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PubMedDate not supplied

Why bioethics needs the philosophy of medicine: some implications of reflection on concepts of health and disease.

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the "science" of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderate of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice.

Attitude to Health↗
PubMed1995

The bioethical standards: the analysis of dilemmas through the analysis of persons.

The contemporary bioethical standards: autonomy, freedom, objectivity, privacy, beneficence, and fidelity are maximally appropriate to the health care setting. It is a common but erroneous belief that they are instruments for the analysis of dilemmas. They are not. They are instruments for the analysis of the character-structure of the person whose role in the dilemma is that of beneficiary. When the bioethical standards are used in this way they produce an understanding that tends to unite nurse and patient in harmonious interactions. These interactions produce results appropriate to ethical agents in a human context. These results are not accidental.

Decision Making↗
PubMed2005

Unesco's proposed Declaration on Bioethics and Human Rights - a bland compromise.

The latest (June 2005) draft of UNESCO's proposed Universal Declaration on Bioethics and Human Rights is a major disappointment. The committee of government 'experts' that produced it made sure that it would not introduce any new obligations for States, and so the document simply restates existing agreements and lists desirable goals without specifying how they can be achieved. This article focuses on the shortcomings of the document as it would apply to health care. These shortcomings are evident in the document's scope, aims and principles. The conclusion is that if UNESCO still thinks that such a declaration is needed, it should produce either an ethical document addressed to individuals and groups, which would be primarily educational in nature, or a legal document addressed to States, which should not have the word 'ethics' in its title.

Advisory Committees↗
PubMed1997

The heterogeneity of clinical ethics: the state of the field as reflected in the Encyclopedia of Bioethics.

The 1995 Encyclopedia of Bioethics is an almost complete reworking of the original 1978 edition, due to the expanding nature of the field. The following article focuses on how the second edition of the Encyclopedia deals with the topic of "clinical ethics" and three related topics: "nursing ethics", "trust", and "conflict of interest". We assess their relevance to the current developments in these fields and the Encyclopedia's usefulness as a resource to ethics consultants, researchers and clinicians. We emphasize the heterogeneity of clinical ethics as a still new and evolving field.

Bioethical Issues↗
PubMed2004

A gower maneuver: the American Society for Bioethics and Humanities' resolution of the "Taking Stands" debate.

The American Society for Bioethics and Humanities debated for several years about whether it should adopt positions and, if so, on what range of issues. The membership recently approved an amendment to its bylaws permitting the Society to adopt positions on matters related to academic freedom and professionalism but not on substantive moral and policy issues. This resolution is problematic for a number of reasons, including the lack of a categorical difference between these types of claims and the Society's inability to speak on behalf of patients and research subjects. The implementation of the amendment also raises several issues. The Society will need to refrain from speaking too specifically and to articulate the responsibilities of its members. If the Society fails to address these concerns, it runs the risk of denigrating its public image and that of the profession.

Bioethical Issues↗
PubMed1999

The dream of consensus: finding common ground in a bioethical context.

Consensus is the holy grail of bioethics, the lynch pin of the assumption that well informed, well intentioned people may reach generally acceptable positions on ethically contentious issues. It has been especially important in bioethics, where advancing technology has assured an increasing field of complex medical dilemmas. This paper results on the use of a multicriterion decision making system (MCDM) analyzing group process in an attempt to better define hospital policy. In a pilot program at The Hospital for Sick Children, Toronto, a series of small scale focus groups was constituted to examine criteria defining organ transplant eligibility. Criteria were organized hierarchically using the Analytic Hierarchy Process, an MCDM approach, and the resulting data was analyzed using Expert Choice 9.0, software designed to facilitate AHP analysis. Qualitative and quantitative analysis map barriers to practical consensus in a way not previously possible.

Child↗
PubMed1997

Transplant of bone marrow and cord blood hematopoietic stem cells in pediatric practice, revisited according to the fundamental principles of bioethics.

The two most widely used sources of hematopoietic stem cells for allogeneic transplants in pediatric practice are bone marrow (BM) and cord blood (CB). While bone marrow transplantation (BMT) is reaching its 30th year of application, human umbilical cord blood transplantation (HUCBT) is approaching its 10th. Although these procedures have basically the same purpose, a number of biological differences distinguish them. In particular, the intrinsically limited quantity of CB stem cells and their immunological naiveté confer peculiar characteristics to these hematopoietic progenitors. From a bioethical point of view, the problems which have repeatedly been raised when the BM donor is a child are well-known. Different but no less important ethical problems are raised when one considers HUCBT; in this regard the most important issues are the easier propensity of programming a CB donor in comparison with a BM donor (clearly due to the shorter time interval needed to collect the hematopoietic progenitors); the in utero HLA-typing; the implication of employing 'blood belonging to a neonate' for a third party; the need to perform a number of investigations both on the CB of the donor and on the mother and the implications that the discovery of disease may have for them, but also the need to establish banks for storing CB, with the accompanying administration and management problems. All these different aspects of UCBT will be discussed in the light of the four fundamental and traditional principles of bioethics, namely autonomy, nonmaleficence, beneficence and justice.

Bone Marrow Transplantation↗
PubMed2006

Bioethics in human nutrigenomics research: European Nutrigenomics Organisation workshop report.

As part of its work on setting standards and establishing guidelines for nutrigenomics research, the European Nutrigenomics Organisation (NuGO) is developing bioethical guidelines for those engaged in human nutrigenomics studies. A NuGO working group developed a set of draft guidelines addressing four areas: (1) information and consenting prior to a nutrigenomics study; (2) the generation and use of genotype information; (3) the establishment and maintenance of biobanks; (4) the exchange of samples and data. NuGO convened a workshop with a panel of invited external experts to assess the draft guidelines. The panel of experts confirmed that these areas are important and that the development of specific bioethical guidelines for nutrigenomics research would therefore enhance the application of established international guidelines in this field of biomedical research.

Biomedical Research↗
PubMed1998

The coevolution of bioethics and the medical humanities with palliative medicine, 1967-1997.

The Department of Humanities that I chair at the Pennsylvania State University College of Medicine was the first such department ever established at any medical school. It opened in 1967. In that same year, St. Christopher's, the first modern hospice, opened in London. Merely a coincidence? I do not think so. The forces that propelled bioethics and the humanities into medical education were the same forces that called the modern hospice movement into being. Over the past three decades, both movements have evolved together, nourishing each other and challenging each other. This essay will sketch three phases in the coevolution of bioethics and the medical humanities on the one hand, and hospice and palliative medicine on the other. The first phase I will call the common matrix of concern. The second phase I will call the elaboration of the concept and practice of "whole person care." The third phase I will call the era of public policy and corporate medicine.

Journal Article↗
PubMed1977

Some additional bioethical questions related to hepatitis B antigen.

Dr. Baruch S. Blumberg has recently raised important questions concerning the bioethics of prevention and cure of hepatitis. This paper extends his inquiry with a view toward examining the full range of the complexity of such issues as the restriction of the use of blood infected with hepatitis B antigen, the screening and possible isolation of health care personnel found to be carriers, and the like. It pointed out that for issues like these, there is not only a conflict between personal liberties and the public interest but also a potential conflict of individual rights, a theme not treated fully by Blumberg. The complex issues that emerge when these two themes are considered together are examined in light of the work of the contemporary American philosopher, John Rawls. His theory permits one to consider these two ethical themes together in analyzing moral problems. In this light, a new strategy is proposed for addressing bioethical questions concerning hepatitis B antigen.

Blood Donors↗
PubMed1995

Human action and God's will: a problem of consistency in Jewish bioethics.

The religious legitimacy of medical practice was an issue of serious contention amongst medieval Jewish scholars. For Nahmanides, altering the patient's fate through manipulation of natural causality amounts to circumventing divine judgment. For Maimonides, however, human accomplishment is part of God's providential design; this view generally prevails in contemporary Jewish bioethics. But the doctrine of deligitimizing human intervention continues, even while unacknowledged, the underlie certain contemporary positions. These include arguments within Jewish bioethics about end-of-life decisions, which are therefore imbued with inconsistencies. It is suggested that, given the overall endorsement of modern medicine, the Nahmanidean approach must be explicitly confronted.

Ethics, Medical↗
PubMed1996

Moral consensus in public ethics: patient autonomy and family decision-making in the work of one state bioethics commission.

Focusing on the work of one bioethics commission, the New York State Task Force on Life and the Law, this article explores the role played by moral consensus in public ethics. Task Force members, who were appointed to represent diverse interests in New York State, identified a culturally strong value of individual autonomy as the ethical basis for their work on life-sustaining treatment. This moral consensus permitted the members to unite across their differences and develop public policy recommendations that substantially reformed a highly troubling New York law. However, the principle of autonomy insufficiently guides decisions by caring family members for incompetent adults in cases where little is known of patient preference. A different, more innovative moral vision is required--one that grants a more robust moral authority to the family. While government efforts that rely on moral consensus developed in a broad-based and well-reasoned manner can serve us well, in some cases the consensus will provide inadequate moral guidance. Government bioethical efforts must guard against the limits of moral vision in light of their disproportionate societal power.

Adult↗
PubMed1999

The medical futility controversy: bioethical implications for the critical care nurse.

Medical futility is a recent, complex bioethical issue. There is disagreement about how futility should be defined and who should be involved in futility decisions when an impasse exists between the patient/family and the physician. Bioethical discussions about Quinlan and Cruzan of the past have been replaced with the Wanglie, Baby K, and Linares cases--all of which involved critical care settings. Nurses often are involved in the debate and encounter ethical conflicts. Cost-containment, managed care, scarce resource allocation, and care due the elderly have fueled the debate. Key issues and their importance for critical care nurses will be reviewed.

Conflict, Psychological↗
PubMed1995

HIV+/AIDS related bioethical issues in Japan.

Annual and cumulative incidences of HIV+ and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV+ or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each of the following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV+ and AIDS patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical consideration.

AIDS Serodiagnosis↗
PubMed1996

[In search of a national forum for bioethics in Brazilian public policy]

This article focus on bioethics as a public policy issue. It analyzes the main existing international codes on biomedical ethics and presents a brief review of the work of some national bioethics committees in developing countries. The author concludes by commenting on the most relevant and controversial aspects to be considered in the Brazilian experience.

Journal Article↗
PubMed1984

Bioethics and health care in industrial society.

Due to rapid development, industrial societies must now make a fresh start based on a new idea of society which will enable them to survive the fast approaching 21st century. In this situation, health problems must be dealt with not only by medical science but also by research in other areas such as economics and technology. In fact, we are now in a situation in which problems of health and health care can no longer be solved without cooperation from these other research areas. What is most necessary is a new ethical standard. This can be developed through ideas based on a system of bioethics in which Occidental humanism and Oriental humanism are combined to a substantial degree. I believe that the establishment of this type of bioethics can lead to the successful institutionalization of health, health care and welfare for the 21st century.

Environmental Health↗
PubMedDate not supplied

[Resistant vegetative state: considerations regarding bioethics of contemporary medicine].

INTRODUCTION: The diagnosis and conduct toward persistent vegetative state (PVS) is one of the emergent themes in bioethic in our contemporary society. This clinical condition is defined. DEVELOPMENT: To homologate PVS with brain death (BD) is one of the most discussed present controversies at the bioethic international area. If we keep in mind the present concepts of BD, it's not correct to homologate both terms. There is an increasing practice in admitting the end of medical treatment in PVS. In fact, with the introduction of cost-effectiveness concept in intensive medicine, the right to treatment of these patients is discussed at Intensive Care Units. Some present criteria about this are presented, taking age into consideration, diagnostic certainty and the establishment of function recovery prognosis. CONCLUSIONS: The introduction of recently developed models for the rehabilitation of patients with severe brain injuries and PVS may lead to substantial improvements in outcome and may also be cost efficient. It is not ethical to make an arbitrary decision to withdraw a medical treatment of a patient, when we know there is the structural possibility of recovering some functions.

Brain Death↗
PubMedDate not supplied

Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics.

The statement on informed consent, parental permission, and patient assent has a long and extraordinary history. The first draft of this document, prepared by William G. Bartholome, MD, was presented to the original American Academy of Pediatrics (AAP) Committee on Bioethics in 1985. Bill put his soul into the manuscript and has watched over it carefully ever since. Now, a decade later, those who have worked on its continued development and urged its adoption as Academy policy applaud its publication. No one is more gratified than its primary author and champion. Those who have had the privilege to know Dr. Bartholome share his sense of accomplishment, but cannot help but experience a cruel sense of irony. Just as the work Bill considers his most important contribution has become available for public appreciation, Dr. Bartholome suffers from a serious illness that threatens his life. Bill always wanted "the experience, perspective, and power of children" to be taken most seriously. Through the years of the statement's revisions and re-presentation within the Academy, Bill "had faith in the power of the text and the ideas it contained, ... that its time would come." The statement embodies Bill Bartholome's dedication to children. Throughout his career, he worked to make medicine and medical research safer and more friendly for children. The AAP and its Committee on Bioethics, on behalf of all our colleagues, extend heartfelt thanks to Dr. William G. Bartholome for helping us more fully appreciate that children are in the process of becoming, in his words, "intelligent, observant, capable, and responsible persons" who deserve our utmost respect.

Child↗