
Bibliography Ama
Alcoholics Anonymous World Services. 1976. Alcoholics Anonymous, 3rd edition. New York Author. Ames, Genevieve M. 1985. American Beliefs about Alcoholism Historical Perspectives on the Medical-Moral Controversy. In The American Experience with Alcohol Contrasting Cultural Perspectives, pp. 23-39, ed. Linda A. Bennett and Genevieve M. Ames. New York Plenum. Anglin, Douglas M. 1982. Alcohol and Criminality. In Encyclopedic Handbook of Alcoholism, pp. 383-394, ed. E. Mansell Pattison and Edward...