This collection of 49 readings with extensive background description exposes students to the breadth of theoretical perspectives and issues in the field of medical anthropology. The text provides specific examples and case studies of research as it is applied to a range of health settings: from cross-cultural clinical encounters to cultural analysis of new biomedical technologies to the implementation of programs in global health settings.

Research on human subjects aims to obtain knowledge of vital importance for human health and functioning. Neuroscientific research specifically is understood as oriented towards three goals: the maintenance of neurological health, the treatment of neurological diseases or syndromes, and the enhancement of neurological functioning. Most guidelines or regulations for pediatric research (whether in the U.S. or elsewhere) require that if a research intervention exposes subjects to more than minimal risk, a prospect of direct benefit is required—along with some other important (...) criteria. It is also required for any research project, that the methods and design will yield scientifically valid knowledge. This is typically met via placebo-controlled trials. This chapter presents an argument to the effect that more than minimal risk research on pediatric subjects cannot meet both ethical requirements. The basic idea is that either the subjects in the control or experimental arm will receive a prospect of direct benefit, but not both. This chapter also argues that the ethical weight or importance of this dilemma is very acute for neuroscientific research given the complexity of the brain’s functioning and the correlated difficulty of judging whether there is a “prospect” of direct benefit. The second half responds to this argument via a case study in neuroscientific research. The solution recapitulates a type of component analysis according to which different ethical principles apply to different activities of a research study. (shrink)

The Swiss linguist Ferdinand de Saussure has exerted a profound influence not only on twentieth century linguistics but on a whole range of disciplines within the humanities and social sciences. His central thesis was that the primary object in studying a language is the state of that language at a particular time – a so-called synchronic study. He went on to claim that a language state is a socially constituted system of signs that are quite arbitrary and that can only (...) be defined in terms of their relationship within the system. This new perspective has changed the way people think about linguistics and has led to important attempts to apply structuralist ideas in anthropology, literary criticism, and philosophy. Professor Holdcroft's book expounds and elaborates Saussure's central ideas. It also offers a critical assessment of them, arguing that many of Saussure's claims are either questionable or have been misunderstood. (shrink)

Michael Landmann, one of the prominent philosophers and scholars of our time, died in Haifa, Israel on January 25, 1984 at the age of seventy. He has enriched contemporary philosophy through his numerous writings whose principal theme was man's place in the world, or 'philosophical anthropology,' summarized as the conception of man as an individual with knowledge of his place within a historical tradition; man is therefore an expression of subjective and objective spirit at the same time. I.

Philosophy and anthropology need to integrate their accounts of what a morality is. I identify three desiderata that an account of morality should satisfy: (1) it should recognize significant diversity and variation in the major kinds of value, (2) it should specify a set of criteria for what counts as a morality, and (3) it should indicate the basis for distinguishing between more or less justifiable moralities, or true and false moralities. I will discuss why these three desiderata are (...) hard to satisfy at the same time, and why they are controversial. Anthropologists and philosophers will differ on which ones they are inclined to reject. I argue that all three should be accepted and can be satisfied. (shrink)

This book attacks the assumption found in moral philosophy that social control as such is an intellectually and morally destructive force. It replaces this view with a richer and deeper perspective on the nature of social character aimed at showing how social freedom cannot mean immunity from social pressure. The author demonstrates how our competence as rational and social agents depends on a constructive adaptation of social control mechanisms. Our facility at achieving our goals is enhanced, rather than undermined, by (...) social control. The author then articulates sources, contracts, and degrees of legitimate social control in different social and historical settings. Drawing on a wide range of material in moral and political philosophy, law, cognitive and social psychology, anthropology and literature, Professor Schoeman shows how the aim of moral philosophy ought to be to understand our social character, not to establish fortifications against it in the name of rationality and autonomy. (shrink)

In Britain before 1911, the vast majority of the population provided medical care for themselves and had evolved a variety of schemes that checked the power of organized medicine and encouraged a steady improvement in standards. The evidence is that at the end of the nineteenth century about 5–6 percent of the population relied on the poor law, 10–15 percent on free care from charitable institutions, 75 percent on mutual aid, and the remainder paid fees to private doctors.

Since its founding in the nineteenth century, social anthropology has been seen as the study of exotic peoples in faraway places. But today more and more anthropologists are dedicating themselves not just to observing but to understanding and helping solve social problems wherever they occur--in international aid organizations, British TV studios, American hospitals, or racist enclaves in Eastern Europe, for example. In Exotic No More , an initiative of the Royal Anthropological Institute, some of today's most respected anthropologists demonstrate, (...) in clear, unpretentious prose, the tremendous contributions that anthropology can make to contemporary society. They cover issues ranging from fundamentalism to forced migration, child labor to crack dealing, human rights to hunger, ethnicity to environmentalism, intellectual property rights to international capitalisms. But Exotic No More is more than a litany of gloom and doom the essays also explore topics usually associated with leisure or "high" culture, including the media, visual arts, tourism, and music. Each author uses specific examples from their fieldwork to illustrate their discussions, and 62 photographs enliven the text. Throughout the book, the contributors highlight anthropology's commitment to taking people seriously on their own terms, paying close attention to what they are saying and doing, and trying to understand how they see the world and why. Sometimes this bottom-up perspective makes the strange familiar, but it can also make the familiar strange, exposing the cultural basis of seemingly "natural" behaviors and challenging us to rethink some of our most cherished ideas--about gender, "free" markets, "race," and "refugees," among many others. Contributors: William O. Beeman Philippe Bourgois John Chernoff E. Valentine Daniel Alex de Waal Judith Ennew James Fairhead Sarah Franklin Michael Gilsenan Faye Ginsburg Alma Gottlieb Christopher Hann Faye V. Harrison Richard Jenkins Melissa Leach Margaret Lock Jeremy MacClancy Jonathan Mazower Ellen Messer A. David Napier Nancy Scheper-Hughes Jane Schneider Parker Shipton Christopher B. Steiner. (shrink)

This manual is a compendium of various health care policies, guidelines, protocols, and programs that concern clinical issues with ethical implications. The collection of policies, guidelines, and procedures are helpful in drafting and reviewing institutional procedures and helping policymakers develop useful mechanisms for assuring ethical treatment of patients and staff.

Karl Rahner’s analysis of genetic manipulation is found most explicitly in two articles written in 1966 and 1968: “The Experiment with Man,” and “The Problem of Genetic Manipulation.” The articles have received some attention in ethical literature. The present paper analyzes Rahner’s use of theological and ethical principles, comparing and contrasting the two articles. In the first article, Rahner emphasizes humankind’s essential openness to self-creativity. What has always been true on the transcendental level—-we choose our final destiny and thus create (...) ourselves—-may now be possible as well on the categorial or historical level. Thus we Christians have no a-priori theological warrant for rejecting genetic manipulation.But there is a considerable difference in Rahner’s second article. Whereas in the first he makes no immediate ethical application, in the second he introduces both a normative principle—-there ought never be a fundamental separation of procreation and marital intercourse—-and a metaethical concept--his “moral instinct of faith”—-to enable him to deal specifically with artificial insemination by third party donor, a procedure he rejects. There is also a shift in emphasis in his anthropological approach from the first to the second article.A close analysis of his method here discloses some difficulties concerning the “moral instinct of faith” and forces us to ask how principles of theological anthropology are and ought to be applied to questions like genetic manipulation. I conclude with my own proposal for the use of theological principles in medical ethics. (shrink)

I am grateful to Dr Stammers and Professor Vacek for their thoughtful commentaries on my paper.1 I will take their points one by one, though in no special order. Given the space available, I will confine myself to their most important remarks. Dr Stammers accuses me of aligning religion and conscience too closely.2 I agree with him that conscience is broader than religion and that the issue of conscientious objection should be framed so as to handle wholly non-religious ethical (...) objections. I wrote, ‘It is essential for the ethics of cooperation not to be seen as necessarily religious in nature in order for it to have proper application to disputed cases, whether or not brought by religious litigants’.3 A potential draftee might be a pacifist and not a religious adherent; the same in healthcare, where one might oppose abortion or euthanasia, say, on secular grounds. The main purpose of my paper is to show that a viable ‘ethics of cooperation’ can be used in all conscientious objection cases where complicity is at stake, whether the objection is religious or not. It is of course right, as Dr Stammers observes, that my ‘methodological neutralist’ will likely bridle at the claim that a top-level primary ethical or religious belief, such as that abortion at 12 weeks is immoral, is beyond a reasonableness test. Notoriously, in our secularised and diverse liberal society, a proposition that seems patently clear to one side of a major ethical debate can seem anything but clear to the other side, who will …. (shrink)

Recent decades have seen a significant increase in physicians participating in international short-term missions to regions with limited or no access to health care by virtue of natural disaster or lack of resources. Recent publications in the ethics literature have explored the potential of these missions for unintentional harm to the intended beneficiaries. Less has been discussed about how to respond when harm actually occurs. The authors review the ethical issues raised by short-term medical and humanitarian missions and the (...) literature on responding to unintended error to provide guidelines for avoiding harm to the intended beneficiaries of missions and an appropriate response when harm occurs. Two cases demonstrating an analysis and response to unintended harm are presented. (shrink)

Why devote an issue of an ethics journal to prison medicine? Why conduct ethics research in prisons in the first place? In this editorial, we explain why prison ethics research is vitally important and illustrate our argument by introducing and briefly discussing the fascinating papers in this special issue of the Journal of Bioethical Inquiry.Ethics is often regarded as a theoretical discipline. This is in large part due to ethics’ origin as a type of moral philosophy, which is frequently associated (...) with armchair theorising about principles and virtues and seems to have little connection with the “real world.” However, medical ethics and bioethics are increasingly becoming empirical disciplines. The “empirical turn” in ethics has led to an explosion in field research in ethics that uses the empirical methods of sociology, anthropology, and the health sciences to investigate a variety of ethical issues. The results of such research are often of much more value than purely theoret. (shrink)

I. Telling a patient: Midrash Rabba and Gersonides.--II. An ancient view on the risk of congenital disaster.--III. Overpopulation: 1300 years ago.

During a prostate exam, Mr. Watson, age 65, learns that his prostate appears to be abnormal. The family physician conducting the exam, Dr. Kleinman, informs Mr. Watson that he may have prostate cancer. Mr. Watson agrees to a variety of tests, including blood tests, bone scans, ultrasound scanning, and a biopsy. After learning about this possible diagnosis and these tests, Mr. Watson surfs the Web for information about prostate cancer and gathers data from many different sources, including the National Cancer (...) Society, the National Institutes of Health, Johns Hopkins University, the Mayo Clinic, and medicine sites. He also searches for information from medical journals using MEDLINE, visits several chat rooms on prostate cancer, and joins some e-mail lists. He arrives in Dr. Kleinman's office for a follow-up appointment with a stack of material and many questions. Dr. Kleinman is surprised, irritated, and offended. He recommends that Mr. Watson have a prostatectomy followed by radiation, but Mr. Watson does not want this operation. He would rather receive a form of radiation therapy recently approved by the FDA that he learned about through his own research. Dr. Kleinman admits that he does not know much about this new treatment, but he says that he would read up on it and consult an oncologist. (shrink)

The anthropological sensibility has often been seen as growing out of opposition to Enlightenment universalism. Johann Gottfried Herder (1744-1803) is often cited as an ancestor of modern cultural relativism, in which cultures exist in the plural. This article argues that Herder’s anthropology, and anthropology generally, are more closely related to Enlightenment thought than is generally considered. Herder certainly attacks Enlightenment abstraction, the arrogance of its Eurocentric historical teleology, and argues the case for a proto-hermeneutical approach which emphasizes embeddedness, (...) horizon, the usefulness of prejudice. His suspicion of the ideology of progress and of associated theories of stadial development leads to a critique of cosmopolitanism and, particularly, of colonialism. But a comparison with a central Enlightenment figure like the natural historian Buffon (1708-88) reveals shared anthropological assumptions: human beings are characterized by the flexibility of their relationship to their environment, and by their ability to transmit and receive social knowledge. Herder’s critique of progress is thus an unstable one: culture [ Kultur] as the process through which humanity develops can also be called Enlightenment [ Aufklärung]. Herder’s definition of culture is much closer to a unitary Enlightenment model of civilization than is frequently suggested. Herder’s relativism is thus open to question: he holds on to certain universal criteria for transcultural judgements. This reassessment of Herder’s place in Enlightenment anthropology raises questions of contemporary relevance regarding cultural relativism on the one hand, and modernization and globalization on the other. (shrink)

Ethical conduct is an essential component in research, especially in medical research. Statistical methods for design and analysis are powerful research tools if used properly. Abuse of these principles and methods are just as unethical as other laboratory or clinical misconduct. Inadequate research design can produce worthless results and thus wastes effort and valuable resources. For clinical research, patient resources are wasted. Inappropriate analysis of data can also produce misleading results and conclusions. For clinical research, inferior therapy might be (...) given to patients as a consequence. These ethical concerns can have implications for and affect the individuals responsible for the statistical design and analysis. Examples are provided which illustrate some possible abuses and inappropriate pressures. (shrink)

With a challenging title, based on an anecdote about a dialogue between a scientist/philosopher and a lady on the structure of the universe, David Kirchhoffer proposes that the insight that human beings are the world (rather than merely live in the world) should be our starting point for reflections on theological anthropology. Relationality thus being the key-word for an up-to-date theological anthropology, this chapter discusses the main challenges that such an anthropology faces: first, anthropocentrism (challenged by (...) the ecological crises, the debate on who counts as a person and technology); second, historicity (as introduced by social-constructivism and as taken more seriously in the Christian tradition in recent decades); third, vulnerability (as a morally neutral consequence of our interdependency); and finally, language (as a means to engage with diverse discourses ranging from art through to philosophy,business and cognitive neuropsychology). More than claiming to know the solutions for these different challenges, Kirchhoffer rather encourages theologians to further reflect on them and the way they are discussed in theological and other discourses with a necessary (self-)critical epistemological suspicion. For only in this way will we arrive at a relevant theological discourse on what human beings are, and be a legitimate dialogue partner for other discourses. (shrink)

The vigorous legal and ethical debates over conscientious objection have taken place largely within the domain of health care. Is this because conscience in medicine is of a special kind, or are th...

Naked Science is about contested domains and includes different science cultures: physics, molecular biology, primatology, immunology, ecology, medical environmental, mathematical and navigational domains. While the volume rests on the assumption that science is not autonomous, the book is distinguished by its global perspective. Examining knowledge systems within a planetary frame forces thinking about boundaries that silence or affect knowledge-building. Consideration of ethnoscience and technoscience research within a common framework is overdue for raising questions about deeply held beliefs and assumptions (...) we all carry about scientific knowledge. We need a perspective on how to regard different science traditions because public controversies should not be about a glorified science or a despicable science. Contributors are: Ward Goodenough, Eloisa and Brent Berlin, Colin Scott, Jean Lave, Emily Martin, Troy Duster, Hugh Gusterson, Charles Schwartz, Joan Fujimura, Sharon Traweek, Estellie Smith, Ellen Bielawaski, David Jacobon, Charles Ziegler, Pamela Asquith. (shrink)

There are several branches of ethics. Clinical ethics, the one closest to medical decisionmaking, can be seen as a branch of medicine itself. In this view, clinical ethics is a unitary hermeneutics. Its rule is a guideline for unifying other theories of ethics in conjunction with the clinical context. Put another way, clinical ethics interprets the clinical situation in light of a balance of other values that, while guiding the decisionmaking process, also contributes to the very weighting of those (...) values. The case itself originates ideas, not only about which value ought to predominate in its resolution, but also provides the origin of clinical rules that can be used in other cases. These are interpretive rules. Some examples of these rules are presented as well. (shrink)

This article suggests that the notion of an educational ‘trading zone’ is an analytically helpful way of describing a space in which ideas about learning and teaching are shared within and between disciplines. Drawing on our knowledge of anthropology and the Humanities, we suggest three possible reasons for the limited development of such zones within academia in the UK and US. The first is the relatively low status of education as a discipline, and its perceived dependence on individualist theories (...) of learning drawn from psychology. The second is that disciplinary pedagogies are often deeply embedded in academic identity and practice, making engaging with an educational ‘trading zone’ an epistemologically unfamiliar habit. A final, and more overtly political, reason is the strategic resistance of many faculty members to engaging with the new visions of teaching ‘professionalism’ offered by ‘faculty development’ and ‘training’ units within universities. We end by exploring whether the emerging debate around the ‘scholarship of teaching and learning’ might circumvent some of these barriers. (shrink)

Recent approaches in the medical and social sciences have begun to lay stress on “plasticity” as a key feature of human physiological experiences. Plasticity helps to account for significant differences within and between populations, particularly in relation to variations in basic physiological processes, such as brain development, and, in the context of this article, daily sleep needs. This article proposes a novel basis for the redevelopment of institutions in accordance with growing awareness of human variation in physiological needs, and (...) articulates a theory of multibiologism. This approach seeks to expand the range of “normal” physiological experiences to respond to human plasticity, but also to move beyond critiques of medical practice that see medicine as simply responding to capitalist demands through the medicalization of “natural” processes. Instead, by focusing on how the institutions of U.S. everyday life—work, family, and school—structure the lives of individuals and produce certain forms of sleep as pathological, this article proposes that minor alterations in institutions could result in less pathologization for individuals and communities. Multibiologism provides a foundation for shared priorities in the social sciences, in bioethics, and in medical practice, and may lay the groundwork for emergent collaborations in institutional reform. (shrink)

Darwinism, Democracy, and Race examines the development and defence of an argument that arose at the boundary between anthropology and evolutionary biology in twentieth-century America. In its fully articulated form, this argument simultaneously discredited scientific racism and defended free human agency in Darwinian terms. The volume is timely because it gives readers a key to assessing contemporary debates about the biology of race. By working across disciplinary lines, the book's focal figures--the anthropologist Franz Boas, the cultural anthropologist Alfred Kroeber, (...) the geneticist Theodosius Dobzhansky, and the physical anthropologist Sherwood Washburn--found increasingly persuasive ways of cutting between genetic determinist and social constructionist views of race by grounding Boas's racially egalitarian, culturally relativistic, and democratically pluralistic ethic in a distinctive version of the genetic theory of natural selection. Collaborators in making and defending this argument included Ashley Montagu, Stephen Jay Gould, and Richard Lewontin. Darwinism, Democracy, and Race will appeal to advanced undergraduates, graduate students, and academics interested in subjects including Philosophy, Critical Race Theory, Sociology of Race, History of Biology and Anthropology, and Rhetoric of Science. (shrink)

Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature (...) minor doctrine and state intervention for neglect. Our discussion approaches this parent–child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors’ decision-making authority in certain medical situations. (shrink)

Background Design thinking is a tool for generating and exploring ideas from multiple stakeholders. We used DT principles to introduce students to the ethical implications of organ transplantation. Students applied DT principles to propose solutions to maximise social justice in liver transplant allocation. Methods A 150 min interactive workshop was integrated into the longitudinal ethics curriculum. Following a group didactic on challenges of organ donation in the USA supplemented by patient stories, teams of students considered alternative solutions to optimise fairness (...) of organ distribution and ethical implications of changing the current model. Facilitators led students through DT steps of empathy, defining the team’s point of view, ideating on potential solutions, prototyping a specific idea and testing the idea through oral presentation, with questions and answers by peers and faculty. The curriculum was evaluated with presurveys and postsurveys including quantitative and open-ended items. Results 100 first year medical students participated. Before the session, 75.3% of students had no practical experience with DT. Following participation, students reported an increased understanding of the current liver transplant allocation system and an increased appreciation of shortcomings of the current organ allocation system. After the session, 73.8% of students felt that DT could be used to approach complex health system problems. Discussion Students participating in a DT workshop displayed improved knowledge and attitudes toward organ transplantation and DT. In this pilot study, DT showed promise as a student-led approach emphasising collaboration and creativity in ethics curricula in medical education. (shrink)

A significant portion of the practice of medicine is dependent on individual acts of medical altruism. Many of these acts, such as the donation of blood, gametes, stem cells, and organs, entail varying degrees of bodily intrusion and, for the altruist, various combinations of discomfort, risk, and expense. Discussion of the ethics of altruism has typically been fragmented under various rubrics such as blood donation, organ and tissue transplantation, health information, and the assisted reproductive technologies. The ethics of these (...) specific examples of altruism are best explored in conjunction with a broader discussion of their relatively neglected mother discipline, altruism in medicine.David Steinberg, M.D., is a board certified internist, hematologist, and oncologist. He is Chief of the Section of Medical Ethics at the Lahey Clinic Medical Center in Burlington, Massachusetts, and Clinical Assistant Professor of Medicine at the Harvard Medical School.FootnotesThis work was made possible by a grant in memory of Harold Karp by the Karp Family Foundation. (shrink)

Physician concern about regulatory scrutiny as a barrier to appropriate prescribing for pain management has been identified and studied. A 1991 Pain Research Group survey demonstrated a need to provide updated information about opioids and pain management to state medical board members. Indeed, a national survey even showed a need to provide more education about pain management to oncology Physicians. Two approaches for responding to these concerns have been undertaken in several states by the state medical boards and (...) the pain management community: the development and adoption of administrative policies designed to bring disciplinary standards in line with clinical practice; and the creation of education programs for state medical board members and staffs. Each can have a substantial impact on removing real and perceived regulatory barriers to effective pain relief. (shrink)

The article discusses the issue of the justification of experimenting on human subjects from the point of view of the individual participant. The discussion is conducted on three levels, which can be viewed as a hierarchy:I. Rationality: does one have good self-regarding reasons to subject oneself to medical experimentation?II. Justice: does one have a duty or an obligation to take part in medical research?III. Virtue: ought one contribute to the long-term attempt to promote medical knowledge and the (...) overall health of human beings?Rationality is shown to have only a limited force in such a justification, since many experiments cannot be shown to serve the interests of the participant in any way. Justice fares slightly better, since it is based on the idea of a social contract which goes beyond individual prudence. But, since many medical experiments promote the health only of future generations, the condition of mutuality, which is one of the bases of a social contract, is not satisfied. Thus, the ultimate reason to take part in medical research is associated with the supererogatory volunteering of people, who are motivated by the wish to contribute to a highly valuable enterprise with no expectation of return.The three types of reasons are complementary rather than exclusive, and the potential failure of all of them may lead to the undesirable commercialization of the field. Der Beitrag untersucht die Frage, ob und wie medizinische Versuche an Menschen aus der Sicht des einzelnen Teilnehmers gerechtfertigt werden können. Die Diskussion dieser Frage wird auf drei Ebenen geführt, die sich in einem Stufenverhältnis darstellen lassen,I. der Ebene der Zweckrationalität: Gibt es gute Gründe, und zwar durchaus des individuellen Eigennutzes, sich selbst für medizinische Versuche zur Verfügung zu stellen?II. der Ebene der Gerechtigkeit: Besteht eine Pflicht oder eine Verbindlichkeit zur Teilnahme an medizinischer Forschung?III. der Ebene der Tugend: Soll man zu dem auf lange Sicht angelegten Versuch beitragen, das medizinische Wissen und die Gesundheit der Menschen insgesamt zu fördern?Es wird gezeigt, daß das Argument der Zweckrationalität für eine mögliche Rechtfertigung nur von begrenzter Bedeutung ist. Denn viele Experimente dienen den Interessen des unmittelbaren Teilnehmers nachweislich in keiner Weise. Das Argument der Gerechtigkeit hat zwar eine etwas größere Kraft, weil Gerechtigkeit auf der Idee eines Gesellschaftsvertrags beruht, die über den Horizont individueller Klugheit hinausreicht. Da aber viele medizinische Experimente nur die Gesundheit zukünftiger Generationen fördern, ist die Bedingung der Gegenseitigkeit, die eine der Grundlagen des Gesellschaftsvertrags bildet, nicht erfüllt. Der dritte und letzte Grund für eine Teilnahme an medizinischer Forschung steht deshalb in enger Verbindung mit dem freiwilligen supererogatorischen Verhalten von Leuten, die durch den Wunsch motiviert sind, ohne Aussicht auf Gegenleistung zu einer höchst wertvollen Unternehmung etwas beizutragen.Die drei Arten von Gründen ergänzen sich mehr, als daß sie sich ausschließen. Ein mögliches Scheitern aller dieser Gründe könnte zu einer unerwünschten Kommerzialisierung der Teilnahme an medizinischen Experimenten führen. (shrink)

The precautionary principle is a useful strategy for decision-making when physicians and patients lack evidence relating to the potential outcomes associated with various choices. According to a version of the principle defended here, one should take reasonable measures to avoid threats that are serious and plausible. The reasonableness of a response to a threat depends on several factors, including benefit vs. harm, realism, proportionality, and consistency. Since a concept of reasonableness plays an essential role in applying the precautionary principle, this (...) principle gives physicians and patients a decision-making strategy that encourages the careful weighing and balancing of different values that one finds in humanistic approaches to clinical reasoning. Properly understood, the principle presents a worthwhile alternative to approaches to clinical reasoning that apply expected utility theory to decision problems. (shrink)

Access to clear and concise medication information is essential to support safe and effective use of prescription drugs. Patient misunderstanding of medication information is a common reason for non-adherence to medication regimens and a leading cause of outpatient medication errors and adverse drug events in the U.S. Medication errors are the most common source of risk to patient safety, leading to poor health outcomes, hospitalizations, and deaths. Over half a million adverse drug events occur in the outpatient setting each year (...) at a cost of approximately $1 billion annually.Nearly half of adults in the U.S. experience difficulty understanding and acting upon health information. Even individuals with high levels of general literacy may find medication information difficult to understand or use. The risk of misunderstanding medication information is compounded for patients with limited English proficiency who may not have access to this information in their own language. (shrink)

Christian health care professionals in our secular and pluralistic society often face uncertainty about the place religious faith holds in today's medical practice. Through an examination of a virtue-based ethics, this book proposes a theological view of medical ethics that helps the Christian physician reconcile faith, reason, and professional duty. Edmund D. Pellegrino and David C. Thomasma trace the history of virtue in moral thought, and they examine current debate about a virtue ethic's place in contemporary bioethics. (...) Their proposal balances theological ethics, based on the virtues of faith, hope, and charity, with contemporary medical ethics, based on the principles of beneficence, justice, and autonomy. The result is a theory of clinical ethics that centers on the virtue of charity and is manifest in practical moral decisions. Using Christian bioethical principles, the authors address today's divisive issues in medicine. For health care providers and all those involved in the fields of ethics and religion, this volume shows how faith and reason can combine to create the best possible healing relationship between health care professional and patient. (shrink)

It is now typical for human subjects research to be regulated by review by an independent research ethics committee in most jurisdictions. However it is common for countries to opt to only compulsorily regulate medical research while leaving some or all non-medical research either unregulated or only regulated on a voluntary basis. In this paper I will argue, using regulation in the UK as an example, that it is difficult to justify this sharp distinction in practices. While I (...) won’t come to any definitive conclusions in this paper as to whether research ought to be regulated compulsorily I will suggest that we would be better to regulate all research, albeit perhaps with a lighter touch than the present UK system if we want to prevent some highly risky research avoiding appropriate regulation. I will examine several arguments to defend making such a distinction; that medical professionals have special moral duties, that medical research has a higher magnitude/frequency of risks and that regulating non-medical research constitutes the inappropriate imposition of the medical model onto non-medical research. Having critiqued these objections I will then discuss the advantages of harmonizing the regulation of research and conclude that there is not a good reason to treat medical and non-medical research as fundamentally different in kind. (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)

Every human community creates its own representation of its surrounding world and of the men who constitute that world. It sets out in an orderly fashion the raison d’être of social and cultural organisation, it ritualises the ties between men and their relationship with their environment. Man creates the world while the world creates man, through a relationship which varies with each society; ethnography shows us innumerable versions. Human cultures consist of symbols. It is always a matter of reducing the (...) world to the human factor, but in line with a social imaginary quantity specific to a particular group, which is itself the tributary of its past and the possible influence of other groups. (shrink)

This book will attempt to achieve a constructive and positive correla tion between mythic-symbolic language and philosophical anthropolo gy. It is intended as a reflection on the philosophical accomplishment of Paul Ricoeur. The term mythic-symbolic language in this context means the language of the multivalent symbol given in the myth with its psychological and poetic counterparts. The term symbol is not con ceived as an abstract sign as it is used in symbolic logic, but rather as a concrete phenomenon - (...) religious, psychological, and poetic. The task inherent in this correlation is monumental when one considers the dual dilemma of problematic and possibility which is at its heart. The prob lematic arises out of the apparent difficulty presented by the so-called challenge of modernity which seems to require the elimination of my thic-symbolic language as an intelligible mode of communication. Mythic-symbolic language is sometimes eliminated because in a world molded by abstract conceptualizations conceptUalizations of science, such a language is thought to be unintelligible. The claim is that its "primitive" explana tions have been transcended by our modernity. Others believe that the problem of mythic-symbolic language is the problem of the myth. If the mythic forms of language could be eliminated, the truth of such language could be preserved through its translation into an intelligible mode of discourse. The problematic is heightened further by the relation of consider ations of language to philosophical anthropology. (shrink)

This interactive independent teaching and learning tutorial can be used by individuals or small groups and takes a problem-based-learning approach to the complex legal and ethical issues raised by six scenarios. Based on real cases clearly demonstrating the problems arising from recent medical advancements, the cases cover reproductive technology, consent, genetic screening, participation in research trials, paternity and confidentiality. Additional features of the CD-ROM are a comprehensive glossary, cross-references to The Cambridge Medical Ethics Workbook and definitions from the (...) Dictionary of Medical Ethics. (shrink)

Medicalization is the process by which conditions, for example, intellectual disability, hyperactivity in children, and posttraumatic stress disorder, become understood as medical disorders. During this process, the medical community often collectively assigns a label to a condition and consequently to those who would be said to have the disorder. We argue that there are at least two previously overlooked ways in which this linguistic practice may be wrongful, and sometimes, unjust: first, when the initial introduction of a (...) class='Hi'>medical label is done without the participation of those individuals who are being labelled, and second, when attempts by those individuals to renegotiate the labels are thwarted or otherwise rendered ineffective. In both cases, we argue, individuals are unfairly excluded from a linguistic practice that would be valuable for them to participate in. Furthermore, we argue that their exclusion depends in part on the authority of the medical institution to ignore their demands for participation. In making this case, we will propose the more general claim that participating in the linguistic processes of determining and renegotiating the words that will be used to describe oneself is an exercise of linguistic agency, a capacity that has both instrumental and intrinsic value. (shrink)

This book, written both for a Canadian and an international readership, provides a multidisciplinary review of the framework and performance of the Canadian Medical Assistance in Dying (MAID) program. In the first five years (2015-2021) of operation, this program delivered voluntary euthanasia and assistance in suicide to over 30,000 Canadian residents, presently representing a 30% annual growth. Looking back on these first five years, the 30 Canadian scholars and clinicians contributing to this volume raise important issues and attempt to (...) answer key questions that have arisen in regards to its operation and its stated objectives. This volume strikes the most appropriate balance between the autonomy of persons who seek medical assistance, versus the interests and protection of vulnerable persons. Finally, the book makes suggestions on how the program can presently be improved. It identifies gaps in knowledge about MAID’s operational program and its impact on individuals, families and society in order to stimulate the necessary research that is essential to the evolution of a healthy and well-balanced program. As a first, comprehensive examination of medically assisted deaths in Canada, this publication will be of great value to lay, professional, academic, political audiences both domestically and internationally, especially in jurisdictions that are examining their options of permitting assisted deaths. (shrink)

1988 : Does being a Christian physician really matter? / Edmund D. Pellegrino, response by John Robinson -- 1989: Clinical medical ethics: a review of the first decade / Mark Siegler, response by Maura Ryan -- 1990 : Who or what is an embryo? / Richard McCormick, response Margaret Monahan Hogan -- 1991: Euthanasia: Where is the debate going? / Daniel Callahan, response by Paul Weithman -- 1992: The moral inevitability of two tiers of health care / H. Tristram (...) Engelhardt, Jr., response by Joel James Shuman -- 1993: Compasionate care of the dying / James F. Bresnahan, response by John Young. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Method in Ancient PhilosophyDavid K. GliddenJyl Gentzler, editor. Method in Ancient Philosophy. Oxford: Clarendon Press, 1998. Pp. viii + 398. Cloth, $72.00.The fifteen papers in this collection constitute revisions of conference proceedings and reflect the varied interests of participants. The ensemble exhibits a thoroughly modern methodology. Whatever and however various ancient methods of philosophy may have been, in Anglo-American scholarship it is standard practice to first address established (...) scholarly interpretations as the primary entry point to critical discussionóoften displacing antiquity with a critical vocabulary of philosophical modernity. Scholars may come to understand each other better, but at the risk of asking the wrong questions or sacrificing ancient texts themselves as mere means of producing papers.Most scholars are progressives. They believe philosophy has advanced past the comparatively primitive wisdom of antiquity, and so such scholars feel perfectly entitled to make better sense of ancient texts, by patiently explaining what the ancients would have meant had they only been able to get it right. There are, of course, exceptions. And some papers in this collection suggest deeper faith in our philosophic fathers. So, the battle between the ancients and the moderns is joined once more, between those who would adorn their papers with footnotes for their peers and those who would attempt more anthropological an inquiry into ancient philosophic practices.Ian Mueller and Robert Bolton each address the same passage in Plato's Phaedo, both beginning with an article from Vlastos, first published in 1969. Mueller thoughtfully explores three different yet related accounts of what we might call scientific method in explaining Plato's views on natural change. Bolton wonders whether scholars are asking the wrong questions. Patricia Curd attempts a progressivist account of Eleatic thought, notwithstanding her recognition of the paucity of ancient sources. Complete with elaborately numbered sentences, Gail Fine focuses primarily on Burnyeat (1976) on Plato on Protagoras. Constance Meinwald presents a rather near-sighted account of two passages in the Philebus that employ the peras-apeiron distinction, with a view toward Plato's allegedly modernist mathematization of understanding. Lesley Brown revisits five pages of the Sophist that were hotly debated in the 1960s. With charity and elegance, she offers several plausible solutions to puzzles posed by previous scholars. Sometimes time smoothes over differences.A. A. Long's essay on Plato's presentation of Socrates in the Theaetetus might appear more philosophically anthropological. Yet Long reveals progressive sympathies, suggesting that Plato dispatches Socrates in the Theaetetus, so as to prepare the way for a more rigorously academic form of philosophizing, such as that exhibited in the Sophist. [End Page 111] In this way, Long speculates, Plato abandoned practical ethics for the academic life of research, so familiar to university professors and conference participants. It might be hard to square such speculation with Plato's Laws and the reception of Plato's writings among his own contemporaries. Still, Socrates' shifting role in Plato's dialogues is well worth pondering.By comparison, T. H. Irwin's contribution is wonderfully old-fashioned. His paper addresses the background knowledge to be presumed by ancient readers of Plato's dialogues and how that knowledge is artfully put to use in Plato's depiction of Socrates' reflections on the unity of virtue. By speculating on Plato's relation to his ancient readers, Irwin displaces many modernist preoccupations, though not without himself falling victim to that peculiar scholarly obsession of dating Plato's dialogues by their doctrines.With characteristic conservatism, Gisela Striker cautions scholars not to over-read Aristotle's Prior Analytics. While that extraordinary work may have deep implications for the history of formal logic, it probably was instead intended to be part of a general account of argument. In a similar vein, Charlotte Witt attempts to rescue Aristotle from scholars who would delimit Aristotle's multifarious uses of the "for the sake of" explanation, which altogether pervade his metaphysics, physics, biology and ethics. Yet, Witt soon finds herself competing in a contest over interpretive distinctions, a sport that will certainly never capture Aristotle's own authorial intentions.Facing another mass of scholarship, in this case on Aristotle's dialectic, C. D. C. Reeve sensibly attempts to... (shrink)

This paper addresses two research questions. The first is theoretical: What is trust? In the first half of this paper we present a distinctive tripartite analysis. We describe three attitudes, here called reliance, specific trust and general trust, each of which is characterised and illustrated. We argue that these attitudes are related, but not reducible, to one another. We suggest that the current impasse in the analysis of trust is in part due to the fact that some writers allude to (...) these distinctions, but unclearly so, whilst others elide them altogether. The second research question focuses on doctor–patient interaction. Trust is often said to be central in medical encounters but this strikes us as too vague. The success of doctor–patient relations in part depends on adopting the most appropriate of the three attitudes we delineate. We argue that reliance is the appropriate attitude for most medical encounters. When circumstances do require trust, the distinction between specific trust and general trust is crucial. We describe medical encounters requiring specific trust. General trust is less often required in medicine; but it is appropriate in some cases and, when called for, it is called for strongly. (shrink)

In recent decades, many jurisdictions have moved toward legalizing euthanasia and assisted suicide—together with a growing recognition of the moral right to a medically assisted death. Herewe draw on a comprehensive quantitative review of existing laws on assisted dying, experimental survey evidence, and four decades of time-series data to explore the relationship between these legislative transitions and changing moral attitudes. Our analysis reveals that existing laws on medical aid in dying impose a common set of eligibility restrictions, based on (...) the patient’s age, decision-making capacity, prognosis and the nature of their illness. These eligibility restrictions shape public moral approval of physician-assisted death, equally in countries where euthanasia is legal (i.e., Spain) and illegal (i.e., the United Kingdom). Additionally, records of public attitudes toward euthanasia across numerous countries over a forty-year period uncovered anticipatory growth in moral approval leading up to legalization, but no accelerated growth thereafter. Collectively, our findings suggest that legal frameworks for medical aid in dying crystallize patterns of moral intuition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Nature and Nurture in French Ethnography and Anthropology, 1859-1914Martin StaumThe adaptability of non-European peoples to "civilization" was a critical issue deriving from the perennial nature-nurture question that haunted debates in the human sciences in late nineteenth-century France.1 The emerging scholarly disciplines of anthropology and ethnography helped provide a scientific veneer that bolstered existing cultural prejudices concerning the innate limitations or retarded development of non-Europeans. Certainly there were (...) many other pragmatic reasons for imperial expansion, and racists did not automatically become imperialists. But if, as Edward Said contended, imperialism "depends upon the idea of having an empire," there is no doubt that many ethnographers and anthropologists helped legitimate the idea.2 Their debates retain a resonance in our twenty-first century postcolonial world struggling with questions of identity, integration, and cultural diversity.Relying on reports from travelers, missionaries, or colonial officials, human scientists from across the political and religious spectrum justified European superiority. Although a few journalists and philosophers outside the scholarly societies represented a minority anti-imperialist counter-current, the remarkable pervasiveness of hierarchical thinking affected both socially radical anthropologists and more conservative ethnographers.3 While ethnographers proclaimed universal fraternity, they conceded that physical differences affected [End Page 475] intellect and character. The later attack on hereditarianism by Durkheimian sociologists and isolated anthropologists with the catalyst of the Dreyfus Affair is all the more striking.4 As George Stocking has argued concerning a British Victorian thinker, the cultural differences between Europeans and non-Europeans became so entangled with biological issues that there was "difficulty conceptualizing them except in terms of 'race.' "5The two most notable anthropological scholarly societies of the late nineteenth century, both founded in 1859, were the Société d'ethnographie orientale et américaine and the Société d'anthropologie de Paris. Historians have justifiably noted their mutual aversion and have contrasted their differences over scientific method, politics, and religion.6 The ethnographers, inspired by a student of Japanese language and Asian religion, Léon de Rosny (1837-1914), were largely linguists and specialists in Asian texts and pre-Columbian codices that represented partly civilized peoples. Rosny invented the term "ambiantisme" for a philosophy that ostensibly privileged the cultural milieu rather than inborn human nature.7 The society membership varied between 115 in 1864 and 470 in 1878, though it declined to 165 by 1903.8 As a group, compared to the anthropologists, they were more politically conservative, more socially elite, and more inclined toward conventional religion, with its belief in the unity of the species. Their "science of destiny" stressed human freedom and unalterably opposed philosophical materialism.9 [End Page 476]The anthropologists, headed by physician and anatomist Paul Broca (1824-80) consisted of a hard core of like-minded medically trained colleagues. The anthropologists' membership peaked around 500 both in 1885 and 1905, though, they, too declined to 165 by 1914.10 Historians have analyzed the nature-nurture issue more subtly for the anthropologists.11 While the Society almost always expressed interest in both physical and cultural spheres, they privileged the study of crania as an index to the intellectual and moral characteristics of "races." The more extreme hereditarians thought that the nature of allegedly inferior "races" precluded perfectibility. Armand de Quatrefages (1810-92), professor of anthropology at the Muséum national d'histoire naturelle and pioneer of the so-called Muséum school, in his later years cast doubt on whether physical indicators actually demonstrated human superiority. However, the Muséum school did not generally renounce racial hierarchy, though they believed that environmental influences formed and continued to shape human varieties.12 In addition, philosophical materialists, militant atheists, and politically radical thinkers dominated the society in the generation after Broca's death. Almost all were neo-Lamarckians who leavened the idea of a fixed human nature with the possibility of adaptation to a milieu and transmissible acquired characteristics.13 The medical physiologist Charles Richet reported that "heredity and milieu are not antagonistic, but synergistic."14 However, many accounts underplay the differential application of neo-Lamarckianism. In this "racial evolutionist paradigm" already noticed by Laurent Mucchielli, even the Muséum school found only civilized people adaptable... (shrink)

This book provides a current review of Medical Research Ethics on a global basis. The book contains chapters that are historically and philosophically reflective and aimed to promote a discussion about controversial and foundational aspects in the field. An elaborate group of chapters concentrates on key areas of medical research where there are core ethical issues that arise both in theory and practice: genetics, neuroscience, surgery, palliative care, diagnostics, risk and prediction, security, pandemic threats, finances, technology, and public (...) policy.This book is suitable for use from the most basic introductory courses to the highest levels of expertise in multidisciplinary contexts. The insights and research by this group of top scholars in the field of bioethics is an indispensable read for medical students in bioethics seminars and courses as well as for philosophy of bioethics classes in departments of philosophy, nursing faculties, law schools where bioethics is linked to medical law, experts in comparative law and public health, international human rights, and is equally useful for policy planning in pharmaceutical companies. (shrink)

In 1866, six Inuits were taken to the United States for the purpose of serving as specimens to American scientists at the Natural History Museum. Shortly after their arrival in New York, four of them had died. One of the survivors returned to the Arctic, while the sixth, Minik, now alone, fought to make possible the return of the remains of his dead companions to their village. Since the latter were being exhibited, as was then often the case (and happens (...) even today in many museums), in order to offer visitors examples of the Inuk people, Minik protested in vain. In 1909 he returned to Greenland when the scientists denied that the remains of his friends still existed. Several years later, still pursuing the issue, he went back to the United States to take up the fight against the bureaucracy for the repatriation of the bodies. He died in the United States in 1918. It was only in 1993 that he won out and that the remains of the four were returned to the Arctic homeland. (shrink)

The general consensus is that reform of medical malpractice law should be part of the health care system's overhaul. Medical malpractice litigation results in the expenditure of tens of billions annually, largely paid out of health care insurance funds and mostly paid to defendants' and plaintiffs' lawyers. By all accounts, this tort law regime ill serves the basic deterrence and compensation goals of civil liability. The causes and magnitude of these failings are disputed, and many typical reform proposals (...) sidestep the basic problems and may do more harm than good. In contrast, we advance a straightforward way to improve both deterrence and compensation. Essentially, the proposal is to remove current legal limitations on the scope of insurance subrogation that bar private and public health care insurers from “buying” the whole of their insureds' potential medical malpractice claims in exchange for lower premiums and taxes and expanded insurance coverage. Our proposal’s benefits accrue regardless of the cause and magnitude of the failings of malpractice law or the further reforms that might be adopted. (shrink)

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps (...) to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)