Medical cosmopolitanism has been introduced partly as a response to the shortcomings of evidence-based medicine. This chapter will describe the main tenets of medical cosmopolitanism, connecting its four stances to other relevant philosophical contributions, and will answer two critiques that have been raised against it. Firstly, the charges of relativism can be addressed by disentangling relativism from pluralism, and accepting a weaker or stronger version of the latter. Secondly, medical cosmopolitanism can incorporate evidence from (...) anthropological studies of local medical knowledge and traditional medicine, which can be a starting point for a more encompassing view of evidence. This is consistent with attempts to integrate medical knowledge and research from the social sciences, including qualitative approaches, and can further help the project of “decolonizing” medicine. (shrink)

While there is a shortage of healthcare workers in virtually all countries, there currently exists a pronounced inequality in the distribution of healthcare workers, with a high concentration of healthcare workers in high income countries (HIC) and low concentrations in low‐ and middle‐ income countries (LMIC). This inequality in the distribution of healthcare workers persists, in spite of the fact that HICs enjoy a much lower disease burden than LMICs This inequality raises medical ethical issues related to what obligations (...) health workers from HICs have to correct these imbalances by working in LMICs. While the biomedical principle of Justice, first formulated by Beauchamp and Childress, advocates for healthcare workers to conduct themselves in a manner that is fair and equitable in light of what is due or owed, it does not elaborate on what sort of obligation this places on healthcare workers from HICs to work in LMICs in a bid fairly distribute the availability of healthcare workers. As such, this paper gives a normative argument for why healthcare workers from HICs have a moral obligation to work in LMICs, a concept we call Medical Cosmopolitanism. Following our positive argument, we debunk prominent objections to the concept of Medical Cosmopolitanism and consider ethical, educational and governmental implications of our findings. (shrink)

Asgary and Smith (2013) identify an important challenge: the difficult position of physicians caught between the obligation to treat every human being with the same professional rigor, and their feelings of responsibility toward the state and its judicial decisions on asylum requests. The authors show that in some cases this conflict leads to a tendency to "sacrifice their medical responsibilities". The authors' core demand is that health care workers should be independent of the state and judiciary systems, and thus (...) prioritize the interests of the patient. We agree entirely with the authors, that well-performed documenting is the only ethically justifiable option and should not be influenced by a feeling of responsibility for contributing to judicial decisions. However, the authors also address the more general, and ethically more challenging, issue of the responsibility of health care workers and the state toward asylum seekers and ask, how much health care provision is appropriate? (shrink)

The U.K.'s National Health Service (NHS) is critically reliant on staff from overseas, which means that a sizeable number of U.K. healthcare professionals have received their training at the cost of other states, whose populations are urgently in need of healthcare professionals. At the same time, while healthcare is widely seen as a primary good, many migrants are unable to access the NHS without charge, and anti‐immigration political trends are likely to further reduce that access. Both of these topics have (...) received close attention in the global health ethics literature. In this article, I make the novel move of suggesting that these two seemingly disparate issues should be folded into the same moral narrative. The ‘brain drain’ upon which the NHS and its users depend derives from the same gradient of wealth, security, and opportunity that produces migrants who require the NHS. I endorse moral cosmopolitanism as a lens for understanding patients' right to healthcare regardless of nationality or immigration status. I argue that the NHS in its current formulation effectively enacts a partial cosmopolitanism in its reliance on medical workers from abroad, but could more meaningfully instantiate that cosmopolitanism were it to offer the same healthcare to migrants as it does to citizens. (shrink)

Neuroethics applies cognitive neuroscience for prescribing alterations to conceptions of self and society, and for prescriptively judging the ethical applications of neurotechnologies. Plentiful normative premises are available to ground such prescriptivity, however prescriptive neuroethics may remain fragmented by social conventions, cultural ideologies, and ethical theories. Herein we offer that an objectively principled neuroethics for international relevance requires a new meta-ethics: understanding how morality works, and how humans manage and improve morality, as objectively based on the brain and social sciences. This (...) new meta-ethics will simultaneously equip neuroethics for evaluating and revising older cultural ideologies and ethical theories, and direct neuroethics towards scientifically valid views of encultured humans intelligently managing moralities. Bypassing absolutism, cultural essentialisms, and unrealistic ethical philosophies, neuroethics arrives at a small set of principles about proper human flourishing that are more culturally inclusive and cosmopolitan in spirit. This cosmopolitanism in turn suggests augmentations to traditional medical ethics in the form of four principled guidelines for international consideration: empowerment, non-obsolescence, self-creativity, and citizenship. (shrink)

My aim in this essay is to argue for a better moral-conceptual framework and for institutional innovation in preparation for the next pandemic. My main conclusions are as follows. (1) The primary moral principle that should guide responses to the next pandemic is the duty to prevent and mitigate serious harms. (2) A proper understanding of the moral foundations and scope of the duty to prevent and mitigate serious harms requires rejecting both Extreme Nationalism and Extreme Cosmopolitanism. (3) A (...) better response to the next pandemic requires transforming the moral landscape through institutional innovation by developing an international institution that can perfect indeterminate duties (i) by identifying duty-bearers, (ii) by specifying their duties to provide medical resources and other forms of aid, (iii) by allocating the specified duties to various public and private entities in such a way as to ensure effective coordination and that the costs of providing aid are fairly distributed, and (iv) by providing effective mechanisms for compliance with the specified duties. (4) Institutional innovation is morally required, regardless of whether the harm prevention and mitigation duties of the better-off are duties of justice or of beneficence, because without institutionalization, some duties of justice, including those requiring the prevention and mitigation of serious harms, suffer some of the same indeterminacies that are present in duties of beneficence. (shrink)

Stereotypes about exotic peoples and animals of the Orient shaped popular origin stories about COVID-19 in media reports. Outbreak narratives centred on the seafood market in Wuhan began to fall apart as new evidence was published by medical doctors, virologists, and epidemiologists. No viruses in bats or pangolins have been found that are direct ancestors of SARS-CoV2, the virus responsible for COVID-19 symptoms. Viruses are also being transformed as they interact with the human institutions, infrastructures and behaviours that facilitate (...) their spread. Epidemiological growth curves are shaped by national and foreign capital, cosmopolitanism, aspirations for independence and ongoing interdependence, the discourse of power and the discourse of resistance, as well as coexistence and violence. In reckoning with SARS-CoV2, we need to anticipate disruptive surprise of viral emergence rather recursively search for origins. Departing from Foucault’s foundational insights, this article gestures towards genealogies of possible viral futures. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deep TherapyDiskin ClayThe Therapy of Desire: Theory and Practice in Hellenistic Ethics, by Martha Nussbaum; xiv & 558 pp. Princeton: Princeton University Press, 1994; $29.95For three decades now interest in Hellenistic philosophy has been gaining among philosophers both in England—and its philosophical colony the United States—and in Europe. The principal documents of the Hellenistic schools have now been made available in both scrupulously edited Greek and Latin texts and (...) fine English translations by A. A. Long and David Sedley in their The Hellenistic Philosophers (1987). Conditions are right for the latest assimilation of this philosophical culture, whose conventional dates are those of the Hellenistic age—from the death of Alexander of Macedon in 323 B.C. to the suicide of the last of his successors, Cleopatra VII of Egypt in 31 B.C., but which in fact extends through the second century A.D. In the fracturing of the autonomous Greek city state and the new empires and cosmopolitanism that grew up in its place, in the turning inward of ethical thought and the simultaneous turning outward of science, the Hellenistic age holds up a mirror to our own. Especially congenial to philosophers in this country and in England is the radical skepticism that reaches from Socrates in the fifth century to Sextus Empiricus in the second century A.D.Martha Nussbaum’s The Therapy of Desire is very much a book for this age. Her topic is the “compassionate medical philosophy” of three of [End Page 501] the Hellenistic schools, the Epicurean, the Skeptic, and the Stoic. In focusing sharply on therapy, she leaves to the side—and on the outside—the connections that made Epicurean and Stoic philosophy systematic. But her awareness of the psychiatric possibilities of modern philosophy and what Michel Foucault called a technique de soi provide the contemporary context for the project of this book, at a stage when Freudian psychology is preparing to make its exit at the end of its century. Medicine is the only science that enters this book’s field of vision. Its thirteen studies (some already familiar) concentrate on the practical and therapeutic aims of Hellenistic philosophy and what the author terms the therapy of the passions, particularly the passions of erotic love, anger, and aggression, and fear of the gods. In The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy (1986), Nussbaum took the side of Aristotle against Plato. Here she takes the part of the Epicurean, Skeptic, and Stoic against the ethical theory of Aristotle, who is impressed to illustrate the practical turn in ethics which Nussbaum explores in Therapy. Plato is glimpsed on the horizon of this book “standing on the rim of the heavens” (p. 23). What links the intellectual program of both Fragility and Therapy is Nussbaum’s keen and sympathetic attention to poetry as a vehicle for philosophy or as a provocation to philosophical engagement. Four of the chapters of this study are devoted to poetry: three to Lucretius’ De Rerum Natura; one to Seneca’s Medea.The ethical project illustrated throughout these studies is formulated by Democritus, who first enunciated the claim: “medicine heals the sickness of bodies; but wisdom rids the soul of its sufferings” (DK 68B31). Each of the Hellenistic schools Nussbaum studies repeated this claim. Unexplored is the medical end of the analogy and the degree to which this much invoked analogy (whose terms are fused in our word psychiatry) conforms to actual medical practice, with its pathology, consultation, diagnosis, and treatment (therapeia). Nor is not clear from the Greek record that desires as opposed to the individual who harbors these desires are regarded as the object of therapy. The Hellenistic philosophers were clearly concerned with “extirpating” desires and disruptive passions, but the object of therapy was usually not desire but the individual who is disturbed by desire (as Philodemus, On Plain Speaking 84.11 Olivieri makes plain). But occasionally by extension the passions are described as the objects of therapy (as they are in Diogenes of Oenoanda, fr. 4.II.3 Smith).No one who has read Fragility will be taken aback by Nussbaum’s [End Page 502] invention of a... (shrink)

This Dictionary presents a broad range of topics relevant in present-day global bioethics. With more than 500 entries, this dictionary covers organizations working in the field of global bioethics, international documents concerning bioethics, personalities that have played a role in the development of global bioethics, as well as specific topics in the field.The book is not only useful for students and professionals in global health activities, but can also serve as a basic tool that explains relevant ethical notions and terms. (...) The dictionary furthers the ideals of cosmopolitanism: solidarity, equality, respect for difference and concern with what human beings- and specifically patients - have in common, regardless of their backgrounds, hometowns, religions, gender, etc. Global problems such as pandemic diseases, disasters, lack of care and medication, homelessness and displacement call for global responses.This book demonstrates that a moral vision of global health is necessary and it helps to quickly understand the basic ideas of global bioethics. (shrink)

Actions to prepare for and prevent pandemics are a common topic for bioethical analysis. However, little attention has been paid to global catastrophic biological risks more broadly, including pandemics with artificial origins, the creation of agents for biological warfare, and harmful outcomes of human genome editing. What’s more, international policy discussions often focus on economic arguments for state action, ignoring a key potential set of reasons for states to mitigate global catastrophic biological risks: moral reasons. In this paper, I frame (...) the mitigation of such risks as a global public good, and I explore three possible categories of moral reasons that might motivate states to provide this global public good: nationalism, cosmopolitanism, and interstate obligations. Whilst there are strong objections to moral nationalism as a reason for states to act, moral cosmopolitanism may provide a broad reason which is further supplemented for individual states through the elaboration of interstate moral obligations. The obligations I consider are moral leadership, fairness, and reciprocity. Moral reasons for individual states action may more effectively or more appropriately motivate states to mitigate global catastrophic biological risks. (shrink)

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

This code of practice for health professionals was prepared by a multi-professional group and reflects good clinical practice in encouraging dialogue about individuals' wishes concerning their future treatment. It has a broad practical approach, considers a range of advance statements, advises of dangers and benefits of making treatment decisions in advance and combines annotated code of practice with a quick pull out guide for easy reference.

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, irrespective (...) of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

Intuition is frequently used in medicine. Along with the use of existing medical rules, there is a separate channel that physicians rely on when making decisions: their intuition. To cope with the epistemic problem of using intuition, I use some clues from Wittgenstein's philosophy to illuminate the decision-making process in medicine. First, I point to a connection between intuition as functioning in medicine and Wittgenstein's notions of "seeing as" or noticing "aspects". Secondly, I use Wittgenstein notion of empirical regularities (...) hardened into rules to suggest that there are two stages that should be addressed in the analysis of medical practice: the first concerns the accumulation of cases and the second pertains to the setting a rule based on these cases. I argue further that the medical context is exceptional in that the two stages are intertwined and, and explain the consequences of this fact for the physician's work. Finally, inspired by Wittgenstein's rule-following conundrum, I argue that medicine is particularly prone to difficulties in applying a general rule to a specific case represented by an individual patient. Recourse to intuition is reflects the physicians' efforts to bridge this gap. (shrink)

Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two (...) practices is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. (shrink)

Current medical genetics research is dominated by a single theory that supports the Human Genome Project rationale. This thesis investigates this and several alternative hypotheses and the ethical context related to their development. Firstly, the hypotheses are discussed in detail followed by a subsection in which research evidence based on each hypothesis is cited. Secondly, these medical genetics hypotheses are situated within the contemporary medical paradigm. To conclude, the thesis examines in depth the ethical and practical implications (...) of medical genetics research. A framework of analysis of scientific responsibility is used to explore these implications. Scientific responsibility, as presented in this thesis, is a process consisting of three steps: scientific discourse; the development of the nature of scientific responsibility; and, effective criticism. Once scientific responsibility is defined, the term is applied specifically to the field of medical genetics research. (shrink)

Every day, medical interpreters encounter the vulnerabilities of patients with limited English proficiency and systemic barriers to doing the right thing for patients. The narratives in this issue of NIB demonstrate a love of the interpretive practice. There are many stories of advocacy that go above and beyond what is expected of them. Yet, even with national standards, tensions exist as to the boundaries of their role—how much advocacy is expected and how much is above and beyond? What are (...) the emotional costs of advocating for patients who are so vulnerable and in a system that is both huge and changing all the time? Overall, the narratives convey a sense of being situated within teams and within healthcare organizations as moral communities. As you read their stories, circle back to this context every now and then to ground the narratives and yourself in what it means to be a member of a team and moral community. I hope this grounding will help us be better at what we do together. (shrink)

1. Aim of the guidelines2. Principles of good practice3. Circumcision for medical purposes4. Non-therapeutic circumcision 4.1. The law 4.1.1. Summary: the law 4.2. Consent and refusal 4.2.1. Children’s own consent 4.2.2. Parents’ consent 4.2.3. Summary: consent and refusal 4.3. Best interests 4.3.1. Summary: best interests 4.4. Health issues 4.5. Standards 4.6. Facilities 4.7. Charging patients 4.8. Conscientious objection5. Useful addresses.

BackgroundMedical disputes, medical disturbances, verbal and physical violence against physicians, and burnout have reached epidemic levels. They may negatively impact both physicians and the healthcare system. The experience of medical disputes, medical disturbances, verbal, and physical violence, and burnout and the correlates in physicians working in public hospitals in China needed to be investigated.MethodsA nationwide cross-sectional survey study was conducted between 18 and 31 March 2019. An anonymous online questionnaire was administered. The questionnaire included the 22-item Maslach (...) Burnout Inventory-Human Services Survey. We also collected data on demographic and job-related factors, as well as physicians’ experiences of medical disputes, medical disturbances, verbal and physical violence from patients and the patients’ family members.FindingsIn total, 22,213 physicians from 144 tertiary public hospitals in all of China’s 31 provinces completed the survey. The overall burnout rate among the surveyed physicians was 31.28%. Moreover, 33.48% of physicians experienced disputes, 20.86% experienced disturbances, 48.52% experienced verbal violence, and 5.84% experienced physical violence in the past 12 months. Factors found to be significantly associated with burnout included younger age, being divorced or widowed, having a lower educational background, working in internal medicine departments, longer working hours per day, working in general hospitals, being in East China, as well as having experienced disputes, disturbances, and physical and verbal violence.InterpretationClose to a third of the Chinese doctors working in the tertiary hospitals reportedly experienced burnout, and the problem is related to the unsafe working environment caused by the worsening doctor-patient relationship. (shrink)

Background: Despite their negative consequences, evidence shows that futile medical treatments are still being provided, particularly to terminally ill patients. Uncovering the reasons behind providing such treatments in different religious and sociocultural contexts can create a better understanding of medical futility and help manage it effectively. Research objectives: This study was undertaken to explore Iranian nurses’ and physicians’ perceptions of the reasons behind providing futile medical treatments. Research design: This was a qualitative exploratory study. Study data were (...) gathered through conducting in-depth semi-structured personal interviews and analyzed using the conventional content analysis method. Participants and research context: Twenty-one nurses and nine medical specialists were recruited purposively from four teaching hospitals affiliated to Tehran University of Medical Sciences. Ethical considerations: This study was approved by the Nursing and Midwifery Research Center and the Research Ethics Committee of Tehran University of Medical Sciences. All participants gave informed consent for the research and that their anonymity was preserved. Findings: The main theme of the study was “having an obligation to provide medical treatments despite knowing their futility.” This theme consisted of three main categories including patients’ and family members’ request for continuing life-sustaining treatments, healthcare professionals’ personal motives, and organizational atmosphere and structure. Discussion and conclusion: Different personal and organizational factors contribute to providing futile medical treatments. Promoting the structure and the function of hospital ethics committees, establishing and developing home care facilities, increasing the number of palliative care centers and hospices, and educating healthcare professionals, patients, and family members about the services and the benefits of such centers can facilitate making wise decisions about continuing or discontinuing treatments which have been labeled as futile. (shrink)

This paper reviews the research done in Finland on medical ethics in the last three years and published in four leading journals. The general characteristics of this area are discussed and some comments on its most conspicuous representatives are offered. The conclusion reached is that medical ethics in Finland is still in a rather embryonic stage of development, and that more systematic and theoretically sophisticated approaches are required. However, since many physicians have become interested in ethical questions, it (...) can be reasonably assumed that a more lively and theoretically grounded discussion will ensue in the near future. (shrink)

The Empirical school of medicine, which arose in the third century BCE, defined itself in opposition to rationalist tendencies in medical thought. Causal explanation, which typically appeals to hidden, theoretical entities, is most at home in rationalist physiology and pathology, and much of what the Empiricists had to say about causes belongs to their anti-rationalist polemics. Over the course of the school’s history, however, some members appropriated the language and idea of cause, though always in ways that was consistent (...) with its defining commitment to Empiricism. (shrink)

The Jubilee Centre’s new report, Virtuous Medical Practice, examines the place of character and values in the medical profession in Britain today. Its findings are drawn from a UK-focused multi-methods study of 549 doctors and aspiring doctors at three career stages, first and final year students and experienced doctors.

As befits an emerging field of enquiry, there is on-going discussion about the scope, role and future of the medical humanities. One relatively recent contribution to this debate proposes a differentiation of the field into two distinct terrains, ‘medical humanities’ and ‘health humanities,’ and calls for a supersession of the former by the latter. In this paper, we revisit the conceptual underpinnings for a distinction between ‘the medical’ and ‘health’ by looking at the history of an analogous (...) debate between ‘medical geography’ and ‘the geographies of health’ that has, over the last few years, witnessed a re-blurring of the distinction. Highlighting the value of this debate within the social sciences for the future development of the medical humanities, we call for scholars to take seriously the challenges of critical and cultural theory, community-based arts and health, and the counter-cultural creative practices and strategies of activist movements in order to meet the new research challenges and fulfill the radical potential of a critical medical humanities. (shrink)

Ancient medical and healing systems are currently attracting considerable interest. This issue includes interdisciplinary studies which focus on new perceptions of some ancient and medieval medical systems, exploring how they related to each other, and assessing their contribution to modern society. It is shown that pre-Greek medicine included some rational elements, and that Egyptian and Babylonian medical systems contributed to a tradition which led from classical antiquity through the Middle Ages and beyond. The reliability of sources of (...) evidence is considered, as well as the legacy of the ancient healing environments and disease treatments. Finally, where documentation survives, the legacy of social attitudes to health and disease is considered. Overarching principles directed policies of social medicine and healthcare in antiquity and the Middle Ages: for example, the causes and transmission routes of infectious diseases, as well as the basic principles of sterilization, were unknown, but nevertheless attempts were made to improve sanitation, provide clean water, and ensure access to trained physicians. In some cases, the need to limit the size of the population prompted the use of contraceptive measures, and surviving information also illuminates attitudes to deformity, disability and the treatment of the terminally ill. (shrink)

A review of fraud in medical research in Britain, Europe, the USA and Australia. It includes a history of known cases of fraud since 1974 and discusses ways for detecting and dealing with fraud that have been devised by government agencies, pharmaceutical companies, academic institutions and scientific publications (especially medical journals).

In the context of medical ethics, how can the concept of informed consent be effectively implemented in a traditional society such as Japan? If the need for more openness and transparency is not felt in the practice of medicine and welfare, the clients must remain under the spell of paternalistic data. Patients and health-care professionals other than doctors are taken to be "responsible for what they do but not to be accountable for their conduct" because they do not participate (...) in a decision-making process. I explore the possibility of the concept's full implementation against the particularists' and communitarian ethicists' effort to reject the universal nature of the concept. (shrink)

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer (...) two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced. (shrink)

Medical research is still in its infancy. Within the memory of many of us, medical knowledge has made more progress than had been achieved in all the preceding time since the beginning of history. We have witnessed the reduction of our death rate, the extension of our life span and the achievement of a general state of health hitherto unknown.

The so-called Trolley Problem was first discussed by Philippa Foot in 1967 as a way to test moral intuitions regarding the doctrine of double effect, Kantian principles and utilitarianism. Ever since, a great number of philosophers and psychologists have come up with alternative scenarios to further test intuitions and the relevance of conventional moral doctrines. Given that physicians routinely face moral decisions regarding life and death, the Trolley Problem should be considered of great importance in medical ethics. In this (...) article, five “classic” trolley scenarios are discussed: the driver diverting the trolley, a bystander pulling a lever to divert the trolley, a fat man being thrown from a bridge to stop the trolley, a bystander pulling a lever to divert a trolley so that a fat man may be run over, and a bystander pulling a lever so that a fat man falls off from a bridge to stop the trolley. As these scenarios are discussed, relevant moral differences amongst them are addressed, and some of the applications in medical ethics are discussed. The article concludes that Trolley scenarios are not the ultimate criterion to make ethical decisions in difficult ethical challenges in medicine cases but they do serve as an initial intuitive guide. (shrink)

OBJECTIVES: Life-sustaining treatment at the end of life gives rise to many ethical problems in Japan. Recent surveys of Japanese physicians suggested that they tend to treat terminally ill patients aggressively. We studied why Japanese physicians were reluctant to withhold or withdraw life-support from terminally ill patients and what affected their decisions. DESIGN AND PARTICIPANTS: A qualitative study design was employed, using a focus group interview with seven physicians, to gain an in-depth understanding of attitudes and rationales in Japan regarding (...) medical care at the end of life. RESULTS: Analysis revealed that physicians and patients' family members usually make decisions about life-sustaining treatment, while the patients' wishes are unavailable or not taken into account. Both physicians and family members tend to consider withholding or withdrawing life-sustaining treatment as abandonment or even killing. The strongest reason to start cardiopulmonary resuscitation- and to continue it until patients' family members arrive-seems to be the family members' desire to be at the bedside at the time of death. All physicians participating in our study regarded advance directives that provide information as to patients' wishes about life-sustaining treatment desirable. All expressed concern, however, that it would be difficult to forego or discontinue life-support based on a patient's advance directive, particularly when the patient's family opposed the directive. CONCLUSION: Our group interview suggested several possible barriers to death with dignity and the appropriate use of advance directives in Japan. Further qualitative and quantitative research in this regard is needed. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for (...) simple medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)