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Biomedical subjects

B Gert

Publications and source records attributed to B Gert.

At least 19 recordsLinked to original sources
PubMed2001

A technique for presenting risk and outcome data to potential living renal transplant donors.

BACKGROUND: Transplant centers have become increasingly interested in living donor kidney transplantation and have always had the obligation to counsel these donors fairly. Counseling techniques vary markedly among centers and can include overly qualitative or unintentional but covertly prescriptive presentation of risk and benefit. METHODS: We describe a simple technique using preprinted fields of stick figures for presenting important risk and benefit data to potential renal donors. We also suggest an approach to formulating basic statistics for donor counseling. RESULTS: Risk and benefit statistics can be presented visually and quantitatively in a way that minimizes the need for donor sophistication and also displays the "all or nothing" nature of adverse events in donor and recipient populations, as opposed to using of percentages or prescriptive phrases by the donor counselor. CONCLUSION: Such stick figure field counseling for living renal transplant donors accurately provides information to both donor and center, appropriately facilitates center impartiality, and may increase the center's and the donor's confidence in the counseling process.

Counseling↗
PubMed2000

Ethical selection of living kidney donors.

Renal transplant centers vary markedly in their rates of living donor kidney transplantation. Recent surveys also document marked differences among centers in both appreciation of medical risk for donation and what constitutes ethical donor selection. Because of this marked variability, some donors likely are being inappropriately denied or others are being inappropriately accepted. In addition to defensible donor education about risk and benefit, three fundamental obligations of the center are identified: (1) to recognize that it is often ethical to participate in acts of individual risk and sacrifice that are performed to benefit others; (2) to not deny transplantation without good reason to donors and recipients who apply to the center; and (3) to neutralize, but not overreact to, center self-interest, which stems from the professional benefits of transplantation and the center's desire to help potential transplant recipients. The basic medical facts surrounding donation must be understood by all parties as part of ethical decision making. Donor risk can be presented quantitatively using US Renal Data System data as a baseline. Confirmation of accurate donor understanding of risks, benefits, and alternatives is always a fundamental center obligation. Donors should not be rejected except for the general reasons we identify, and when these reasons do not seem to apply, the decision to deny transplantation should be reconsidered.

Academic Medical Centers↗
PubMed2000

Common morality versus specified principlism: reply to Richardson.

In his article 'Specifying, balancing and interpreting bioethical principles' (Richardson, 2000), Henry Richardson claims that the two dominant theories in bioethics--principlism, put forward by Beauchamp and Childress in Principles of Bioethics, and common morality, put forward by Gert, Culver and Clouser in Bioethics: A Return to Fundamentals--are deficient because they employ balancing rather than specification to resolve disputes between principles or rules. We show that, contrary to Richardson's claim, the major problem with principlism, either the original version or the specified principlism of Richardson, is that it conceives of morality as being composed of free-standing principles, rather than as common morality conceives it, as being a complete public system, composed of rules, ideals, morally relevant features, and a procedure for determining when a rule can be justifiably violated.

Bioethics↗
PubMed1996

The nature and limits of violence.

I take advantage of a point made by H. J. Gert, in "Rights and Rights Violators: A New Approach to the Nature of Rights" (The Journal of Philosophy 1990; 87 (12): 688-694) to provide the following definition of violence. "Violence is an intentional or knowing attempt by a moral agent to directly cause harm, i.e., death, pain, disability, loss of freedom or pleasure, to someone who is protected by morality without the consent of that person." I show how this definition applies to violence in hospitals and discuss some of the ethical problems created by violent patients.

Allied Health Personnel↗
PubMed1993

The method of public morality versus the method of principlism.

Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge to us to show that our account of mortality is more adequate than principlism. In particular we show that recognition of mortality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label "Dartmouth Descriptivism."

Beneficence↗
PubMed1992

A sex caused inconsistency in DSM-III-R: the definition of mental disorder and the definition of paraphilias.

The DSM-III-R definition of mental disorder is inconsistent with the DSM-III-R definition of paraphilias. The former requires the suffering or increased risk of suffering some harm while the latter allows that deviance, by itself, is sufficient to classify a behavioral syndrome as a paraphilia. This inconsistency is particularly clear when examining the DSM-III-R account of a specific paraphilia, Transvestic Fetishism. The author defends the DSM-III-R definition of mental disorder and argues that the DSM-III-R definition of paraphilias should be changed. He recommends that the diagnostic criteria for specific paraphilias, particularly that for Transvestic Fetishism, be changed to make them consistent with the DSM-III-R definition of mental disorder.

Female↗
PubMed1990

A critique of principlism.

The authors use the term "principlism" to refer to the practice of using "principles" to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these "principles" do not function as claimed, and that their use is misleading both practically and theoretically. The "principles" are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for consideration when dealing with a moral problem. The "principles" lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory.

Beneficence↗
PubMed1990

The inadequacy of incompetence.

Patients' competence to make medical decisions, analysts frequently hold, is the key concept for determining whether those decisions may be overruled. Competence, however, is neither a necessary nor a sufficient condition for concluding when it is morally admissible to supersede refusals of treatment. People may be able to reach kinds of decisions involving immediate medical consequences, but not ones entailing long-term outcomes. Open recognition of the limited but important exceptions to the principle of never overruling competent patients' refusal of care would better preserve their autonomy than unduly accepting the absoluteness of the principle.

Beneficence↗
PubMed1989

Moral theory and neurology.

This article presents an outline of a general moral theory and shows its relationship to the concepts of paternalism and that of valid consent and refusal. The authors then show how this theory and these concepts can be usefully applied to the moral problems that neurologists often face in determining how to act when they have distressing information for their patients. Finally, a procedure is provided for determining when it is morally justified to deceive patients by withholding information about their diagnoses, prognoses, or about their prospective treatments.

Comprehension↗
PubMed1986

Rationality in medicine: an explication.

Various meanings of "rational" implicitly and explicitly suggested in this issue's articles are abstracted and stated. Two accounts of rationality are shown to be able to explain most uses of "rational": the "cool moment" account and a more objective account. The former is examined and modified, but still found inadequate. The objective account of rational is developed, taking "irrational" as the basic concept. "Irrational" is given content in terms of a list, and "rational" is subsequently defined as "not irrational". Reasons and motives are defined and distinguished. The advantages of the objective account are explored and some challenges to it are answered.

Consumer Behavior↗