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PubMed2005

[The 'feminine' in the history of medical didactics].

Women are present in the 'long' history of medicine both as patients and as healers specialising in curing and caring. The nowadays existing attempt to define a female specific medical knowledge (discussing, for instance, the quality of a supposed 'female' cultural and professional training; the role of women in medical research as well as in discussing bioethical subjects; the relationship between women-physicians and other medical professionals; the female approach to important bioethical issues such as euthanasy, 'therapeutical fury' for the incurable sick, female genital mutilations) is here analyzed in a broader historical context.

Bioethical Issues↗
PubMed1990

Current trends in biomedical ethics in the United States.

Enormous growth of medical activities and issues in the 1960s and 1970s stimulated birth of the field of contemporary biomedical ethics. Nevertheless, when one examines recent trends within the field in the United States, one is struck with how many significant transformations and developments have occurred since that time. This presentation examines recent developments in five areas--those of patient rights and autonomy, termination of life, manipulation of Nature, health care resource allocation, and decision-making by the general public. The author also notes that although bioethical issues have become politicized as major interest groups and the general public have become increasingly involved, the quest for consensus remains a central one for health care ethics in the United States.

Bioethical Issues↗
PubMed1989

The President's Commission: the need to be more philosophical.

This paper argues, contrary to what has sometimes been claimed, that public commissions need to be more philosophical than they have been in analyzing crucial bioethical issues. It argues (a) that the failure of the President's Commission to develop and use even simple distinctions between life and personhood led to flaws in both its discussion of death and its discussion of persistent vegetative patients, and (b) that its treatment of access to health care fails to develop a coherent approach precisely because it is based on no serious philosophical reflections about justice in health care.

Advisory Committees↗
PubMed1990

Improving hospital ethics committees: testing an educational model.

Overall, the project described in this paper appears to represent a considerable success in the field of postsecondary education, moving from the identification of a population with special educational needs to the implementation of a well-received program in a two year period. The extensive curriculum developed for the project seems to have been appreciated by participants and, in the case of relatively new members, to have improved their readiness to participate in committee work. Even in the case of more experienced HEC members, participation may have had significant, if unmeasureable, benefits. As one experienced HEC member noted, "It was a very stimulating, challenging, exhausting week and one I would recommend to others." These sentiments were echoed by another experienced participant who indicated that, "In the brochure the seminar looked like it might turn out to be the 'same old thing,' but it turned out to be a challenge and a chance to go home and begin again at a 'higher level'." Beyond its immediate benefits to individual participants, the project has led to the completion of 21 participant papers on procedural and bioethical issues, and the founding of a new journal for HEC members in which they will be published (HEC Forum, Pergamon Press, Oxford and New York). For the project faculty, the challenge ahead will be not only to respond to participant concerns, but to adapt the curriculum for presentation "on site" at hospitals across the country. While the move from formal demonstration to full-scale implementation will allow new flexibility, care must be taken to ensure that any changes do not sacrifice the program's clearly documented strengths.(ABSTRACT TRUNCATED AT 400 WORDS)

Bioethical Issues↗
PubMed1990

Public philosophy: distinction without authority.

An assumed core of normative ethical principles may constitute a philosophically proper framework within which public policy should be formulated, but it seldom provides any substantive solutions. To generate public policy on bioethical issues, participants still need to confront underlying philosophical controversies. Professional philosophers' proper role in that process is to clarify major philosophical options, to press wider-ranging consistency questions, and to bring more parties into the philosophical debate itself by arguing for particular substantive claims. Though questions of fact that mediate final policy conclusions frequently fall outside philosophical competence, one sort of fact, lack of political support, should seldom cause philosophers to stand aside; philosophers still have an important role as critics of culture, politics, and profession. They have no authority, however, on even the philosophical presuppositions of public policy.

Advisory Committees↗
PubMed2003

[Bioethical aspects of health care reform in Chile. II. Discrimination, free election and informed consent].

Bioethical issues emerge each time health care reform projects are discussed. These affect diverse moral values and principles and have an impact on cultural, social and political areas. Thus, they demand more than just organizational, financial or administrative solutions. This review analyses discrimination, free election of professionals and informed consent. All three concepts are alluded in the legislative debate raised upon the actual process for health reform. Having clear ideas about these subjects is crucial to foresee the reactions expected to arise among physicians and the general public, when confronting the proposed changes.

Bioethical Issues↗
PubMed2003

Nonaltruistic kidney donations in contemporary Jewish law and ethics.

BACKGROUND: In 2000, the Consensus Statement on the Live Organ Donor reported that "direct financial compensation for an organ from a living donor remains controversial and illegal in the United States" and took note of the position of the Transplantation Society that "Organs and tissue should be given without commercial consideration or commercial profit." Christian authorities insist that organ donors must not accrue economic advantage, and "selling" organs deprives the donation of its ethical quality. METHODS: The writings of major contemporary authorities of Jewish law and ethics whose halakhic positions on bioethical issues are regularly considered by Orthodox, Conservative, and Reform ethicists were reviewed. Their positions on this issue were contrasted with those of various contemporary secular and religious authorities. RESULTS: These Jewish authorities reject the notion that generosity and charity, rather than monetary gain and greed, must serve as the exclusive basis for donation of functioning organs. CONCLUSION: Although nonaltruistic sale of kidneys may be theoretically ethical, ultimately its ethical status in Jewish ethics and law is inextricably connected to solving a series of pragmatic programs, such as creating a system that ensures that potential vendors and donors are properly informed and not exploited. Lacking such arrangements, ethical nonaltruistic kidney donations remain but a theoretical possibility.

Bioethical Issues↗
PubMed2001

What happened to our free bioethics search service? The terrible and premature death of BIOETHICSLINE.

BIOETHICSLINE, in existence from 1973 thorough 2000, was a bibliographic database covering the English-language literature on bioethical issues. It reflected the cross-disciplinary field of bioethics. During 2001, the National Library of Medicine is expected to dismantle BIOETHICSLINE and incorporate its data into two of their other databases, PubMed and LOCATORplus. Once this is completed, BIOETHICSLINE, as a unified database, will be discontinued. The users of BIOETHICSLINE will no longer have access to this important and useful resource specifically targeted to the vocabulary and cross-disciplinary nature of the bioethics literature. As a scholar and student of bioethics, and as a trained and former reference librarian, I feel it is important to examine these changes and their consequences. There are good reasons to integrate BIOETHICSLINE into these other databases on the NLM Gateway, but I argue that, in addition this integration, BIOETHICSLINE should be continued as a distinct database.

Abstracting and Indexing↗
PubMed1986

Selected bibliography of recent articles in ethics and geriatrics.

The disciplines of bioethics and geriatrics have had parallel development in recent years. From small and relatively esoteric fields 15 or 20 years ago, both have grown enormously. Although the numbers of geriatricians and ethicists in practice or in academic centers have increased substantially, these disciplines represent areas in which better understanding is sorely needed. This bibliography is intended to assist the clinician in locating salient literature concerning bioethical issues in geriatric medicine and research. It is highly selective; it does not attempt to cover all the literature on bioethics. There are several excellent general bioethics bibliographies for clinicians in the recent literature, as well (not limited to clinical journals or clinical topics), some of which are included in section 13 for the reader's further information. The ethical issues that arise in geriatric medicine are similar to those that arise in the care of younger patients, but certain kinds of problems happen with far greater frequency. Dilemmas concerning decisions about care at the end of life are particularly relevant in geriatrics, as persons of extreme old age are often presented with choices about life-sustaining therapy when critical illness occurs. This includes decisions about cardiopulmonary resuscitation and nutritional support. When these clinical decisions arise in the care of patients who cannot decide for themselves, the question arises as to what role the assessment of "quality of life" ought to play in decisions to pursue or to forego life-sustaining therapy. Informed consent to treatment and to participation in research has been an important area of ethical investigation. Dilemmas about consent to treatment are complicated in some elderly populations because of the higher incidence of cognitive impairment and the higher incidence of the clinician's suspicion (or assumption) of cognitive impairment. In consent to research, there are additional issues of voluntariness and equitable selection, especially when subjects are residents of nursing homes. Because of the increasing numbers of elderly persons in our society, and because of the role of social resources (federal, state, and local) in acute and long-term medical major concern in gerontologic bioethics. The topic headings for this bibliography reflect these common issues which arise in the care of the elderly.+2

Bibliographies as Topic↗
PubMed2003

Legal and ethical issues of newborn screening.

Newborn screening raises many ethical and legal concerns, from the bioethics issues commonly faced with genetic testing and the practice of informed consent to the classical medical ethics questions that surround resource allocation. This mandatory, state-based healthcare intervention has not met with the resistance that one might have anticipated, yet it is still not integrated into society to its full potential. While there is room for newborn screening programs to improve on the technical, ethical, and legal fronts, this should not discourage policymakers, physicians, scientists, and other stak-holders from learning from the successful aspects of its implementation and applying these lessons to other, related technologies.

Biological Specimen Banks↗
PubMed1998

The development of bioethics and the issue of euthanasia: regulating, de-regulating or re-regulating?

This paper relates the development of bioethics and the issue of euthanasia to social control. It suggests that, contrary to appearances, developments in these areas indicate increasing government control of health care practice. Specifically, it argues that, although the emergence of bioethics may appear to indicate health care professionals engaging in self-regulation, the reality is more a case of re-regulation or a shift of regulatory control from health care professionals to governments or agents of governments. By contrast, the issue of euthanasia appears to be proceeding in a different direction in that it seems to be a dispute over de-regulation of health care practice. In reality, though, it is similar to the development of bioethics. The issue of euthanasia, especially in recent years, rests on the same type of re-regulation of health care practice--a shift from medical control to increasing control by government.

Advisory Committees↗
PubMedDate not supplied

[Embryonic stem cells: from fundamental studies--to clinical application].

A short history of embryonic stem cell (ESC) discovery, cell line isolation, phenotyping and cell behavior both in situ and in vitro is outlined. The path of ESC differentiation into restricted specialized cell types mediated by signal network in culture and by grafting cell into recipient tissues is considered. Potentialities of ESC as the generator of spare parts of organs for regenerative medicine and related bioethical issues are briefly outlined.

Animals↗
PubMed2002

Bioethical conflicts between Muslim patients and German physicians and the principles of biomedical ethics.

In the age of globalisation, more and more people who are members of different religions and cultures live in the same society. This situation tends to create many conflicts in different areas of life and not least in the health care system, a fact which raises a number of bioethical issues. The cultural and religious differences between patient and physician can be a cause of bioethical conflicts and therefore represent a challenge for biomedical ethics. The confrontation between Turkish Muslin patients and the German health care system is a convenient example of this situation. The Muslim Turks came to Germany 40 years ago as industrial workers. Their value system had been shaped by traditional and Islamic parameters in Turkey. With this value system, they now found themselves in the German modern health care system. In many fields of modern medicine there are areas of potential conflict of values, where a Muslin patient will argue differently from a secular or Christian person. In an ethical conflict between two individuals who are members of different cultures, it is necessary to make sure that the ethical concept which is to be used for resolving the problem is relevant. In this particular case, both the Islamic legal responses (fatwa) and the classical theories of biomedical ethics are often insufficient. This paper tries to give a brief outline of these bioethical conflicts and discuss these conflicts with regard to the principle of respect for autonomy in the concept of "principilism," as introduced by T.L. Beauchamp and J.F. Childress. The central question is whether this bioethical concept is able to analyse and to help solve the kinds of ethical conflicts which involve transcultural dimensions. This question is discussed with some consideration of the ongoing debate about universalism versus relativism in biomedical ethics.

Communication Barriers↗
PubMed1997

The Northern California Conference for Guidelines on Aid-in-Dying.

End-of-life care in the United States is inadequate. Long-standing and unresolved issues in the care of the terminally ill have led to debates that have become major bioethical issues. Recognizing that practical solutions to deal with these issues are desperately needed, the Stanford University Center for Biomedical Ethics organized and convened a consensus development conference for health care professionals and health care institutions on Sept. 27 and 28, 1996.

California↗
PubMed2003

Disability: a voice in Australian bioethics?

The rise of research and advocacy over the years to establish a disability voice in Australia with regard to bioethical issues is explored. This includes an analysis of some of the political processes and engagement in mainstream bioethical debate. An understanding of the politics of rejected knowledge is vital in understanding the muted disability voices in Australian bioethics and public policy. It is also suggested that the voices of those who are marginalised or oppressed in society, such as people with disability, have particular contribution to make in fostering critical bioethics.

Advisory Committees↗
PubMed2002

Overview of cancer control programs in Japan.

Japan has a population of about 127 million, with an average life expectancy that is one of the highest in the world. Cancer has been the leading cause of death in Japan since 1981. The incidence of cancer for all sites in 1994 was estimated to be 440 000; crude incidence rates per 100 000 for males and females were 416.3 and 299.4, respectively. In 1997, the number of cancer deaths was 275 413; crude death rates for males and females per 100 000 were 273.0 and 169.9, respectively. Projections for 2015 indicate that 890 000 people will develop cancer and 450 000 will die as a result. It is not too much to say that Japan is now amid a 'Cancer Era'. Meanwhile, the progress in medical sciences is improving survival in cancer patients; in cancer patients diagnosed during 1987-89, relative 5-year survival was reported to be 41.2% for all sites and cancer survivorship research estimated the number of cancer survivors for all sites in 1998 who have lived for between 5 and 24 years after diagnosis to be 1.5 million. The Ministry of Health and Welfare is focusing on five different measures in the implementation of its cancer control programs: public health education, nationwide cancer screening programs, development and support of specialized medical institutions, training of specialists and promotion of basic and clinical cancer research. As a tool for public health education, the Ministry published in 2000 a 10-year health promotion program entitled 'Healthy Japanese in the 21st Century'. In the plan, seven particular goals are enumerated with regard to cancer. In practice, issues of concern include the development of new modalities, telling the truth to cancer patients, clinical trials and bioethical issues.

Female↗
PubMedDate not supplied

Bioethics and health instruction: issues, questions, and advocacy.

The purpose of this article is to define bioethics and illustrate some current bioethical issues facing society today, provide an overview of arguments opposing teaching about bioethics by health educators, describe selected aspects of the who, what and how of the teaching of bioethics, and advocate the teaching of bioethics at all levels of health education curricula. The intent is not to provide conclusive solutions to the many complex issues related to the teaching of bioethics, but rather to discuss some of the issues and stimulate debate.

Bioethics↗