Abstract: Patient competence is an essential element of every doctor-patient relationship. In this paper I provide a case report involving an older Korean man in a Hawaiian hospital who refused treatment on the basis of mistaken facts or beliefs about his doctors and treatment. I discuss the case as it relates to competency and extends it to informed consent, autonomy and paternalism. I suggest and argue firstly, that the older Korean man is not fully competent, and secondly, that if he is not fully competent, then soft and weak paternalism may be justified in his case and in cases similar to his.
Culture and the Principles of Biomedical Ethics
Abstract: This paper examines the roles of culture in the principles of biomedical ethics. Drawing on examples from African, Navajo and Western cultures, the paper maintains that various elements of culture are indispensable to the application of the principles of biomedical ethics.
Postmenopausal Motherhood: Immoral, Illegal? A Case Study
Abstract: The paper explores the ethics of post-menopausal motherhood by looking at the case of Adriana Iliescu, the oldest woman ever to have given birth (so far). To this end, I will approach the three most common objections brought against the mother and/or against the team of healthcare professionals who made it happen: the age of the mother, the fact that she is single, the appropriateness of her motivation and of that of the medical team.
The promise and predicament of cosmetic neurology
Abstract: Advances in cognitive neuroscience make cosmetic neurology in some form inevitable and will give rise to extremely difficult ethical issues.
Ethics in medicine: Virtue, Vice and Medicine
Publisher: How, in a secular world, should we resolve ethically controversial and troubling issues relating to health care? Should we, as some argue, make a clean sweep, getting rid of the Hippocratic ethic, such vestiges of it as remain? Jennifer Jackson seeks to answer these significant questions, establishing new foundations for a traditional and secular ethic which would not require a radical and problematic overhaul of the old.
These new foundations rest on familiar observations of human nature and human needs. Jackson presents morality as a loose anatomy of constituent virtues that are related in different ways to how we fare in life, and suggests that in order to address problems in medical ethics, a virtues–based approach is needed. Throughout, attention is paid to the role of philosophy in medical ethics, and how it can be used to clarify key notions and distinctions that underlie current debates and controversial issues. By reinstating such concepts as justice, cardinal virtue, and moral duty, Jackson lays the groundwork for an ethics of health care that makes headway toward resolving seeming dilemmas in medical ethics today.
This penetrating and accessible book will be invaluable to students of sociology and health care, as well as those who are interested in the ethical uncertainties faced by the medical world.
Telling the Truth
Abstract: Are doctors and nurses bound by just the same constraints as everyone else in regard to honesty? What, anyway, does honesty require? Telling no lies? Avoiding intentional deception by whatever means? From a utilitarian standpoint lying would seem to be on the same footing as other forms of intentional deception: yielding the same consequences. But utilitarianism fails to explain the wrongness of lying. Doctors and nurses, like everyone else, have a prima facie duty not to lie – but again like everyone else, they are not duty-bound to avoid intentional deception, lying apart; except where it would involve a breach of trust.
Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value
Introduction: Dworkin puts forth two main arguments to justify adhering to the wishes the patient expressed before becoming demented. As he sees it, this course of action both promotes the patient’s well-being and is required in order to respect the patient’s autonomy. In each argument, while I consider most of the ideas well-founded, I challenge the crucial premise. In the argument focused on the patient’s well-being, I dispute the claim that demented patients are no longer capable of generating what Dworkin calls “critical interests.” In the argument concerning autonomy, I question the premise that demented patients no longer possess the “capacity for autonomy.”7 In each case, I will trace how the problematic premise arises within Dworkin’s argument and then develop an alternative account of the relevant capacity.
Are Pregnant Women Fetal Containers?
Content: Purdy offers a strong argument against overriding the decisions of pregnant women and tries to reconcile the significance of the dependence of the fetus on the mother with the mother’s right to control her own body.
From Nuremberg to Guantánamo: Medical Ethics Then and Now
Abstract: On October 25, 1946, three weeks after the International Military Tribunal at Nuremberg entered its verdicts, the United States established Military Tribunal I for the trial of twenty-three Nazi physicians. The charges, delivered by Brigadier General Telford Taylor on December 9, 1946, form a seminal chapter in the history of medical ethics and, specifically, medical ethics in war. The list of noxious experiments conducted on civilians and prisons of war, and condemned by the Tribunal as war crimes and as crimes against humanity, is by now more or less familiar. That list included: high-altitude experiments; freezing experiments; malaria experiments; sulfanilamide experiments; bone, muscle, and nerve regeneration and bone transplantation experiments; sea water experiments; jaundice and spotted fever experiments; sterilization experiments; experiments with poison and with incendiary bombs. What remains less familiar is the moral mindset of doctors and health care workers who plied their medical skill for morally questionable uses in war. In his 1981 work, The Nazi Doctors, Robert Jay Lifton took up that question, interviewing doctors, many of whom for forty years continued to distance themselves psychologically from their deeds. The questions about moral distancing Lifton raised (though not the questions about criminal experiments) have immediate urgency for us now. Military medical doctors, psychiatrists and psychologists serve in U.S. military prisons in Guantánamo, Abu Ghraib, Kandahar, and, until very recently, in undisclosed CIA operated facilities around the world where medical ethics are again at issue. Moreover, they serve in top positions in the Pentagon, as civilian and military heads of command, who pass orders and regulations to military doctors in the field, and who are in charge of the health of enemy combatants, as well as U.S. soldiers. Because we recently marked the sixtieth anniversary of the judgment at Nuremberg, I want to awaken our collective memory to the ways in which doctors in war, even in a war very different from the one the Nazis fought, can insulate themselves from their moral and professional consciences.