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Breast cancer in two regimes: the impact of social movements on illness experience.

This article uses the narrative of one woman, Clara Larson, to explore changes over time in the experiences of illness available to women diagnosed with breast cancer. To claim that different illness experiences become available at different times is simply to acknowledge that experiences of disease are shaped not only by the individual circumstances of disease sufferers and the particular character of their pathologies, but by culturally, spatially and historically specific regimes of practices. This article explores the impact of social movements on the regime of breast cancer and makes four contributions to the scholarship on illness experience. First, it offers the concept disease regime as a way of conceptualising the structural shaping of illness experience. Second, it demonstrates the value of incorporating social movements more thoroughly into the study of illness experience. Third, it proposes that social movements change illness experiences in two ways: (1) by changing the sufferer or her relationship to the regime's practices; and (2) by changing and expanding the regime's actual practices. And fourth, it demonstrates how gender and sexuality are constituted within disease regimes and are challenged by social movements. This article is informed by four years of ethnographic research conducted in the San Francisco Bay Area between 1994 and 1998, supplemented by historical research and more than 40 taped interviews and oral histories with current and former breast cancer patients, activists, educators, scientists, support group leaders and volunteers.

Breast Neoplasms↗

Death, democracy and public ethical choice.

The Danish Council of Ethics...believed that the brain-death criterion should not be accepted without public education and debate. Following the introduction of a spectrum of educational and related activites, a Gallup poll found that 98% of the survey population was aware of the debate over brain-vs-heart criteria and that 80% favoured the adoption of a supplemental brain-death standard... This raises the fundamental question of decisionmaking in pluralist democratic societies, of the limits of democratic involvement in such choices, and of the role of bodies like the Danish Council of Ethics... It must be part of the mission of a governmental bioethical body to use its peculiar expertise to teach and to lead -- to build a popular consensus out of confusion. But in doing so, such a Commission will be steering a dangerous course....

Advance Directives↗

Ethics consultation as moral engagement.

I will begin by presenting some doubts about what might be called the "received view" of the role of the moral expert as a health care consultant. Then I will review the literature on moral experts and moral expertise and proceed to apply the results of that review to the notion that there are some who are expert in ethical decision making in health care. I will try to show that certain conclusions that can be drawn from this rather circumscribed topic have implications for the very conception of the relationship between moral theory and clinical ethics.

Bioethical Issues↗

The impossibility and necessity of quality of life research.

There are probably a number of reasons why the medical community pays surprisingly little systematic attention to quality of life, either in research or in clinical care. Possibly our society's fascination with high technology and the rescue of endangered lives has encouraged the medical profession to focus on acute care, where their interventions can bring dramatic results. And perhaps because such high-tech acute care requires great knowledge and skill, medical educators have not devoted as much time to educating students and residents about the more mundane matters of medicine. Another reason, on which I will focus here, is the fact that scientific research into quality of life is particularly difficult, methodologically. It does not lend itself easily to the crisp, clean answers for which we strive in basic science. It is "soft," inexact, not "hard." In this article I hope to explain why such research is indeed fraught with hazard. The scientists are attempting a task that is, in a profound philosophical sense, impossible. They have no direct access to the data they most need, and every method of validating their results is fundamentally flawed. Nevertheless, I will also suggest how we can fruitfully undertake such research and, equally important, why we must.

Attitude↗

What has bioethics to offer the developing countries.

My paper consists of three parts. In the first part I try to explain the intellectual basis of bioethics in developing countries. In the second part I describe the bioethical dilemmas facing these countries. In the third part I shall discuss the changes that have to be made in bioethics if it is to take root in these countries, and thereby help them to improve the human existence.

Bioethical Issues↗

Teaching bioethics to future health professionals: a case-based clinical model.

In summary, I believe that ethics teaching based on actual cases, presented in a small-group format led by a clinician and an ethicist, offers the best prospect for achieving these goals. The physician serves as a role model and ensures that information and options are medically accurate. The ethicist helps to identify morally relevant features, can articulate ethical principles, and direct students to the appropriate literature. This method does not guarantee that the behavior of future health professionals will always be humane or ethically sound. But it is likely to get future health professionals to think about what they are doing when they encounter cases that resemble those discussed in teaching conferences devoted to clinical ethics.

Bioethical Issues↗

Bioethics in a low key: a report from Germany.

I now, by way of reporting rather than analysing (see my title) would like to do two things; first to give a sketch of bioethical priorities as implied in public political debate and legislation, and second to mention some of the bioethical research activities on the academic level. Important under the first heading seem to me three contexts of activity: the passing of a genetic engineering law (Gentechnikgesetz)in 1990, the passing of a law for the protection of embryos (Embryonenschutzgesetz) in 1990 too, [and] the reforming of the presently divided status of the penal code on abortion this year, 1992 (Schwangerschaftsabbruch).

Abortion, Induced↗

Ethics in a bicultural context -- a report from New Zealand.

The distinctiveness of Bioethics in New Zealand stems in part from a renewal of emphasis on Maori rights, based on the Treaty of Waitangi, the foundation document of the New Zealand state. Increasingly, committees dealing with health research ethics and with the ethics of assisted reproductive technology have to incorporate Maori values and perspectives.

Advisory Committees↗

Bioethics: an African perspective.

In this paper I have attempted to open a window on an African approach to Bioethics -- that of the Nso' of the Bamenda Highlands of Kamerun [Cameroon] -- from the vantage position of someone who has familiarity with both African and Western cultures. Because of its scientific-cum-technological sophistication and its proselytising character, Western culture, as well as Western systems of thought and practice, have greatly affected and influenced other cultures, particularly African culture. But Western culture, systems of thought and practice, have been highly impervious and immune to influences from other cultures, philosophies, systems of thought and practice, even where these might have been salutary and enriching to Western culture and systems. What I have here termed Nso' eco-bio-communitarianism clearly indicates a viable alternative world-view within which some of the bioethical perplexities and controversies of today might be more satisfactorily resolved than within a Western framework. I have further attempted to show, by way of example, how, within such a world-view, abortion and suicide, for instance, would be disapproved of while euthanasia, in its etymological purity, is approved of.

Abortion, Induced↗

Defining death.

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Bioethical Issues↗