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PubMed1984

Research with the mentally retarded and mentally ill: rights and duties versus compelling state interest.

This paper examines the assumptions underlying the ethical reasoning involved when the natural right to informed consent has been violated. Ramifications of the compelling need of the state to protect society by overriding the rights of individual freedom receive special attention. Specifically these issues are addressed: natural rights versus state's rights to preserve rights, state's rights versus parental autonomy, rights and duties versus paternalism, self interest and self survival versus the common good, coercion versus progress in research, and benefit versus cost. Building on these ethical considerations, the authors present a theoretical framework for ethical decision making with research involving the mentally retarded and the mentally ill.

Civil Rights↗
PubMed1985

Dignity and death: a reply.

Some form of utilitarian approach can be discerned as underlying much current medical ethical decision-making. Criticisms of the practical effects of such an approach are not parried by asserting the fundamental strengths of utilitarianism as theory.

Aged↗
PubMed1990

The titration of death: a new sin.

..."Titration of death" is the phrase I have used, in private musings and discussions, to express the undertaking of causing or permitting death to occur within carefully delimited parameters. It is, I think, a new form of sin. I distinguish it from a similar enterprise, in principle benign, that we might call "titration of dying," which attempts to manage the dying process. The focus of attention of titration of dying is the experience of the patient prior to death, with little or no concern given to the condition of the cadaver following death. Titration of death, on the other hand, is primarily concerned with producing, at the close of the process, a cadaver that is usable in some manner; and titration of death, per se, has only incidental concern with the dying process.

Aborted Fetus↗
PubMed1991

The physician as fortune teller: a commentary on "The ethical justification for minimal paternalism.

...I shall summarize my argument to this point. 1) A new technology -- medicalizing life choices -- introduces additional sources of uncertainty into the physician-patient relationship. The implications for the authority-autonomy tension of that relationship are not fully worked out, as is evidenced by differing views on professional obligations. 2) The warrants for paternalism are complex, ranging from a pragmatic response in the face of uncertainty to a proactive, highly directive determination of the patient's best interests. 3) Although some proponents of autonomy argue that it entails positive rights to intervention and information, the "strong sense" of autonomy is not the prevailing view. 4) The as yet unclear benefits of knowledge about one's genetic makeup are even less clear in the case of HD. Strong circumstantial evidence of risks of harm from disclosure of unfavorable test results have not been dispelled by early experience with use of the HD test. 5) A cautious approach in the use of HD test seems warranted, even at the cost of restricting autonomy. Legitimating that approach by reference to traditional ethical theory is a necessary element in the transfer of the new technology to the wider clinical setting. 6) While PMP [the principle of minimal paternalism] attempts to offer such an approach, some questions do not appear to have been resolved or fully addressed by this formulation.

Altruism↗
PubMedDate not supplied

The new genetic technologies: why a theological perspective is necessary.

Secular bioethics poses questions that can be recognized as important, though it lacks the resources to answer them. Secular bioethics may retain the sense that there should be moral limits to the use of germline genetic engineering, but it lacks the basis to justify limits in principle. The contemporary practice of bioethics arose in the United States to fill a moral vacuum created by (1) the marginalization of medical ethics through the deprofessionalization of medicine, (2) the secularization of American society, and (3) an increased reliance on individual decision-making. The result is an ethics at the core of secular bioethics severed from a sense of ultimate purpose or direction for humans or the cosmos. This ethics and its bioethics are marked by (1) moral fragmentation and pluralism and (2) a loss of ultimate orientation. This bioethics can at best require (1) the prudent maximization of benefits over harms, (2) the condemnation of malevolent acts, and (3) the use of persons only with their consent. However, there fails to be a basis for a common view of benefit or of harm. Within this impoverished moral context, human biological nature can only appear to be a contingent outcome of spontaneous mutations, selective pressure, the constraints of physical laws, and random catastrophes. Such a bioethics, deprived of ultimate orientation, can provide no ground in principle for forbidding cloning, germline genetic engineering, or the fundamental recasting of human nature. Absent a theological point of orientation, medicine and the genetic technology are left with more power than ever but no clear moral sense of how to use that power.

Bioethics↗
PubMed1991

What has bioethics to offer health policy?

The field of bioethics has quickly become a subject of intense public fascination; and, following on an earlier period of resistance and skepticism, bioethics has been welcomed by clinicians as well. Bioethics, however, is largely a practical activity rather than a scholarly one, and its pretensions as an academic discipline within health policy and health services research must be greeted cautiously. Continuing problems in moral theory suggest that the most secure contributions that bioethics can make to health policy research are analysis and criticism rather than positive moral claims.

Advisory Committees↗
PubMed2004

The precautionary principle: a dialectical reconsideration.

This essay examines an overlooked element of the precautionary principle: a prudent assessment of the long-range or remote catastrophes possibly associated with technological development must include the catastrophes that may take place because of the absence of such technologies. In short, this brief essay attempts to turn the precautionary principle on its head by arguing that, (1) if the long-term survival of any life form is precarious, and if the survival of the current human population is particularly precarious, especially given contemporary urban population densities, and (2) if technological innovation and progress are necessary in order rapidly to adapt humans to meet environmental threats that would otherwise be catastrophic on a large scale (e.g., pandemics of highly lethal diseases), then (3) the development of biomedical technologies in many forms, but in particular including human germ-line genetic engineering, may be required by the precautionary principle, given the prospect of the obliteration of humans in the absence of such enhanced biotechnology. The precautionary principle thus properly understood requires an ethos that should generally support technological innovation, at least in particular areas of biotechnology.

Bioethical Issues↗
PubMed2005

Enhancement technologies and human identity.

As the President's Council on Bioethics emphasized in a recent report, rapid growth of biotechnologies creates increasingly many possibilities for enhancing human traits. This article addresses the claim that enhancement via biotechnology is inherently problematic for reasons pertaining to our identity. After clarifying the concept of enhancement, and providing a framework for understanding human identity, I examine the relationship between enhancement and identity. Then I investigate two identity-related challenges to biotechnological enhancements: (1) the charge of inauthenticity and (2) the charge of violating inviolable core characteristics. My thesis is that a lucid, plausible understanding of human identity largely neutralizes these charges, liberating our thinking from some seductive yet unsound objections to enhancement via biotechnology.

Aging↗
PubMed1989

On transplanting human fetal tissue: presumptive duties and the task of casuistry.

The procurement of fetal tissue for transplantation may promise great benefit to those suffering from various pathologies, e.g., neural disorders, diabetes, renal problems, and radiation sickness. However, debates about the use of fetal tissue have proceeded without much attention to ethical theory and application. Two broad moral questions are addressed here, the first formal, the second substantive: Is there a framework from other moral paradigms to assist in ethical debates about the transplantation of fetal tissue? Does the use of fetal tissue entail cooperation in abortion? To answer these questions I develop a theoretical framework by combining the paradigm of just-war reasoning with canons governing the use of cadaverous tissue. The kinds of safeguards provided by this paradigm allow fetal tissue to be procured without the taint of association with abortion. Central to solving the problem of cooperation is the distinction between intending and foreseeing a moral misdeed. Fetal researchers may foresee fetal death in elective abortions without intending such deaths to occur. Thus, even those who object unequivocally to elective abortion may condone the procurement of fetal tissue, if sufficient reason exists.

Aborted Fetus↗
PubMed1984

Depo-Provera--ethical issues in its testing and distribution.

Ethical issues relating to the use of the injectable contraceptive in developed and developing countries alike involve public policy decisions concerning both criteria for testing a new drug and individual choices about using a specific form of contraception approved for national distribution. Drug testing consists of an important but still evolving set of procedures. Depo-Provera is not qualitatively different from any other drug and some unpredictable risks are inevitable, even after extensive animal experiments and clinical trials. In assessing the risks and benefits of Depo-Provera use, epidemiological data from large-scale human use is now beginning to become more important than data from animal experiments and clinical trials. The consumer's best interest is central to any ethically responsible system of drug distribution. Systems of informed choice are needed, even in societies where illiteracy remains common and medical services are weak. In the case of a contraceptive, the risks of non-use leading to unintended pregnancy, which can result in high mortality, are relevant as well as the side-effects of the method. An attempt, therefore, is made here to categorise those issues which are universal and those which are country-specific.

Contraceptive Agents, Female↗