Search PubMed⌕ Search

Biomedical subjects

Dan W Brock

Publications and source records attributed to Dan W Brock.

17 recordsLinked to original sources
PubMed2003

Separate spheres and indirect benefits.

On any plausible account of the basis for health care resource prioritization, the benefits and costs of different alternative resource uses are relevant considerations in the prioritization process. Consequentialists hold that the maximization of benefits with available resources is the only relevant consideration. Non-consequentialists do not reject the relevance of consequences of benefits and costs, but insist that other considerations, and in particular the distribution of benefits and costs, are morally important as well. Whatever one's particular account of morally justified standards for the prioritization of different health interventions, we must be able to measure those interventions' benefits and costs.There are many theoretical and practical difficulties in that measurement, such as how to weigh extending life against improving health and quality of life as well as how different quality of life improvements should be valued, but they are not my concern here. This paper addresses two related issues in assessing benefits and costs for health resource prioritization. First, should benefits be restricted only to health benefits, or include as well other non health benefits such as economic benefits to employers from reducing the lost work time due to illness of their employees? I shall call this the Separate Spheres problem. Second, should only the direct benefits, such as extending life or reducing disability, and direct costs, such as costs of medical personnel and supplies, of health interventions be counted, or should other indirect benefits and costs be counted as well? I shall call this the Indirect Benefits problem. These two issues can have great importance for a ranking of different health interventions by either a cost/benefit or cost effectiveness analysis (CEA) standard.

Journal Article↗
PubMed2002

Human cloning and our sense of self.

This Viewpoint formulates and responds to three lines of argument concerning human reproductive cloning's potential to undermine our sense of self or identity. First, cloning would undermine our sense of individuality or uniqueness. But it could only undermine our genetic uniqueness, not our full individuality. Second, cloning would undermine the value or worth of human beings. But it would not make individuals replaceable or of any less moral worth. Third, a clone's freedom or autonomy to construct his or her own life would be undermined by the presence of an earlier twin. But only a mistaken belief in genetic determinism supports this feared loss of freedom.

Cloning, Organism↗
PubMed1995

The non-identity problem and genetic harms -- the case of wrongful handicaps.

The Human Genome Project will produce information permitting increasing opportunities to prevent genetically transmitted harms, most of which will be compatible with a life worth living, through avoiding conception or terminating a pregnancy. Failure to prevent these harms when it is possible for parents to do so without substantial burdens or costs to themselves or others are what I call "wrongful handicaps". Derek Parfit has developed a systematic difficulty for any such cases being wrongs -- when the harm could be prevented only by preventing the existence of the individual who would have a worthwhile life even with the handicap, then bringing him into existence with the handicap does not make him worse off and so does not wrong him. I argue that a non "person-affecting" principle requiring the avoidance of suffering and limited opportunity correctly accounts for cases of wrongful handicaps without requiring that the individuals with the handicap have been made worse off and therefore wronged. It is an advantage, not a difficulty, of this account that it does not imply that the person with the handicap has been wronged or is a victim with a special moral complaint.

Abortion, Eugenic↗
PubMed1993

A proposal for the use of advance directives in the treatment of incompetent mentally ill persons.

[M]y question is how these patients while competent might be able to give their own informed consent to treatment, despite being both unwilling and incompetent to do so when treatment is to be begun, thereby reducing the need to relax the dangerousness criteria for involuntary commitment. It is uncontroversial that the dangerousness requirement would be too restrictive for all treatment of mental illness. When competent patients voluntarily seek and/or accept treatment for their mental illness, neither public policy nor medical practice restricts treatment to those patients judged to be dangerous. Instead, criteria should be and generally are comparable to those for the treatment of physical illness -- whether the patient is ill, in this case mentally ill, and likely to benefit from treatment. Through use of advance directives, it would be possible for mentally ill persons who are currently refusing treatment to give prior consent, while competent and with their disease in remission, to treatment at a later time when they are incompetent, have become noncompliant, and are refusing treatment. My proposal is certainly not entirely novel, since others have made similar proposals under the heading of Ulysses contracts and voluntary commitment contracts. Addressing briefly some of the criticisms of these earlier proposals will bring out one fundamental difference between them and my proposal here for a new use of advance directives -- whether the patient must then be incompetent when the contract or directive made earlier is later invoked -- a difference I shall argue strongly favors my proposal.

Advance Directives↗
PubMed1992

What is the moral basis of the authority of family members to act as surrogates for incompetent patients?

... The authority of family members should be understood as presumptive; that is, there is a moral presumption that a close family member should serve as surrogate for an incompetent patient. That presumption can be overcome or rebutted in a particular case, either when there is sufficient evidence that the usual reasons supporting this presumption do not hold or when the surrogate's decision exceeds appropriate limits of surrogates' decision-making discretion. In order to clarify these hard cases and appropriate public policy, we need a much deeper and more complex analysis than either the conventional view, or the alternative account that Pearlman and colleagues provide. I have sought here only to point toward some of the other grounds that a full account of family members' authority as surrogates would have to develop and explore in much more detail....

Aged↗
PubMed1991

Decisionmaking competence and risk.

Mark Wicclair criticizes Allen Buchanan's and my claim that determining an appropriate level of competence (Wicclair substitutes "decisional capacity" for "competence", the import of which I note briefly below) for health care treatment decisionmaking involves balancing respecting a patient's self-determination and protecting his or her well-being. The most important implication of this balancing is that a standard of competence should vary in significant part with the effects for the patient's well-being of accepting his or her choice. Wicclair's criticisms take two main forms. First, he considers and rejects four of the positive reasons we offer in support of a risk-related standard. Second, in rejecting our fourth reason he argues that a risk-related standard leads to faulty competence determinations -- too high a standard in some cases and too low a standard in others. If he is correct, there are no positive reasons for adopting a risk-related standard and there are as well specific reasons not to adopt such a standard in order to avoid mistaken competence determinations. My response will address both sorts of criticisms in turn.

Altruism↗
PubMed1986

Deciding for others.

Decision making for incompetent elderly people is an increasingly serious issue for American society. The decision-making processes we choose will reflect choices among a number of ethical principles--those specifying the purpose of substituted judgment, those guiding the surrogate decision maker, and those used in choosing the surrogate--and depends as well on the way we construe the concept of decision-making competence.

Advance Directives↗
PubMed1985

Taking human life.

Explore the source record for details and available documents.

Ethical Analysis↗
PubMedDate not supplied

Practicing the PSDA.

Explore the source record for details and available documents.

Advance Directives↗