The central theme of this book is that technological advances in medicine have created a multitude of choices for each individual -- choices that can influence how we live and die. These choices are difficult ones, and the book provides a better understanding of the issues. Thus, the implications of each choice become clearer. Such decisions remain inherently very difficult and personal. Thoughtful, compassionate societies must consider these difficult problems. Can we develop mechanisms to assist in the medical (...) choices that will inevitably take place throughout each individual's life? Jane Stein makes a stimulating effort to clarify these subjects in this book. She calls to attention problems we would prefer to avoid, touches the untouchable, and in so doing contributes to a constructive debate on the future of human life. - Preface. (shrink)

Considered ahead of its time since the first publication in 1981, Medical Choices, Medical Chances provides a telescope for viewing how developments in the fields of medical research, medical technology, and health care organization are likely to influence the doctor-patient relationship in the 21st Century. The book explores this intricate web of relationships among doctors, patients, and families and offers a new framework for mastering the emotional and intellectual challenges of uncertainty, while at the same time (...) providing tools for all concerned to regain control from managed care. It is a must-read for all those interested in medicine and where it is headed in the new millennium. (shrink)

In The Harm Principle, Personal Identity and Identity-Relative Paternalism,1 Wilkinson offers a thoughtful argument about medical decision-making and Derek Parfit’s reductionist account of personal identity. I agree that Parfit’s account can contribute to the ethical analysis of patients’ choices. My own work in this area emphasises challenges the reductionist account presents to conventional understanding of advance treatment directives, particularly in cases involving people with dementia.2 I have also urged people making directives to consider the harm their directives could impose (...) on future selves with dementia.3 But as Wilkinson points out, Parfit’s account has implications in other medical contexts as well. Wilkinson presents examples of people making medical decisions that could impose serious harm on their future selves. These examples consider decisions made before a health crisis. Another kind of case involves people in the midst of illness who face a series of ongoing care choices. As people in this situation adjust to their …. (shrink)

In the medical field in general, and in the one of organ transplants in particular, what effect can the institutional agents' perceptions of equity have?

Fundamentals -- Beginning-of-life issues -- Reproductive technologies -- Contraception, sterilization, and natural family planning -- End-of-life issues -- Cooperation with evil -- Respect for the body -- The ten commandments for health care professionals and patients.

(2013). Review of Peter Ubel, Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. The American Journal of Bioethics: Vol. 13, No. 4, pp. 53-54. doi: 10.1080/15265161.2013.768866.

Critics of medical aid in dying (MAID) often argue that it is impermissible because background social conditions are insufficiently good for some persons who would utilize it. I provide a critical evaluation of this view. I suggest that receiving MAID is a sort of “hard choice,” in that death is prima facie bad for the individual and only promotes that person’s interests in special circumstances. Those raising this objection to MAID are, I argue, concerned primarily about the effects (...) of injustice on hard choices. I show, however, that MAID and other hard choices are not always invalidated by injustice and that what matters is whether the injustice can be remediated given certain constraints. Injustice invalidates a hard choice when it can, reasonably, be remedied in a way that makes a person’s life go better. I consider the implications of this view for law and policy regarding MAID. (shrink)

Twelve writers (health care professionals, ethicists, pastors, and teachers) address some of the difficult issues in health care. Individuals and families are often forced to face medical crises alone. This book will help Christians better understand how to apply their faith to areas of medical crisis and to become more helpful and effective caregivers to people around them who face tough situations. Thought-provoking study questions at the end of each chapter assist a discussion group or Sunday school class (...) in dealing with the pertinent issues in an educational manner. (shrink)

AbstractWhile the literature on oncofertility decision-making was central to the bioethics debate on social egg freezing when the practice emerged in the late 2000s, there has been little discussion juxtaposing the two forms of egg freezing since. This article offers a new perspective on this debate by comparing empirical qualitative data of two previously conducted studies on medical and social egg freezing. We re-analysed the interview data of the two studies and did a thematic analysis combined with interdisciplinary collaborative (...) auditing for empirical ethics projects. Despite their different contexts, major similarities in women’s decision-making and reasoning were found. We developed two main common themes. Firstly, women felt a clear need to plan for future options. Secondly, they manipulated decision-times by postponing definitive decisions and making micro-decisions. The comparison highlights that the passage of time and the preservation of future choice seems to permeate all aspects of the patient experiences in both studies. As a result of considering real-world lived experiences, we suggest that there are many overlaps in women’s reasoning about egg freezing regardless of why they are making a decision to freeze. These overlaps are morally relevant and thus need to be further integrated into the existing arguments that have been canvassed in the flourishing egg freezing and fertility preservation debates across the field, and in policy and practice globally. (shrink)

Polskie przepisy prawne formułujące warunki dopuszczalności eksperymentu medycznego, a więc ipso facto wyznaczające jego granice, można różnorako interpretować, zwłaszcza w tym zakresie, w jakim określają wymagany dla przeprowadzenia eksperymentu bilans związanych z nim możliwych korzyści i szkód. W artykułach prawniczych komentujących te przepisy w zasadzie jednak brak prób systematycznego i (na tyle, na ile pozwala na to sam przedmiot analizy) ścisłego wyróżnienia tych interpretacji w języku tzw. teorii racjonalnego wyboru (rational choice theory), teorii szczególnie przydatnej w tym kontekście z (...) uwagi na jej rozbudowany aparat pojęciowy pozwalający badać różnorakie konfiguracje relacji między costs i benefits. Artykuł próbuje wypełnić tę lukę: wyróżnione w nim zostały różne interpretacje przepisów prawnych określających warunki dopuszczalności eksperymentu medycznego; interpretacje te zostały również poddane ocenie. (shrink)

In this paper I examine various aspects of the proposal that scarce lifesaving medical resources should (morally) be allocated by some random procedure. I argue that a fundamental assumption of this approach is that there are no morally relevant differences among the candidates for such services, and I challenge this general claim. I also argue that there are a great many lotteries among which we must choose if we are to use a lottery at all, and that we should (...) choose among them on valuational grounds. (shrink)

Joining the ongoing academic debates around medical students’ alternative career choices, this research examines the role of family in medical school attendees’ entrepreneurial intention. Specifically, this study decomposes the multidimensionality of family embeddedness and highlights the mediated nature of the family–EI relationship. The empirical analysis relied on data from graduation year medical students from diverse geographical locations and from different institution types in China. These data were collected from a total of 687 questionnaires covering the basic information (...) of individual, parents, and family composition, as well as the measuring scale of EI. Examining medical students’ EI and its antecedents provide a dual-missing-link in the extant knowledge, i.e., it adds the medical school piece to the overall picture of university students’ EI, and equally important, it de-trivializes entrepreneurship from the extant theorizations of medical students’ career choices. This study also bears implications for educators, practitioners, and policymakers interested in better understanding EI of medical school attendees and family embeddedness. (shrink)

In his paper, ‘Patients, doctors and risk attitudes’, Makins argues that doctors, when choosing a treatment for their patient, need to follow their risk profile.1 He presents a pair of fictitious diseases facing a patient who either has ‘exemplitis’, which requires no treatment or ‘caseopathy’, which is severe and disabling and for which there is a treatment with unpleasant side effects. The doctor needs to decide whether the patient should pursue the unpleasant treatment, just in case he has caseopathy. Makins (...) believes that rational-choice theory is a productive way to approach this problem. This theory frames all decisions as gambles. Each possible gamble (eg, not to pursue treatment) leads, probabilistically, to a set of outcomes (life with no disease and no side effects, but also, possibly, life with a disabling disease, since no treatment is taken). Utilities of these outcomes and probabilities that they will happen are combined to yield a number—expected utility. One is supposed to gamble—to make a choice—in a way that maximises this expected utility. Makins takes this framework for granted and is focused on an additional complication, the patient’s risk preference. He believes that, in his hypothetical example, even if expected utility were exactly the same, withholding treatment …. (shrink)

Putting in writing what you want -- What may happen if you don't make it "clear and convincing" -- Facts and statistics -- Empathy and the imagination -- Ancient myth and modern medicine: what can we learn from the past? -- Hoping for a miracle -- What could be wrong with hope? -- Medical futility -- Beyond futility to an ethic of care -- Future decisions we may all have to make.

It is reasonable to consider and trust that information taken from us about our medical health and history will be protected by rules on confidentiality and consent. Apart from very rare cases, perhaps of major public interest or for public health reasons, this information will not be shared with others without our consent. However, both a number of reforms in National Health Service patient data management policy (now enshrined in legislation) and developments in the general law on privacy challenge (...) this traditional view of our control and choice over our medical information, as this article will show. In doing so, it analyses the question as to whether in spite of the rhetoric do any of us now really have choice over the access to and use of our medical data? In reality, our choices are limited and in any relationship of trust and shared decision making this ought to be transparent. (shrink)

The healthcare systems of the United States and United Kingdom are vastly different. The former relies primarily on private sector incentives and market forces to allocate medical care services, while the latter is a centrally planned system funded almost entirely by the public sector. Therefore, each nation represents divergent views on the relative efficacy of the market or government in achieving social objectives in the area of medical care policy. Since its inception in 1948, the National Health Services (...) of the United Kingdom has consistently emphasized equity in the allocation of medical services. It has done so by creating a system whereby services are universally free of charge at the point of entry. Conversely, the United States has relied upon the evolution of a perplexing array of public and private sector insurance schemes centered more around consumer choice than equity in allocation. (shrink)

An original examination of the relevance of behavioral economics for the practice of medical ethics.

Medical practice should evolve alongside medical ethics. As our understanding of the ethical implications of physician-patient interactions becomes more nuanced, physicians should integrate those lessons into practice. As early as the 1930s, epidemiological studies began to identify that the rates of medical procedures varied significantly along geographic and socioeconomic lines. Dr. J. Alison Glover recognized that tonsillectomy rates in school children in certain school districts in England and Wales were in some cases eight times the rates of (...) children in other districts, with the only significant predictive factors being the current chief medical officer in the area and the socioeconomic well-being of the child's parents. Unfortunately, Dr. Glover's work revealed that the increase in tonsillectomies did not improve the health of adolescent patients and appeared to be performed “as a routine prophylactic ritual for no particular reason and with no particular result.”. (shrink)

Bowman-Smart et al. (2023) do an admirable job of explaining the expansion of noninvasive prenatal testing and outlining the arguments for and against testing for “non-medical” traits—arguments com...

Book reviewed in this article: Practical Medical Ethics. By Alastair Campbell, Grant Gillett, and Gareth Jones. If I Were a Rich Man Could I Buy a Pancreas? and Other Essays on the Ethics of Health Care. By Arthur L. Caplan. Bloomington Ethics on Call: A Medical Ethicist Shows How to Take Charge of Life and Death Choices in Today's Health Care System. By Nancy Dubler and David Nimmons.

There has been a significant growth in the literature on nudging and behavioural economics, since Richard Thaler and Cass Sunstein published their well-known book Nudge: Improving Decisions about H...

Tragic choices arise during the COVID-19 pandemic when the limited resources made available in acute medical settings cannot be accessed by all patients who need them. In these circumstances, healthcare rationing is unavoidable. It is important in any healthcare rationing process that the interests of the community are recognised, and that decision-making upholds these interests through a fair and consistent process of decision-making. Responding to recent calls (1) to safeguard individuals’ legal rights in decision-making in intensive care, and (2) (...) for new authoritative national guidance for decision-making, this paper seeks to clarify what consistency and fairness demand in healthcare rationing during the COVID-19 pandemic, from both a legal and ethical standpoint. The paper begins with a brief review of UK law concerning healthcare resource allocation, considering how community interests and individual rights have been marshalled in judicial deliberation about the use of limited health resources within the National Health Service (NHS). It is then argued that an important distinction needs to be drawn between procedural and outcome consistency, and that a procedurally consistent decision-making process ought to be favoured. Congruent with the position that UK courts have adopted for resource allocation decision-making in the NHS more generally, specific requirements for a procedural framework and substantive triage criteria to be applied within that framework during the COVID-19 pandemic are considered in detail. (shrink)

In medical practice, the doctrine of informed consent is generally understood to have priority over the medical practitioner’s duty of care to her patient. A common consequentialist argument for the prioritisation of informed consent above the duty of care involves the claim that respect for a patient’s free choice is the best way of protecting that patient’s best interests; since the patient has a special expertise over her values and preferences regarding non-medical goods she is ideally (...) placed to make a decision that will protect her interests. In this paper I argue against two consequentialist justifications for a blanket prioritisation of informed consent over the duty of care by considering cases in which patients have imperfect access to their overall best interests. Furthermore, I argue that there are cases where the mere presentation of choice under the doctrine of informed consent is detrimental to patient best interests. I end the paper by considering more nuanced approaches to resolving the conflict between informed consent and the duty of care and consider the option of permitting patients to waive informed consent. (shrink)

The growing practice of returning individual results to research participants has revealed a variety of interpretations of the multiple and sometimes conflicting duties that researchers may owe to participants. One particularly difficult question is the nature and extent of a researcher’s duty to facilitate a participant’s follow-up clinical care by placing research results in the participant’s medical record. The question is especially difficult in the context of genomic research. Some recent genomic research studies — enrolling patients as participants — (...) boldly address the question with protocols dictating that researchers place research results directly into study participants’ existing medical records, without participant consent. Such privileging of researcher judgment over participant choice may be motivated by a desire to discharge a duty that researchers perceive themselves as owing to participants. However, the underlying ethical, professional, legal, and regulatory duties that would compel or justify this action have not been fully explored. (shrink)

Medical missions to provide cardiac surgical procedures in developing and technologically less advanced countries is a great challenge. It is also immensely gratifying, personally and professionally. Such missions typically present significant ethical dilemmas, especially making difficult choices, given limited time and resources, and the inability to help all children in need of cardiac surgery. We describe some of these issues from our perspective as visiting cardiologists.

We were interested in exploring the associations and effects of experimental language (i.e., native – L1, or foreign – L2), dilemma type (i.e., personal – D1 or impersonal – D2), the digital device participants used (i.e., PC/laptop or smartphone), along with gender and age in sacrificial COVID-19 and non-COVID moral dilemmas. We performed two studies involving 522 participants aged 18 to 69 in April 2020. In Study 1, we found no significant associations between the dilemma type and the digital device. (...) However, most participants chose to sacrifice an older COVID-19 patient in a critical medical condition to prioritize rescuing similar, younger patients (i.e., 45-year-old males). Results also suggested that male and younger participants were more likely to choose the utilitarian option when the sacrificial dilemma was presented in French. In study 2 (i.e., non-COVID-19), participants made significantly more utilitarian choices in the personal dilemmas presented in French. Results are discussed concerning the SARS-CoV-2 pandemic context and its emotional impact on moral judgment. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC (...) is a solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

Protestant and Roman Catholic Ethics: Prospects for Rapprochment. By James Gustafson. Ethics at the Edge of Life: Medical and Legal Intersections. By Paul Ramsey. The Moral Choice. By Daniel Maguire.

Medical crowdfunding has become a popular choice worldwide for people with unaffordable health needs. In low-income and middle-income countries with limited social welfare arrangements and a high incidence of catastrophic health spending, the market for medical crowdfunding is booming. However, relevant research was conducted exclusively in North America and Europe; little is known about medical crowdfunding activities inother contexts. As a first step towards filling this knowledge gap, this study depicts the realities of medical crowdfunding (...) in a middle-income country China through empirical investigation and ethical analysis. We examine 100 randomly selected medical campaigns from a major Chinese crowdfunding platform and analyse the relevance of the previously identified ethical concerns to the Chinese context. The empirical findings show that Chinese campaigns have low and uneven success rates, require legally the participation of charitable organisations and focus on financial distress and family values in appealing for donations. In addition, the ethical analysis suggests that medical crowdfunding in China shares several ethical concerns raised in developed countries such as the veracity of claims and privacy violation. More importantly, our research reveals the inadequacy of current evidence and the lack of indicators to evaluate ethical issues in practice. Additional research is needed to better understand this fundraising practice across different social and cultural contexts. (shrink)

In their paper titledChoosing death in unjust conditions: hope, autonomy and harm reduction,Wiebe and Mullin argue against the stance of diminished autonomy in chronically ill, disabled patients living in unjust sociopolitical environments who pursue medical assistance in dying (MAiD). They suggest that it would be paternalistic to deny these people this choice and conclude that MAiD should actually be seen as a form of harm reduction for them.This response to their article argues that basing discussions surrounding this important (...) topic on a single bioethical concept does not address the needs of this cohort and is restrictively siloed. The discussion should include considerations of human rights and the need for legislative reforms to address social conditions, in addition to traditional bioethical principles. Work in this area needs to become interdisciplinary and collaborative as well as integrate input from the patients themselves. The concept of the dignity of these patients, in its broadest sense, needs to be infused into the discussion in order to optimise the exploration for solutions for this cohort.The stance of MAiD as harm reduction, in this context, does not meet the definition of harm reduction, nor does it represent a commitment to the best interests of these patients. (shrink)

The prelims comprise: Reproductive Choice and Reproductive Autonomy The Limits of Reproductive Autonomy The Right to Reproduce? Who Should Be Provided with Assistance to Reproduce? Reproductive Choices in Pregnancy Future Reproductive Choices Conclusions Notes References.

ZusammenfassungImmer mehr Menschen unterziehen sich chirurgischen Eingriffen, um ihr äußeres Erscheinungsbild zu verändern. Angesichts der omnipräsenten Konfrontation mit medial vermittelten Schönheitsstandards stellt sich die Frage des selbstbestimmten Umgangs mit den zur Verfügung stehenden Techniken der kosmetischen Chirurgie. Dieser Aufsatz analysiert die Frage, ob die Inanspruchnahme schönheitschirurgischer Maßnahmen als Ausdruck einer autonomen Entscheidung von Individuen betrachtet werden kann, oder ob sich entsprechende Körpereingriffe vielmehr dem Diktat von moralisch fragwürdigen Normen äußerer Erscheinungen verdanken und damit Ausdruck des zunehmenden Konformitätsdrucks und der Unterwerfung (...) des Individuums unter soziale Standards sind. Im Ergebnis wird gezeigt, dass ein subjektivistisches Autonomieverständnis für eine normative Bewertung schönheitschirurgischer Körpereingriffe unangemessen ist und anschließend ein Autonomiekonzept skizziert, das Bedingungen dafür formuliert, welche Formen der Nötigung als autonomiebeschränkend gelten können. (shrink)

When talking about personal identity in the context of medical ethics, ethicists tend to borrow haphazardly from different philosophical notions of personal identity, or to abjure these abstract metaphysical concerns as having nothing to do with practical questions in medical ethics. In fact, however, part of the moral authority for respecting a patient’s self-regarding decisions can only be made sense of if we make certain assumptions that are central to a particular, psychological picture of personal identity, namely, that (...) patients will remain psychologically connected to a certain degree with their future selves. I draw this out, show problems with approaches in medical ethics based on alternate theories of personal identity that do not recognise this, and explore some important implications. Namely, I show how this recognition can better explain the circumstances under which we should respect advance directives and why, and how it can better make sense of patient fears that they will not "survive" personality-altering deep brain stimulation procedures, and provide guidance on approaching patient decisions concerning this type of procedure in a manner that captures and addresses such concerns. (shrink)

Background: Patients in different countries have different attitudes toward self‐determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement. Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self‐administered questionnaire. Results: A total of 307 patients participated in our survey. Of the respondents, (...) 47% would accept recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one. Seventy‐six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One‐third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement. Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information. (shrink)