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Arguments are advanced, on a pragmatic basis, for preferring a 'situational' approach to medical ethical problems, rather than an approach based on any one of the dogmatic formulations on offer. The consequences of such a preference are exemplified in relation to confidentiality; and in relation to the ethical dilemmas which surround the beginning and the end of terrestrial human life.
This article presents a set of moral arguments regarding the selective abortion of fetuses on the basis of prenatal screening for late onset genetic diseases only, and for Huntington's Disease* in particular. After discussion of human suffering, human perfection and the distinctive features of the lives of people confronting late onset genetic disease, the author concludes that selective abortion is difficult to justify ethically, although it must remain a matter of personal choice.
In 1989, in the wake of the first operations to transplant fetal tissue into the brains of sufferers from Parkinson's Disease, the UK Code of Practice governing the use of the fetus for research was overhauled by an eminent committee under the chairmanship of the Reverend Dr John Polkinghorne. The Polkinghorne Report has, however, attracted remarkably little comment or analysis. This paper is believed to be the first to subject it to sustained ethical and legal scrutiny. The author concludes that, although the committee's recommendations meet the major objections to the Code of Practice, the report is nevertheless vulnerable to criticism in its treatment of at least three issues: the moral status of the fetus; paternal consent to fetal use, and the ethical inter-relation of fetal use and abortion.
The question who is the subject of the right to prenatal diagnosis may be answered in four ways: the parents, the child, society, or no one. This article investigates the philosophical issues involved in each of these answers, which touch upon the conditions of personal identity, the principle of privacy, the scope of social responsibility, and the debate about impersonalism in ethics.
Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection.
The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies.
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Treatment of women patients with chronic mental illness who are at risk of unwanted pregnancies presents ethical challenges to the clinician who wishes to respect the patient's autonomy while also helping her avert the potential adverse consequences of unwanted pregnancy. The clinician who simply allows the patient to continue at risk or coerces her into using contraception may not have adequately considered the variable nature of the patient's autonomy. The authors suggest that the clinician should assess and treat conditions underlying the patient's variable impairment of autonomy to maximize her ability to participate in family planning decisions. Case examples are used to illustrate assessment of patients' decision-making capacity, development of family planning approaches that respect patients' autonomy, and use of a newly available contraceptive implant.
1. The role of the neurohormone oxytocin is a physiological factor in the reproductive cycle of coitus, birth, breast-feeding, the milk-ejection reflex, nipple erotism, and female sexual responsiveness. 2. The capacity for "motherliness," the attributes of empathy, consideration, confidence, and love are dependent on the level of psychosexual, ego, and superego maturity of the mother as well as on the pattern of mothering she experienced as a child. 3. The satisfaction of the oral hunger-satiation cycle is essential. Without it, even the most satisfactory maternal environment proves insufficient and results in serious ego constriction. 4. Bottle-feeding, as breast feeding, may offer a relatively satisfactory solution to the basic, physiological, hunger-satiation cycle and may fulfill, to a limited extent, the libidinal requirements of the crucial oral phase, depending on the psychosexual maturity and ego and superego development of the mother. 5. However, breast-feeding alone provides the experience of the original primal scene on which the later primal scene is based. 6. The breast-feeding capacity in itself is no more an indication that psychosexual maturity and the genital phase have been achieved than is the ability to achieve vaginal orgasm (or genital orgasm, in the male). 7. Sherfey's (1966) findings notwithstanding, Freud's (1925) statement that the elimination of clitoral primary (not participation) is essential for the development of femininity remains valid.
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The current status of the study of population geography is examined, with some reference to the situation in the United Kingdom. The authors note that whereas the volume of studies in this area indicate its healthy growth, the subdiscipline has become increasingly distant from mainstream geography and runs the risk of being absorbed into general demography. The authors suggest that "population geographers, while taking a serious interest in the methods and philosophy of the neighbouring discipline of demography, should look elsewhere to find direction for their subdiscipline."
The objectives of family planning educational programs often include information diffusion as well as attitude and behavior change within a target population. This paper suggests that working with opinion leaders might be one possible means of fulfilling these objectives. But in order to work with opinion leaders, it is necessary first to identify them. For family planning studies, the operational indicators used in past studies do not appear to be adequate. These indicators do not accurately identify persons who will take an opinion leadership behavior in the future, do not measure knowledge by the opinion leader, do not distinguish positive from negative opinion leaders, and do not take account of the bi-directional flow of information and advice both to and from the opinion leader. Drawing upon data from a family planning study in Baltimore, various examples for inadequate opinion leadership indicators are given. The paper suggests the need to revise these indicators and then outlines a simple and inexpensive program that might be used to channel the energies and activities of family planning opinion leaders towards the fulfillment of program objectives.