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Biomedical subjects

D C Thomasma

Publications and source records attributed to D C Thomasma.

At least 37 records · Page 2Linked to original sources
PubMed1997

Bioethics and international human rights.

Noting how the spread of medical technology is creating clashes with traditional values and within cultures, the author addresses the clash between Western rights-based incentives, as used by the United Nations to guarantee respect for life and dignity, and communitarian traditions. He proposes a mean between wholesale cultural relativism and international absolutism.

Bioethical Issues↗
PubMed1996

Marketing human organs: the autonomy paradox.

The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a "gift of life" and a "commodity exchange." The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources.

Altruism↗
PubMed1996

Promisekeeping: an institutional ethos for healthcare today.

The relationship between a physician and a patient, which survived unchanged for decades--indeed centuries--has in recent years undergone a serious change due to the advent of managed care. Controlling costs and maximizing profits are now as equally important as medical concerns, and ethical, economic, and political issues have forever changed the way physicians perform their duties. This article proposes the concept of promisekeeping as a remedy to the sometimes contradictory positions in which patients and providers find themselves. Composed of honesty, explicit disclosure, flexible decision making, and, most of all, beneficence, promisekeeping is one method to ensure that all parties in the managed care system can succeed.

Cost Control↗
PubMed1996

The ethics of managed care: challenges to the principles of relationship-centered care.

Health care reform involves ethical issues on many levels. First, the impetus to reform the health care system stems in large part from concerns about equity, just distribution of goods and services, and commitments to one another in society. Health care itself is more than a commodity, it is a personal healing activity carried out through institutions that embody values such as respect for persons, the value of human life, and duties to care for individuals who suffer. These issues fall under major overarching concerns on the macro level. Reform, however, often functions as a euphemism for changing the health care system to provide greater profitability, and for controlling costs. Admittedly, such changes can be disguised under reforming the health care system, and indeed, some of them are capable of enhancing and simultaneously making more efficient, our care for one another when sick. Most changes, nonetheless, are clearly driven from less noble ideals. Every schema for providing care also embodies values since these schemas presuppose various competing notions of justice and equity. Further, they may endanger long-held values of health care providers in meeting the needs of patients. As part of state or local-level changes in the health care system, issues in this category can be called micro level concerns. when all the changes impact on individuals, either providers of care, or the patients themselves, then the issues are of concern on the personal level. This essay, therefore, examines ethical issues presented by managed care networks on the macro, micro, and individual level, with special attention paid to the health care relationship. The subtitle of the essay points out the focus of the discussion on the impact of these changes for more traditional models of relationship-centered care.1 In particular, the essay concentrates on health providers, including allied health professionals, that in the past were grouped into the category of primary care givers but ought to be called first-level care givers today.

Beneficence↗
PubMed1994

Clinical ethics as medical hermeneutics.

There are several branches of ethics. Clinical ethics, the one closest to medical decisionmaking, can be seen as a branch of medicine itself. In this view, clinical ethics is a unitary hermeneutics. Its rule is a guideline for unifying other theories of ethics in conjunction with the clinical context. Put another way, clinical ethics interprets the clinical situation in light of a balance of other values that, while guiding the decisionmaking process, also contributes to the very weighting of those values. The case itself originates ideas, not only about which value ought to predominate in its resolution, but also provides the origin of clinical rules that can be used in other cases. These are interpretive rules. Some examples of these rules are presented as well.

Beneficence↗
PubMed1993

The ethics of letting go.

Emphasis in medical training is laid on therapeutic approaches that prolong life at all costs. This training is reinforced by current medical practices in the United States and by an ever-expanding medical technology, such that it becomes difficult, if not impossible, to "let the patient go." In response, individuals promote the "right-to-die" and euthanasia, so that patients may maintain their human dignity during the dying process. A more rational and nonpolarized approach to this issue would be to strive for the preservation of human function, not physiological function alone. The goal would include helping patients advance their life plans and values. On this basis, therapies can be withheld and withdrawn when they no longer reflect these goals. Caution regarding potential abuses of this approach need to be raised, however, when considering care for the very vulnerable of society. In that regard, therapeutic goals directed at maintaining human function need to be developed in parallel with global societal values regarding quality of life issues.

Beneficence↗