Aujourd'hui, des malades atteints de pathologies graves pour lesquelles les alternatives therapeutiques sont limitees ou inexistantes reclament, non plus tant une protection contre les essais cliniques, qu'un droit d'y participer. Cette nouvelle revendication est le point de depart de la presente enquete, a la fois historique, juridique et sociologique, qui montre comment s'est formee, dans les normes et dans les pratiques, du XVIIIe au XXe siecle, la distinction entre l'animal de laboratoire et le sujet humain. Entre les cobayes et les (...) hommes. La premiere partie de l'ouvrage decrit la formation, de part et d'autre du proces des medecins de Nuremberg, d'un consensus normatif international en reponse aux crises sanitaires, accidents et scandales qui emaillent l'histoire des essais medicaux sur l'etre humain. La seconde partie detaille la situation en France, l'emergence d'une legislation sur les recherches biomedicales, les paradoxes qui persistent dans la loi et les realites nouvelles, sociologiques et scientifiques, qu'elle doit affronter. L'ouvrage montre l'urgence d'un nouveau contrat social en matiere de recherche biomedicale, articulant respect de l'autonomie, equite d'acces et protection des personnes. Et il propose des solutions. (shrink)

All the powerful influences exertedby the subjective-interpersonal dimension onthe organic or technical-functional dimensionof sickness and health do not make anintersubjective test concerning medicaltherapeutic results impossible. Theseinfluences are not arbitrary; on the contrary,they obey laws that are de facto sufficientlystable to allow predictions and explanationssimilar to those of experimental sciences.While, in this respect, the rules concerninghuman action are analogous to the scientificlaws of nature, they can at any time be revokedby becoming aware of them. Law-like andreproducible regularities in the sciences ofman (...) are by no means separated from a patient'spersonal-hermeneutic mediation. This makes itpossible for human beings to modify, improve orsometimes even entirely (or better almostentirely) suspend these psychological,sociological, ethnological, medical,regularities. For this reason the sciences ofman including medicine are under the obligationof constantly inspecting the continuingvalidity of the rules on which theirpredictions and explanations are based, namelyby indirect, statistical methods. Thisrequires a synergistic collaboration ofextra-clinical and clinical tests through whichmedicine can obtain a good level ofintersubjective testability. (shrink)

Human experimentation can have different meanings: indeed, with the development of medical research, therapeutic acts have to be distinguished from acts of cognitive values. For each kind of acts, specific conditions of acceptability and specific protections of human beings have to be defined.Human experimentation must be envisaged at different levels to evaluate ethical aspects: its scientific value, the risks, benefits envisaged, the populations implicated, etc…The individual consent must be present too in the relationship between the (...) subject and the doctors. In fact, is a real consent possible?Instead to insist on problems in terms of medical research, one would have to insist perhaps more on the fact that the medical practice in general would have to answer more to ethical grounds and to scientific rules. It is the non scientific medicine which is immoral and dangerous, as well the medicine with financial interests, or also the medecine without experimentation.The main arguments must remain at the level of the dignity of the persons, autonomy and freedom of choice must remain the fundamental values. (shrink)

Spectacular treatment disasters in recent years have made it clear that informal "let's-try-it-and-see" methods of testing new proposals are more risky now than ever before, and have led many to call for a halt to experimentation in clinical medicine. In this easy-tp-read, philosophical guide to human experimentation, William Silverman pleads for wider use of randomized clinical trials, citing many examples that show how careful trials can overturn preconceived or ill-conceived notions of a therapy's effectiveness and lead (...) to a clearer understanding of clinical anomalies. Because it gives careful guidance on setting up trials and avoiding conceptual pitfalls, this book will be of great interest to all epidemiologists and clinical statisticians, and to a wide varitey of clinicians, pharmacologists, and nurses. Since it requires no medical or statistical knowledge, it will also appeal to ethicists, lawyers, and the general public. (shrink)

La autora de esta obra desarrolla un estudio en el que se analizan los derechos del individuo en contraposición con los del profesional de las ciencias de la vida, parte de los preceptos de la bioética, que ofrece el sustento ético-teórico, y el Derecho, que constituye el sistema normativo. Contempla temas referentes a cuestiones bioéticas y jurídicas relacionadas con el tratamiento y manipulación del embrión, apropiación indebida de material genético, responsabilidad civil en la transmisión de enfermedades congénitas y genéticas derivadas (...) de la reproducción asistida, anencefalia, clonación, entre otros aspectos relacionados con el genoma humano. (shrink)

In this introduction, we address some of the complexities associated with the emergence of medicine’s bodies, not least as a means to ‘working with the body’ rather than simply producing a critique of medicine. We provide a brief review of some of the recent discussions on how to conceive of medicine and its bodies, noting the increasing attention now given to medicine as a technology or series of technologies active in constituting a multiplicity of entities – (...) bodies, diseases, experimental objects, the individualization of responsibility for health and even the precarity of life. We contrast what feminist theorists in the tradition of Judith Butler have referred to as the question of matter, and Science and Technology Studies with its focus on practice and the nature of emergence. As such we address tensions that exist in analyses of the ontological status of ‘the body’ – human and non-human – as it is enacted in the work of the laboratory, the randomized controlled trial, public health policy and, indeed, the market that is so frequently entangled with these spaces. In keeping with the recent turns toward ontology and affect, we suggest that we can regard medicine as concerned with the contraction and reconfiguration of the body’s capacities to affect and be affected, in order to allow for the subsequent proliferation of affects that, according to Bruno Latour, marks corporeal life. Treating both contraction and proliferation circumspectly, we focus on the patterns of affects wrought in particular by the abstractions of medicine that are described in the contributions to this special issue. Drawing on the work of A.N. Whitehead, we note how abstractions such as ‘medical evidence’, the ‘healthy human body’ or the ‘animal model’ are at once realized and undercut, mediated and resisted through the situated practices that eventuate medicine’s bodies. Along the way, we touch on the implications of this sort of perspective for addressing the distribution of agency and formulations of the ethical and the political in the medical eventuations of bodies. (shrink)

Abortion prohibitions in some states include carve-outs based on the medical condition of either the mother or the fetus. These carve-outs, however, may be couched in limiting language structured by legislators rather than in language understandable in the context of medical care. In circumstances where legislative bodies fail to adequately incorporate medical professionals in the drafting of medical laws, the resulting vagueness or ambiguity may lead to a lack of utility or viability. This paper considers the consequences of such legislative (...) misreading of medicine. It does so with a particular example, Utah’s abortion trigger law, 2020 Senate Bill 174 (S.B. 174). S.B. 174 was enacted in 2020 (currently enjoined pending the outcome of _Planned Parenthood Association of Utah v. State of Utah_) and includes an exception for serious fetal anomaly—in other words, disability. While Utah is not alone in its inclusion of a disability exception for abortion, S.B. 174 is unique in the language it uses to carve out this exception: the law requires that the fetus has a “uniformly diagnosable and uniformly lethal” defect. This article explores the medical-legal mismatch in S.B. 174 through an analysis of the statute’s legislative history and its language, an academic and legal database review, and an application of the statutory language to multiple serious genetic diagnoses. In doing so, this paper unpacks just how mismatched these terms are and reveals the massive gap the law will leave between the legal consequences and the medical realities of abortion. (shrink)

The basic principles of scientific research from the great French physiologist whose contributions in the 19th century included the discovery of vasomotor nerves; nature of curare and other poisons in human body; more.

This past July, five professional societies, whose members together provide the majority of clinical care in the United States, published a statement objecting to “inappropriate legislative interference” with the physician‐patient relationship and reiterated the importance of “putting patients’ best interests first.” Such a collective response is helpful, but given the apparently growing interest among legislators in legislating aspects of physician‐patient communications, individual physicians, too, may have to face this problem. What should a physician do when confronted with a law that (...) attempts to intervene in the doctor‐patient relationship in a way that the physician believes undercuts good medical care? (shrink)

The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional (...) practice of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families. (shrink)

Most people know precious little about the risks and benefits of participating in a clinical trial--a medical research study involving some innovative treatment for a medical problem. Yet millions of people each year participate anyway. Patients at Risk explains the reality: that our current system intentionally hides much of the information people need to make the right choice about whether to participate. Witness the following scenarios: -Hundreds of patients with colon cancer undergo a new form of keyhole surgery at leading (...) cancer centersnever -Tens of thousands of women at high risk of developing breast cancer are asked to participate in a major research study. They are told about the option of having both breasts surgically removed but not told about the option of taking a standard osteoporosis pill that might cut the risk of getting breast cancer by one-half or more. Patients at Risk written by two nationally prominent experts, is the first book to reveal the secrets that many in the research establishment have fought long and hard to keep from patients. It shows why options not commonly knownincluding getting a new treatment outside of a research studycan often be the best choice. It explains how patients can make good decisions even if there is only limited information about a treatments effect. And it does this through the eye-opening stories of what is happening daily to thousands of people. Day after day, we are learning how little we know about what really works. Headlines regularly announce that a previously unquestioned treatmenthormone replacement therapy, drugs such as Vioxx or Celebrexmay now be much riskier than we thought. The latest book in a surge of recent books criticizing the medical establishment (but the first to look at clinical trials specifically), Patients at Risk helps to empower patients to survive in a world of medical uncertainty, and makes positive recommendations for systemic reform. (shrink)

This article defends the classical liberal view of human interactions that gives strong protection to associational freedom except in cases that involve the use of force or fraud or the exercise of monopoly power. That conception is at war with the modern antidiscrimination or human rights laws that operate in competitive markets in such vital areas as employment and housing, with respect to matters of race, sex, age, and increasingly, disability. The article further argues that using the “ (...) class='Hi'>human rights” label to boost the moral case for antidiscrimination laws gets matters exactly backwards, given that any program of forced association on one side of a status relationship (employer, not employee; landlord, not tenant) is inconsistent with any universal norm governing all individuals regardless of role in all associative arrangements. The articled also discusses the tensions that arise under current Supreme Court law, which protects associational freedom arising out of expressive activities (as in cases involving the NAACP or the Boy Scouts), but refuses to extend that protection to other forms of association, such as those involving persons with disabilities. The great vice of all these arrangements is that they cannot guarantee the stability of mandated win/lose relationships. The article further argues that a strong social consensus against discrimination is insufficient reason to coerce dissenters, given that holders of the dominant position can run their operations as they see fit even if others do otherwise. It closes with a short model human rights statute drafted in the classical liberal tradition that avoids the awkward line drawing and balancing that give rise to modern bureaucracies to enforce modern antidiscrimination laws. (shrink)

It would be unproblematically correct to say "the laws of Pennsylvania have it that a person is eligible to vote at age eighteen." But whether someone is actually mature enough to exercise his electoral franchise appropriately will very much depend on the individual. In setting the voting age by fiat, Society leaps in where Nature fears to tread. Many quantities that figure importantly in shaping our conduct of affairs are not specified by nature but are artifacts of human contrivance. (...) At what age, for example, is a person old enough to marry, drink alcoholic beverages responsibly, handle fireworks safely, manage his own property, enter into contracts, see a violent movie, serve on a jury, or hold a public office? These are not quantities writ large in nature's impersonal scheme of things but matters of social decision made for reasons of public polity and administrative convenience. They are legislated quantities. (shrink)

From an ethical standpoint, the goal of clinical research is to benefit patients. While individual investigations may not yield results that directly improve patients’ evaluation or treatment, the corpus of the research should lead in that direction. Without the goal of ultimate benefit to patients, such research fails as a moral enterprise. While this may seem obvious, the need to protect and benefit patients can get lost in the milieu of clinical research. Many advances in emergency medicine have been (...) based upon the results of research studies conducted both within the specialty and by others outside of the field. But has this research benefited patients? Has it followed the Hippocratic commitment “to do good or at least do no harm”? The answer is: yes, and no. This paper attempts to demonstrate this: first by citing advances from applied research that have benefited emergency department patients over the past three decades, and follows with some aspects of emergency medicine research that makes one question both its safety and its efficacy. While enormous gains have been made in patient care as a result of emergency medical research, ethical considerations complicate this rosy picture, and point to future areas of concern for researchers. (shrink)

On January 18, 2006, the United States Supreme Court unanimously held that the constitutional challenge to New Hampshire's Parental Notification Prior to Abortion Act would be remanded to the United States Court of Appeals for the First Circuit, to determine whether the Court of Appeals could, consistent with New Hampshire's legislative intent, formulate a narrower remedy than a permanent injunction against enforcement of the parental notification law in its entirety.In 2003, New Hampshire enacted the Parental Notification Prior to Abortion Act. (...) The Act specifies, in pertinent part, that “No abortion shall be performed upon an unemancipated minor or upon a female for whom a guardian or conservator has been appointed… until at least 48 hours after written notice of the pending abortion has been delivered....” The Act allows for three exceptions where a physician may perform an abortion on a minor child without parental or guardian notification. (shrink)

In this paper I argue, from the point of view of a legal positivist conception of law and its associated approach to legal interpretation, that having a ‘democratic Bill of Rights’ as a basis for enacting ‘human rights legislation’ is more legitimate and likely to be more effective with respect to promoting human rights than the contemporary model of using ‘juridical Bills of Rights’ as a basis for modifying or overriding enacted legislation.Resumen:Desde una concepción positivista del derecho (...) y su respectivo enfoque hacia la interpretación jurídica, en este artículo se argumenta que el tener un “Bill of Rights democrático” como base para expedir una “legislación de derechos humanos” resulta ser más legítimo y más efectivo para la promoción de los derechos humanos, que el modelo contemporáneo de “Bill of Rights jurisdiccionales” que sirve para modificar o invalidar la legislación promulgada. (shrink)

From the perspectives of Jewish tradition, particularly that of the Halakhah (Jewish law), this paper considers the policy problem of the balance in health care allocations between preventive and curative or crisis medicine. Since the value of human lives has a high degree of supremacy, and the duties to rescue imperiled life and to treat the sick are recognized, it might be argued that a basically curative policy should be favored. On the other hand, the duty of personal (...) health maintenance and safety would appear to argue in favor of a preventive policy. In balancing these considerations, it is suggested that the halakhic tradition can accommodate a preventive policy of health care because the duty to rescue is lessened or negatived by risk to the as-it-were rescuers. It is further suggested that Halakhah permits a non-divertable allocation of tax-generated funds to preventive health care. Keywords: Preventive medicine, curative medicine, value of human lives, duty to rescue, risk taking, Jewish law ( Halakhah ), charity tax CiteULike Connotea Del.icio.us What's this? (shrink)

The case of women radium dial painters — women who tipped their brushes while painting the dials of watches and instruments with radioactive paint — has been extensively discussed in the medical and historical literature. Their painful and abhorrent deaths have occupied the interest of physicians, lawyers, politicians, military agencies, and the public. Hardly any discussion has concerned, however, the use of those women as experimental subjects in a number of epidemiological studies that took place from 1920 to 1990. This (...) article addresses the neglected issue of human experimentation in relation to the radium dial painters. Although women’s medical examinations have been classified as simple, routine measurements of radiation burden on the body and presented as a great offer to humanity, for more than fifty years those women had been repeatedly used as experimental subjects without proper consent. I argue that through this case it becomes obvious that the issue of defining what counts as human experimentation shifts from an epistemological to a serious ethical and political question, concerning the making of scientific knowledge while issues of gender related to this process are also discussed. (shrink)

Until approximately twenty years ago, advances in the study of human genetics had little influence on the practice of medicine. In the 1980s, this changed dramatically with the mapping of the altered genes that cause cystic fibrosis and Huntington disease. In just a few years, these discoveries led to DNA-based tests that enabled clinicians to determine whether prospective parents were carriers of CF or whether an individual carried the Huntington gene and, as a result, would almost certainly develop (...) the disease.Observers interested in the social and economic implications of genetic technology realized that such genetic tests could be used by insurance companies to predict which insurance applicants were likely to become ill or even die from these diseases. (shrink)

Polish medical law does not explicitly regulate the possibility of off-label use of medicines. Such procedures therefore raise doubts in medical practice, where medicines are often prescribed beyond the Characteristic of Medicinal Product. This phenomenon particularly affects the treatment of children, as there is a lack of registered medicines in this age group, but they are registered for use in adults. Since such treatment goes beyond the scope of registration, a dilemma arises as to whether it is permissible and, if (...) so, under what conditions and whether sanctions are imposed on the medical professional using the off-label medicine. These issues are addressed in an article by Dr Maria Gutowska-Ibbs, entitled 'Off label - practical consequences of unclear legislation". The present study complements these considerations and is in part an ad vocem statement. The article attempts to differentiate between the use of off-label medicines and medical experiments, following the criterion of the purpose for which a given medical action is performed. The limits of admissibility of such actions under criminal law are also discussed in more detail. Off-label treatment is considered through the prism of the required precautionary rules, compliance with which is the antithesis of inadvertence. It is assumed that if the drug was administered in accordance with current medical knowledge and the treatment is adequate to the patient's condition, there is no violation of these rules, which excludes the imputation of inadvertence. An extensive section of the study is devoted to the issue of the patient's consent to treatment outside the indications. Above all, it emphasises the need to explain in detail to the patient the circumstances of prescribing such a drug and, on this basis, to obtain informed consent. It also stresses the importance of the written form of consent, which can have a significant evidentiary impact in potential litigation. (shrink)

Serious concerns about pervasive, persistent, and unjustified social inequalities have prompted a small—but growing—number of academic commentators to raise some hard and troubling questions for those who would like to legalize physician-assisted suicide. In various ways, these commentators have asked: In light of existing social inequalities—inequalities that operate, for example, along sometimes intersecting lines of race, class, age, sex, and disability—how persuasive are autonomy-based arguments in favor of legalization of assisted suicide when those arguments depend on a conception of autonomy (...) that either presupposes social equality or does not expressly account for its absence? How compelling are arguments that we ought to legalize assisted suicide out of feelings of mercy for the sick and dying, when such affective expressions may actually be the socially acceptable manifestation of private ambivalence that includes merciless discrimination? (shrink)

Background. South Africa (SA) currently has a golden opportunity to legislate on human heritable genome editing (HHGE), as the country is revising its assisted reproductive technology regulations. A set of sub-regulations that deals with HHGE, which could seamlessly slot into the current regulations, has already been developed. The principles underlying the proposed set of sub-regulations are as follows: HHGE should be regulated to improve the lives of the people and should not be banned; the well-established standard of safety and (...) efficacy should be used in the regulation of HHGE; quality of life is what matters, and not preserving a ‘normal’ genome; parents’ reproductive autonomy must be respected; and equality of access to approved HHGE technology should be promoted. Objectives. To ascertain whether the proposed set of sub-regulations that deals with HHGE is aligned with public opinion in SA, and SA’s Bill of Rights. Methods. Public opinion in SA is determined with reference to a deliberative public engagement study on HHGE conducted among South Africans, and the relevant rights in the Bill of Rights are interpreted with reference to recent case law. Results. This proposed set of sub-regulations that deals with HHGE is aligned with public opinion in SA, and SA’s Bill of Rights. Conclusion. Despite the legal and ethical complexities of HHGE, the proposed set of sub-regulations provides a targeted and effective legislative approach. They fit seamlessly into the country’s existing health law framework, creating specific legal standards for HHGE that align with both public opinion and the country’s Bill of Rights. (shrink)

Government’s responsibility to safeguard the public’s health through law has been part of the social contract since ancient times. Cicero declared salus populi suprema lex esto - “the safety of the people is the supreme law”. Disraeli proclaimed that protecting the public’s health is the first duty of the statesman. Of the ten most important public health achievements of the 20th century in the US., seven are directly related to legal interventions, including legislative interventions. As new and existing risks to (...) health risks emerge internationally, governments have consistently used the law as a tool to define the goals of public health, direct public health authorities to accomplish these goals, and equip them with the power and resources to do so.Tobacco control represents a salient example of how law can be used to ensure health. Like other public health laws, tobacco control laws have historic grounds. Government and other policymakers have enacted laws to control tobacco use for hundreds of years. The Russian church forbade tobacco use as an “abomination.”. (shrink)

This book traces the historic transformation of institutional review boards (IRBs) from academic committees to compliance bureaucracies. Sarah Babb opens the black box of contemporary IRB decision-making, which is increasingly outsourced to specialized private firms.

In the last years of his life, Gerald C. MacCallum, Jr., defied illness to continue his work on the philosophy of law. This book is a monument to MacCallum’s effort, containing fourteen of his essays, five of them published here for the first time. Two of those previously published are widely admired and reprinted: “Legislative Intent,” certainly one of the best papers ever published on its topic, and “Negative and Positive Freedom,” which offered a new way of looking at a (...) distinction that had been canonical for the last two centuries. To complete MacCallum’s unfinished pieces, Marcus G. Singer and Rex Martin painstakingly consulted MacCallum’s notes for planned revisions. MacCallum discusses legal reasoning, the application of rules, the interpretation of statutes and constitutional provisions, and the relation of these matters to morality and justice. In the last decade of his working life, he became greatly concerned with the interrelated themes of integrity, autonomy, conscience, and violence. He wished to relate competition to morality and justice to adversarial systems of law. These themes are woven together in Legislative Intent and constitute the main subject of some of the essays. MacCallum was engaged in a constant search for truth and understanding, and in his life and work lived up to Emerson’s vision of the “American Scholar” as a “human being thinking.” These essays are informed by the author’s deep curiosity, penetrating intelligence, wide knowledge, and outstanding character. They will be treasured wherever these characteristics and true philosophy are treasured. (shrink)

Consumers are prone to cognitive biases in decision-making due to the impact of time restrictions, specific environment, and project inducements in the process of experience. Compared with traditional marketing scenarios, it is easy to bias decision makers due to the existence of anchor information. Research on anchoring effect focuses on psychology, economics, law, and medicine instead of the price judgment of consumers. This article uses experimental research to explore the existence and influencing factors of anchoring effect when consumers judge (...) and estimate the price of a product in experiencing scenes. In this article, the hypothesis is that anchoring effect exists and is influenced by factors including anchor value, gender, emotion, personality, knowledge and skill, time pressure, early warning indication, cognitive need, and self-confidence level under external and internal anchor conditions. Subjects judged and estimated different prices after product experience through the design of different decision-making scenarios of external and internal anchors, and finally, the anchoring index and the mean skew index were used to calculate the anchoring effect. The experimental results showed that consumers were affected by anchoring effect when making price judgment in experiencing scenes. In addition to the factors of time pressure and self-confidence level, gender, personality, knowledge, and skill all had a significant influence on anchoring effect under external anchor conditions. Finally, this article provides advice for enterprise marketing planners including setting reasonable anchor values, highlighting the design of experiencing scenes, and developing differentiation strategies. (shrink)

This article analyses the conflicting professional ethical demands imposed on judges to, on the one hand, faithfully apply the existing law of the land and, on the other hand, do justice in the face of urgent global challenges such as ensuring an equal access to life-saving medicines. After establishing the precise nature of the professional ethical duties of judges (as opposed to those of lawyers) and noting the tensions they face when the duty of applying the law prevents them from (...) complying with the duty of delivering material justice in the domain of access to medicines, the article then analyses the way this issue plays out in Latin America, a región where judicially-mandated access to medicines has been common. The article concludes by arguing that the Latin American experience suggests that judges around the world should take seriously the need to find a balance between their duty of deference towards public health authorities in this domain (when this is mandated by legislation), and the duty to do justice to individuals who cannot afford live-saving medicines. (shrink)

This special issue aims to explore and investigate a new subfield, namely experimental philosophy of medicine. Whereas experimental philosophy is relatively new on the philosophical block, some of its takes and findings have already shaped central debates in ethics, philosophy of action, philosophy of language, and epistemology. Interestingly, the approach of this program was for a long time almost wholly ignored within bioethics and philosophy of medicine—although this seems to have changed somewhat recently. In this introduction, we briefly (...) sketch the program of experimental philosophy and how it can be used to shed philosophical light on issues in the philosophy of medicine. (shrink)

This chapter describes the field of philosophy of medicine and its methods. We discuss the history and potential of experimental approaches in philosophy of medicine. We give an overview of the chapters in the book.

James Drane's More Humane Medicine: A Liberal Catholic Bioethics is an outstanding contribution to the study of bioethics in our day. Catholics and others who are interested in the issues discussed here will benefit from this masterful treatment. The author opens with a set of definitions, starting with what he means by a “more humane medicine.” Drane contends that a more humane medicine has become necessary and desired, but not because the traditional medical ethic as “a self-declared (...) and self-imposed ethic, outlining what noble service to others entails” is no longer valid. Rather he defines it as an advance on the traditional ethic; a “new foundation” based on a “lived set of obligations derived from a felt commitment to other persons … an ethics based on the relationship between doctors and patients and essentially an ethics of virtue.” Drane's work is a “liberal Catholic Bioethics” in which he challenges his own faith tradition, the Roman Catholic Church, on such topics as sexuality, birth control, abortion, cloning, stem cell research, aging and dying, and euthanasia and physician-assisted suicide. The present article is a critical essay that analyzes the author's statements and conclusions. (shrink)

Human and veterinary medicine have many commonalities. The split into distinct disciplines occurred at different times in different places. In Europe, the establishment of the first veterinary universities towards the end of the 18th century was triggered by ravaging rinderpest epidemics and the increasing importance of livestock for draft, food supply, and war fare. Given this background, would it make sense to combine human, animal, traditional and modern medicine in healthcare provision, especially in less developed countries? (...) Such a “one-medicine” approach could enhance biomedical progress, improve the outreach of medical and veterinary services especially in remote areas, offer greater choices to patients, and make healthcare more culturally appropriate. On the other hand, it would require generalists rather than specialists and rare diseases may go unrecognized. The commonalities of human and veterinary medicine and the financial constraints many governments are presently facing are arguments in favor of a “one-medicine” approach, while status thinking, education systems, administrative structures, and legislations hinder its implementation. There are no instant recommendations for the application of one medicine but governments and development professionals need to generate fine-tuned, location-specific healthcare solutions. Advocacy, changes in education and training, the creation of institutional linkages, and the removal of legal barriers could help overcome obstacles. (shrink)

The European model of the constitutional review of legislation, characterized by the concentration of the constitutional review power in a single constitutional court, had its origin in the Austrian Federal Constitution of 1920. This is all the more remarkable when one considers that this Constitution established at the same time a parliamentary system of government in a fairly radical form. As the author explains, this “invention” of a constitutional court is attributable to two factors. One factor is the federal aspect. (...) The Court was conceived by the framers of the Austrian Federal Constitution of 1920 as an umpire between federal legislation and the legislation of the states or Länder. In this respect it was meant as a substitute for the principle of the priority of federal law over state or Land law. This is manifest in the initial draft of the Constitution, where actions on questions of the constitutionality of legislation could only be brought by the Federal government (against the legislation of one or another of the states or Länder) and by the State or Land governments (against federal legislation). Right from the beginning, however, the Court could examine a parliamentary act ex officio when it had to apply such an act in another proceeding. It was this power of the Court that triggered the development of constitutional review. Its exercise gradually transformed the Court into a guardian of the Constitution as a whole, in particular, the fundamental rights of citizens. The author traces this development in the context of the concept of state and law that prevailed in the late nineteenth and early twentieth century. This concept included specific restrictions on constitutional review. On the basis of a different understanding of the functions of a constitution, the Court gave up these restrictions and followed the examples of the European Court of Human Rights, the German Constitutional Court and—indirectly—the American Supreme Court. (shrink)

Does reading poetry make you a better clinician?Can euthanasia be understood in terms of the meaning of a life?What is the moral and existential significance of ...