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PubMed2001

Developing drugs for the developing world: an economic, legal, moral, and political dilemma.

This paper discusses the economic, legal, moral, and political difficulties in developing drugs for the developing world. It argues that large, global pharmaceutical companies have social responsibilities to the developing world, and that they may exercise these responsibilities by investing in research and development related to diseases that affect developing nations, offering discounts on drug prices, and initiating drug giveaways. However, these social responsibilities are not absolute requirements and may be balanced against other obligations and commitments in light of economic, social, legal, political, and other conditions. How a company decides to exercise its social responsibilities to the developing world depends on (1) the prospects for a reasonable profit and (2) the prospects for a productive business environment. Developing nations can either help or hinder the pharmaceutical industry's efforts to exercise social responsibility through various policies and practices. To insure that companies can make a reasonable profit, developing nations should honor pharmaceutical product patents and adhere to international intellectual property treaties, such as the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. To insure the companies have a good business environment, developing nations should try to promote the rule of law, ethical business practices, stable currencies, reliable banking systems, free and open markets, democracy, and other conditions conducive to business. Overall, this paper advocates for reciprocity and cooperation between pharmaceutical companies and developing nations to address the problem of developing drugs for the developing world. In pursuing this cooperative approach, developing nations may use a variety of other techniques to encourage pharmaceutical companies to act responsibly, such as subsidizing pharmaceutical research, helping to design and implement research protocols, providing a guaranteed market, and bulk buying.

Beneficence↗
PubMed2004

Coding and consent: moral challenges of the database project in Iceland.

A major moral problem in relation to the deCODE genetics database project in Iceland is that the heavy emphasis placed on technical security of healthcare information has precluded discussion about the issue of consent for participation in the database. On the other hand, critics who have emphasised the issue of consent have most often demanded that informed consent for participation in research be obtained. While I think that individual consent is of major significance, I argue that this demand for informed consent is neither suitable nor desirable in this case. I distinguish between three aspects of the database and show that different types of consent are appropriate for each. In particular, I describe the idea of a written authorisation based on general information about the database as an alternative to informed consent and presumed consent in database research.

Databases, Factual↗
PubMed2004

The problem of abortion: essentially contested concepts and moral autonomy.

When one thinks about the ethics of abortion, one inevitably thinks about rights, since it is in terms of the concept of rights that much of the debate has been conducted. This is true of overtly feminist as well as non-feminist accounts. Indeed, some early feminist writers--Judith Jarvis Thomson and Mary Ann Warren, for example--employ a model of rights that is indistinguishable, or virtually indistinguishable, from that of their non-feminist counterparts. However, more recent feminist writers have developed a different understanding of 'a woman's right to choose.' In this paper, I will begin by outlining the non-feminist debate over the moral permissibility of abortion. I will suggest that this debate is irresolvable, since at its heart is an 'essentially contested concept', that of personhood. I will then consider the way in which some feminist writers have attempted to reconceive the terms of the abortion debate and suggest an expanded account of women's right to abortion, drawing on the work of Susan Sherwin. Finally, I will argue that there is a further element to a 'woman's right to choose' that expands on and provides a conceptual link between feminist and non-feminist understanding of abortion.

Abortion, Induced↗
PubMed2006

Moral considerations in body donation for scientific research: a unique look at the University of Tennessee's anthropological research facility.

This paper discusses keys to the moral procurement, treatment and disposition of remains used for scientific research, specifically those donated to the University of Tennessee's Anthropological Research Facility (ARF). The ARF is an outdoor laboratory dedicated to better understanding the fate of human remains in forensic contexts, and focuses its research on decomposition, time since death estimates, body location and recovery techniques, and skeletal analysis. Historically, many donations were unclaimed bodies received from medical examiners (although it will be shown that this trend is changing), and it has been argued that the use of the unclaimed bodies for medical or scientific purposes is a violation of autonomy since no consent was given by the individual. It is argued here, however, that the domain of autonomous choice extends to one's own corpse only insofar as expressed wishes are made known prior to one's death, and that in the absence of expressed intent toward final disposition, it is acceptable for institutions to receive donations from medical examiners or family members. This paper also discusses other philosophical issues related to donation, consent and autonomy, and the forensic benefits of research conducted at the Anthropological Research Facility.

Cadaver↗
PubMed1991

Castillo-Morales' orofacial therapy: treatment of 67 children with Down syndrome.

Infants with Down syndrome often present with a typical orofacial disorder, the features of which include hypotonicity of the perioral muscles, lips and chewing muscles, and a protruding tongue, later followed by active tongue protrusion, as well as problems with sucking, drooling, etc. This study presents the effects of Castillo-Morales' therapy with 67 Down syndrome children (average age at start of therapy 13.9 months), who wore the palatal plate intermittently for an average of 12.1 months. Significant positive results were obtained in spontaneous tongue position, upper and lower lip tonicity and position, mouth closure, drooling and sucking.

Child↗
PubMed1995

The medical-moral account on epilepsy by Pedro de Horta: a historical review.

We bring to reader's attention the book Medical-Moral Account of the Most Troublesome and Rigorous Illness of Epilepsy, written in 1754 by the Mexican physician Pedro de Horta. This book is the earliest text on epilepsy written in the New World. We examine Pedro de Horta's medical and religious concepts of epilepsy and analyze concepts of epilepsy in Hispanic communities during the eighteenth century.

Epilepsy↗
PubMed2001

Moral problems in the use of coercion in dealing with nonadherence in the diagnosis and treatment of tuberculosis.

Coercion and detainment can be a morally acceptable strategy to fight the spread of tuberculosis, but these measures need to be placed into a much broader context than that of their short-term potential effectiveness. TB should be de-stigmatized by full acknowledgment that we all share the blame for its perpetuation. When coercion and detention are necessary, they should incorporate a strategy of optimum protection for minimum violation of autonomy. National and international health care programs should provide effective and nonthreatening treatments for TB and other related illnesses such as HIV and should develop policies to tackle the environmental causes of TB and provide support for vulnerable victims. Corporate pressures to continue world poverty must be undermined.

Civil Rights↗
PubMed2005

Demanding pure motives for donation: the moral acceptability of blood donations by haemochromatosis patients.

Blood banks all over the world attempt to cover the demand for blood by donations from voluntary non-remunerated donors. The discussion regarding the acceptability of blood donations by haemochromatosis patients focuses on the question of whether health benefits violate the rule of the altruistic donor. Utilitarian and deontological arguments for and against the policy of accepting blood donors who need to let blood regularly in order to stay healthy are considered by this article. A closer look at the procedure reveals that the confusion is due to the conflation of, on the one hand the phlebotomy, and on the other hand, the decision about the destination of the blood afterwards. The health benefits are connected to the phlebotomy and not to the donation. The morally relevant point in the decision as to whether the candidate is a truly altruistic donor is whether he donates without asking for a benefit in return. It is concluded that haemochromatosis patients can be free, voluntary, and altruistic blood donors.

Altruism↗
PubMed2005

The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy.

Bioethical Issues↗
PubMed1982

Reductions in insurance for mental disorders: adverse selection, moral hazard, and consumer demand.

Coverage for mental illness has been sharply reduced in the Federal Employees Health Benefits Program (FEHBP), especially in the largest of the participating plans, the Blue Cross and Blue Shield plan. The authors examine the role of adverse selection (accumulation of high-risk consumers within a given plan), moral hazard (demand for services for illness depending in part on the price of the services), and lack of overt consumer demand in the current trend. They point out the critical need for psychiatry to develop more effective approaches to public education on the nature of mental illness and its treatment. If the recent major cutbacks in the FEHBP prevail, this kind of restriction is likely to become the prevailing mode of mental illness coverage under private health insurance.

Blue Cross Blue Shield Insurance Plans↗
PubMed2003

Ethical practice and evaluation of interventions in crime and justice. The moral imperative for randomized trials.

In considering the ethical dilemmas associated with randomized experiments, scholars ordinarily focus on the ways in which randomization of treatments or interventions violates accepted norms of conduct of social science research more generally or evaluation of crime and justice questions more specifically. The weight of ethical judgment is thus put on experimental research to justify meeting ethical standards. In this article, it is argued that just the opposite should be true, and that in fact there is a moral imperative for the conduct of randomized experiments in crime and justice. That imperative develops from our professional obligation to provide valid answers to questions about the effectiveness of treatments, practices, and programs. It is supported by a statistical argument that makes randomized experiments the preferred method for ruling out alternative causes of the outcomes observed. Common objections to experimentation are reviewed and found overall to relate more to the failure to institutionalize experimentation than to any inherent limitations in the experimental method and its application in crime and justice settings. It is argued that the failure of crime and justice practitioners, funders, and evaluators to develop a comprehensive infrastructure for experimental evaluation represents a serious violation of professional standards.

Criminal Law↗
PubMed2004

Beneficence and autonomy in nursing. A moral dilemma.

Nurses frequently have to make decisions which require moral judgements, influenced by the ethical standards expected of the profession. They have a duty of care, promoting good, and minimising harm, whilst acting in the patients' best interests. In complicated situations it is not uncommon to wonder whether further ethical consideration is pertinent before a decision or action is made.

Beneficence↗
PubMed2001

Euthanasia: moral paradoxes.

Over the past 30 years, euthanasia has been under continuous debate in The Netherlands. This contribution aims to provide a moral assessment of this debate. It is argued that euthanasia should be understood within a historical context, as a protest against medical power and as a way to bring about good death. Within the euthanasia debate, two paradoxes are identified which make the issue inherently complex and hard to regulate. The first paradox results from the dialectical relation between individual autonomy and relief of suffering as the major justifications of euthanasia. Although euthanasia represents an ultimate effort to give the individual patient control over his dying, the result of the debate is an increase of medical power. The second paradox is that although euthanasia emerged from a commitment to good death, it is resulting in a reduced range of options to bring about good death.

Acute Disease↗
PubMed1983

Motives, values and moral judgments.

This study examined McClelland's (1981) hypothesis that operant and respondent measures of personality are orthogonal and assess different dimensions of personality structure. An operant measure of motives, a sentence completion test, and two respondent measures of cognitive schema variables, the Rokeach Value Survey and the Defining issues Test, were administered to 311 subjects. As predicted and in support of McClelland's hypothesis, 69% of the correlations between the respondent measures were significant at the alpha .05 level of probability versus 14% of the correlations between the operant and respondent measures. Further, within the domain of cognitive schema variables, it was theoretically possible to predict which values would correlate with different levels of moral judgment. The findings were discussed in terms. of their implications for person x situation models of social interaction and the prediction of criterion variables from typologies of personality.

Journal Article↗
PubMed1990

1990 Ogura memorial lecture: moral dilemmas in head and neck cancer.

Neither morality nor dilemma can be defined meaningfully in the concept of the practical management of head and neck cancer. Although both have important implications, particularly with regard to ethnic and social factors, they play a relatively minor role in determining management policy. With little knowledge of the intrinsic causes of cancer and with a treatment strategy limited to radiotherapy and surgery, our desire for cure must be tempered by concern to avoid any increase in patient privations. My philosophy, based upon the care of more than 3500 patients over almost 30 years, reflects some of the difficulties of applying the concept "do nothing that may cause harm," while offering each patient the opportunity for long-term cure.

Disclosure↗
PubMedDate not supplied

Moral and ethical dilemmas in relation to research projects.

Nurses involved in ward-based research projects may face many moral and ethical dilemmas. As the number of research studies increases, nurses must be aware of their responsibilities to the research team, their patients and their profession.

Codes of Ethics↗
PubMed2003

Trusting George Cheyne: scientific expertise, common sense, and moral authority in early eighteenth-century dietetic medicine.

Whenever physicians give directions to patients there is always a question of their authority to do so: what is it that they know, and who is it that they are, that gives them this authority? The problem is fully general, but it takes especially interesting forms in early modern dietetics, where patients were reckoned to possess much pertinent and reliable knowledge, and where medical dietetics occupied terrain already densely occupied by moral prudence. This article addresses these issues in relation to the writings and practice of George Cheyne (1671-1743), iatromechanist, dietary writer, and fashionable physician. Special attention is given to the relation between Cheyne's scientific expertise and the texture of the advice he gave to two patients, the printer and novelist Samuel Richardson and Selina, countess of Huntingdon.

Authoritarianism↗