Medical bribery seems to be a global problem from Eastern Europe and the Balkans to China, a diffuse phenomenon, starting with morally acceptable gratitude and ending with institutional bribery. I focus my attention on Romania and analyze similar cases in Eastern European and postcommunist countries. Medical bribery can be regarded as a particular form of human transaction, a kind of primitive contract that occurs when people do not trust institutions or other forms of social contract that are (...) meant to guarantee their rights and protect their interests. Concluding with strategies to fight medical bribery, I will underline better public policies for financing health and social care, and an ethic of trust that may help to restore trustworthiness of institutions and to rebuild interpersonal trust. This should be complemented by an educational program dedicated to understanding the negative consequences and mechanisms of corruption and the importance of ethical behavior. (shrink)

This article presents an artistic and political experiment as an effort to advance democratic transactions in the life sciences. Artists built a ‘gender democratic labyrinth’ in Maastricht, in which scientists, women’s groups, people in general, artists, philosophers, politicians, journalists, clinical geneticists and many others interacted and negotiated on the creation of human embryos for medical-scientific research. By taking a gender perspective on the process of democratizing science, we aimed to create a space in which alterity and difference are constitutive (...) elements in the public exchanges on science and technology. The idea to build a labyrinth was theoretically based on the notion of agonistic democracy - in which pluralism is the result of contestations and divisions - and on a notion of science and technology as being contextualized and socialized. (shrink)

A training physician has his first interaction with a pharmaceutical representative during medical school. Medical students are often provided with small gifts such as pens, calendars and books, as well as free lunches as part of drug promotion offers. Ethical impact of these transactions as perceived by young medical students has not been investigated in Pakistan before. This study aimed to assess the association of socio-demographic variables with the attitudes of medical students towards pharmaceutical companies and (...) their incentives. (shrink)

It may seem reasonable, even inevitable, that architectural practice should be based on an understanding that architects, like lawyers and doctors, should discover their clients' needs and accommodate them to the best of their abilities. But current discussion within the legal and medical professions of the conflict between service to private individuals who can pay, and to the public who cannot, suggest an expanded or altered definition of professional responsibility. Actually, the conflict between public and private interest may be (...) more acute in architecture than in other professions: the kind of buildings architects design are costly and are made possible only by the wealth of a small segment of the population or the state, yet every one raised affects the lives of people other than the one who makes the program and pays the architect for his services. Furthermore, the decisions of architects are embodied in buildings that last for generations, even for millennia, so that the overwhelming majority of people in our culture live and work in places designed not only for other people but for other times and conditions. For this reason, even the "private" practice of architecture involves responsibilities to a widespread constituency. James S. Ackerman is the author of The Architecture of Michelango, Art and Archaeology, The Cortille del Belvedere, Palladio and Palladio's Villas and is professor of fine arts at Harvard University. He has contributed "On Judging Art without Absolutes" to Critical Inquiry. (shrink)

Binding arbitration is generally less available in tort suits than in contract suits because most tort plaintiffs do not have a pre-dispute contract with the defendant, and are unlikely to consent to arbitration after the occurrence of an unforeseen injury. But the Federal Arbitration Act applies to all “contract[s] evincing a transaction involving commerce,” including contracts for healthcare and medical services. Given the broad trend towards arbitration in nearly every other business-to-consumer industry, coupled with some rollbacks in tort (...) reform measures that have traditionally favored medical professionals in the judicial system, it is very possible that we may witness in the near future more medical contracts containing arbitration provisions. As a consequence, all manner of tort claims might be hashed out in the sequestered universe of arbitration. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

Prevailing ethical thinking about informed consent to clinical research is characterized by theoretical confidence and practical disquiet. On the one hand, bioethicists are confident that informed consent is a fundamental norm. And, for the most part, they are confident that what makes consent to research valid is that it constitutes an autonomous authorization by the research participant. On the other hand, bioethicists are uneasy about the quality of consent in practice. One major source of this disquiet is substantial evidence of (...) the “therapeutic misconception”—the tendency of patient-subjects in clinical trials to confuse participating in research with receiving personalized medical care. This .. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the (...) provider-patient relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

Conceptually, entrepreneurship is seen as the engine that drives a robust economy, promotes a favorable quality of life, and assures the availability of the attributes needed for meaningful living. However, like many popular concepts in this world, its limitations are normally not well acknowledged. A grouping of entrepreneurial ventures which has recently come into existence deals with the personal fiscal issues associated with the end-of-life phase of the human cycle. While generally praised as humanitarian services for society, that are assuredly (...) within legal bounds, these activities have potentially significant negative implications. When examined from an ethical perspective, some questionable practices became apparent. Three such undertakings in particular have to do with the terminally ill and are examined in this paper. The first, viatical transactions, is defined as the transfer of a life insurance policy's ownership to someone who does not have an insurable interest in the life of the insured individual. The second, creative tax shelters for wealthy people involved in estate planning, involves hiring unrelated parties, particularly those who are young and in failing health, to do the dying for the principal. The third, mind games, involves curtailing the use of medical resources for the dying. The justification for this is rationing scarce medical resources. (shrink)

In many countries where human embryo commercialization is banned, and no profit is allowed to be made directly from the transaction of frozen embryos between donor and recipient, there is still considerable opportunity for profiteering in medical fees arising from laboratory and clinical services rendered to the recipient. It is easy to disguise the 'sale' of altruistically donated human embryos through substantially increased medical fees, particularly in a private practice setting. The pertinent question that arises is what (...) would constitute a fair and honest profit margin for the medical professional and health institution in question? A suitable benchmark would obviously be the level of medical fees normally charged to patients for a self-freeze/thaw embryo transfer cycle, after initial failure at their first attempt in ART. This is because the level of medical expertise, clinical and laboratory services required for a donor- and self-freeze/thaw embryo transfer cycle should, in theory, be about the same, although slight variation in treatment can be expected owing to patients' respective medical histories, which results in varying predisposition to medical complications. In any case, the health authority should ensure that there is no gross disparity in the medical fees for both donor- and self-freeze/thaw embryo transfer cycle, as this could mask opportunistic profiteering by medical professionals and, in fact, be a covert form of embryo commercialization. (shrink)

Resources of professional companies operating on the medical services market contain data from a huge number of transactional documents. This allows them to collect and process, among other actions, information about medical products. Organized data is obviously more valuable. In this paper, the possibility of supporting the process of organizing information is considered, with the goal to extract values of attributes of medical products from brief descriptions in transactional documents. This helps to build a structured product specification (...) and makes it possible to make comparisons between products. For this purpose, an approach based on regular expressions and their generation with the use of the genetic algorithm is proposed. The results presented in the paper show a great potential of the presented method. (shrink)

In November of 1893, Richard Cabot euthanized his brother Ted, who was suffering from the effects of untreated diabetes. Richard assumed responsibility of Ted’s care in June of that year and administered many treatments to ease the suffering and symptoms of his brother. These treatments, however, were ultimately ineffective to stave off the pain of renal failure and infection. Richard adored his older brother, and according to him, was the one that Richard “loved best.” As the date of Ted’s euthanization (...) approached, Richard shuttled from Ted’s bed to his father’s study, begging the elder Cabot for the permission to end Ted’s life. His father, at last, according to Richard, gave the permission. Ted, however, was.. (shrink)

It is widely believed that medically inert treatments (“placebos”) can bring about therapeutic benefits. There is also evidence that medically active treatments may also have “placebo” effects. Since anything that has the potential to benefit patients ought to be exploited, subject to appropriate ethical standards, it has been suggested that more should be done to investigate and exploit the power of the placebo for therapeutic benefit. I explore the acute epistemic and ethical constraints that such exploitation is likely to face, (...) and conclude that effective exploitation is unlikely. (shrink)

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient’s consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions. -/- What could morally justify the physician’s special legal duty to inform? I argue that existing justifications have tried but failed to ground such special (...) duties directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an indirect justification of physicians’ special duties from an argument in Kant’s political philosophy. Kant argues that pre- legal rights to freedom are the source of a duty to form a state. The state has the authority to conclusively determine what counts as “consent” in various kinds of transactions. The Kantian account can subsequently indirectly justify at least one legal standard imposing a duty to inform, the reasonable person standard, but rules out one interpretation of a competitor, the subjective standard. (shrink)

This article focuses on ethical issues surrounding the selling and buying of human organs. The author argues that most people who sell their organs in India do so in order to pay already existing debts. The transaction is only temporarily an exchange of “life for life,” and most “donors” are back in debt soon after the operation. The author discusses the flexible ethics that reduce reality to dyadic transactions and the purgatorial ethics that collapse real and imaginary exploitation in (...) the service of complex interests. He also offers a sophisticated discussion of the ethics of publicity and public ethics. He emphasizes the lack of factual information, intentional manipulation of information, and the dissemination of kidney panics and kidney scandals, especially by the new developing bioauthorities and bioethical brokers. (shrink)

Introduction -- Facing up to paternalism in research ethics -- Preface to a theory of consent transactions in research : beyond valid consent -- Should we worry about money? -- Exploitation in clinical research -- The interaction principle.

Financial relationships and business transactions between physicians and the health care industry are common. These relationships take a variety of forms, including payments to physicians in exchange for consulting services, reimbursement of physician travel expenses when attending medical device and pharmaceutical educational conferences, physician ownership in life science company stocks, and the provision of free drug samples. Such practices are not intrinsic to medical practice, but as the Institute of Medicine described in its 2009 report, these relationships have (...) the potential to produce positive collaborations that improve patient care and public health, and most physicians view it as “ethically proper to accept items ranging from drug samples to a lucrative consultantship.”However, financial relationships between physicians and pharmaceutical, medical device and biotechnology companies can also create negative influences on physician judgment that compromise patient care and jeopardize the public’s trust. (shrink)

The present review on dyadic coping (DC) aims at providing a critical integration of both the conceptual and empirical DC literature and overcoming the limitations of past reviews by (a) describing, comparing, and integrating all the DC models, (b) presenting and integrating findings from studies based on DC models, and (c) suggesting directions for further research. The DC models identified and compared include: The congruence model (Revenson, 1994 ), the relationship-focused model (Coyne and Smith, 1991 ; O'Brien and DeLongis, 1996 (...) ), the communal coping model (Lyons et al., 1998 ), the systemic-transactional model (Bodenmann, 1995, 1997 ), the relational-cultural model (Kayser et al., 2007 ), and the developmental-contextual coping model (Berg and Upchurch, 2007 ). After discussing each DC model, we advance a conceptual integration of all models, which serves as the framework to organize the review of the empirical literature. This integration includes the following DC dimensions: (a) Stress Communication, (b) Positive DC by One Partner (supportive DC, empathic responding, delegated DC, active engagement), (c) Positive Conjoint DC (common, collaborative, communal, mutual responsiveness); (d) Negative DC by One Partner (protective buffering, overprotection, and hostility/ambivalence), and (e) Negative Conjoint DC (common negative DC, disengaged avoidance). Developmental, relational, and contextual variables are included as factors shaping DC. To be included in the empirical review, articles had to be published in or a peer-reviewed journal in English and/or German before 2017 and include an original empirical study guided by one of the DC models. The review included 139 studies and, with the exception of the congruence model whose findings were discussed separately, findings were presented for overall DC and each of the dimensions identified in the conceptual integration. Findings were grouped also according to whether the stressor related or not to a medical or mental health condition. Demographic and cultural factors affecting DC were discussed. Overall, the empirical review suggests that in Western couples, positive individual, and conjoint DC forms, taken together or separately, have individual and relational benefits for couples coping with stress in general and/or mental health or medical stressors. Research on DC can be expanded to include other populations and stressors and use improved designs. (shrink)

The thesis of this paper is that our understanding of life, as reflected in the biological and medical sciences but also in our everyday transactions, has been hampered by an inappropriate metaphysics. The metaphysics that has dominated Western philosophy, and that currently shapes most understanding of life and the life sciences, sees the world as composed of things and their properties. While these things appear to undergo all kinds of changes, it has often been supposed that this amounts to (...) no more than a change in the spatial relations of their unchanging parts. From antiquity, however, there has been a rival to this view, the process ontology, associated in antiquity with the fragmentary surviving writings of Heraclitus. In the last century it has been especially associated with the work of the British metaphysician and logician, Alfred North Whitehead. For process ontology, what most fundamentally exists is change, or process. What we are tempted to think of as constant things are in reality merely temporary stabilities in this constant flux of change, eddies in the flux of process. My main claim in this paper will be that a metaphysics of this latter kind is the only kind adequate to making sense of the living world. After explaining in more detail, the differences between these ontological views, I shall illustrate the advantages of a process ontology with reference to the category of organism. Finally I shall explore some further implications of a process ontology for biology and for philosophy. (shrink)

An ethical issue that has largely been overlooked and neglected is the potential conflict of interests faced by medical professionals in the recruitment, counselling and reimbursement of egg donors. It must be noted that fertility treatment in private practice is an overwhelmingly profit-driven enterprise. To attract more patients and generate more income, there is a strong incentive for fertility clinics and doctors to actively and aggressively recruit women for their egg donation programme. In some countries where substantial financial remuneration (...) for egg donation is permitted—for example, the United States,1 2 fertility doctors and clinical embryologists often act as the “middleman” or broker to facilitate the transaction of eggs between donor and recipient. Very often, the usual practice is for fertility clinics to charge patients a commission for sourcing egg donors, which is an additional profit on top of substantial medical fees that would be earned from provision of fertility treatment to the same patient. This is ethically contentious; because the money earned is not directly related to medical services rendered to the patient, but is instead attributed to the brokerage and transaction of donated human material.There is a risk that the welfare of the …. (shrink)

In my recent article in the Journal of Medical Ethics, I attacked the Laissez Choisir Argument in defence of letting individuals choose whether to sell kidneys or other organs as living donors, and I argued that such transactions should generally remain prohibited.1 The LC Argument arises as a response to a prohibitionist claim that I endorse: organ sales should be banned to protect potential poverty-stricken vendors, even if a free market could provide great benefits to potential organ recipients. The (...) LC Argument says that this is misplaced paternalism, since banning the market only takes away from willing vendors what they must regard as their best option, thereby leaving them even worse off, at least as they see things. My refutation of the LC Argument pointed out, on the contrary, that giving some people the option to sell their organs may harm them in ways they would reasonably prefer not to be harmed—even though they would reasonably prefer to take the option once it is presented. The upshot is that many potentially willing organ vendors might themselves reasonably prefer prohibition. I argued that the harms of a live donor organ market to this group would in fact be significant and unavoidable, and that it would be morally impermissible to impose these harms. And I suggested that this argument for prohibition best explicates an inchoate but widely shared moral concern about the exploitative nature of live donor organ trading.I thank Gerald Dworkin, Janet Radcliffe Richards and Adrian Walsh for their engaging and often insightful commentaries.2–4 I agree with a lot, but I will …. (shrink)

Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which (...) other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law. (shrink)

It has become common to distinguish between altruistic and commercial contract motherhood (or ‘surrogacy’). Altruistic arrangements are based on the ‘gift relationship’: a woman is motivated by altruism to have a baby for an infertile couple, who are free to reciprocate as they see fit. By contrast, in commercial arrangements both parties are motivated by personal gain to enter a legally enforceable agreement, which stipulates that the contract mother or ‘surrogate’ is to bear a child for the intending parents in (...) exchange for a fee. She is required to undergo medical examinations and to refrain from behaviour that could harm the foetus. The intending parents are the child's legal parents from the outset. The parties to the contract can, but are not expected to, maintain contact after the transaction is completed. We argue that contract motherhood should not be organized according to the norms of the gift relationship, and that contract mothers should be compensated for their labour. However, we accept that there are good reasons for rejecting the commercial model as a suitable framework for contract pregnancy, and argue, instead, in favour of viewing it as a profession. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Gifts and Obligations: The Living Donor as StorytellerPaul Root WolpeThe Illness NarrativeEach of us lives with an inner biographical narrative, the story we tell ourselves about ourselves, the story that becomes our account of who we are. It is the story we have constructed about our life and its meaning, built from memories of our past—our childhood, our parents, our friends, our experiences. We construct that story through our (...) subjective experience and memories of our past, bringing together the disparate parts of our lives and weaving them into a coherent whole by which we make sense of ourselves.Under the pressures of the advent of sudden illness, or in the face of chronic illness that becomes a dominant status, “individuals often feel a pressing need to re-examine and re–fashion their personal narratives in an attempt to maintain a sense of identity” (Bury, 2001, p.264). Illness forces us to re–imagine our life in the face of often sudden new circumstances. Illness narratives about chronic or lifelong illness are not necessarily about suddenly needing to recast one’s life due to new circumstances, but about the need to understand the way chronic illness positions and defines us in the web of social and institutional relationships.The narratives in this collection might be thought of as a peculiar type of illness narrative. The people who populate these stories are not themselves sick (or at least were not when their stories began); yet they are bound up in the medical world, have had their bodies cut open and pieces removed, have had, at times, problematic recoveries and lasting physical and mental challenges. For that reason, the stories of living donors are particularly interesting in the illness narrative literature, and they raise a unique set of questions. Living donors have not discovered a sudden illness that requires re–imagining their lives, nor are they coping with a long illness that has become a thematic frame for how they conceptualize their world. The key aspect that differentiates the living donors’ narratives from the usual illness narratives is volition; the donors have chosen to enter the world of the infirm, have chosen to subject themselves to surgery and medical management, and have chosen to join their stories to someone else’s—and in so doing to become allied to, and yet never fully a part of, the illness narratives of the recipients.Gifting and OwnershipIf it is true that we tell our stories informed by the other stories of our culture, that we must fit our own stories into the narrative resources available in our particular society, then the living donors need to find a cultural frame to make sense of this strange position they find themselves in: joining the world of the sick and infirm not because of intrinsic illness but, to the contrary, because of their relative health. Almost thirty years ago, Renée Fox and Judith Swazey began their ground-breaking work The Courage to Fail (1974) with a clear [End Page 39] statement of the way in which the donor’s role is understood:The donor who offers a part of his body for transplantation is making an inestimably precious gift. The acutely ill patient who receives the organ accepts a priceless gift. The giving and receiving of a gift of enormous value, we believe, is the most significant meaning of human organ transplantation. The extraordinary gift exchange, moreover, is not a private transaction between the donor and the recipient. Rather, it takes place within the complex network of personal relationships that extends to the families, the physicians, and all the members of the medical team who are involved in the operation. Within the network of these relations, a complex exchange occurs through which considerably more than the organ itself is transferred(p. 5).It is the sociological and psychological power of the idea of the gift that makes transplantation an especially evocative case. Eighteen years later, in their second book about organ transplantation, Spare Parts (1992), Fox and Swazey cite their own quote above and comment about it that “Despite all the biomedical and social changes that have ensued within and around the... (shrink)

During the COVID-19 pandemic, there were many vaccine trials which had significant purposes which participants needed to understand to validly consent. For example, participants needed to understand that the purpose of dose-escalation vaccine trials was to give incremental doses of vaccine until participants became ill. Likewise, participants needed to understand that if they received placebos, they could no later take a genuine vaccine to preserve the integrity of the trials. Yet, these intuitive judgements about what participants need to understand to (...) validly consent are rejected by recent accounts of consent. According to these accounts, as long as participants were given a good opportunity to learn these purposes, they do not need to actually understand them to consent. In this paper, I reject this consensus, and I argue that participants who failed to understand these aims associated with vaccine trials failed to provide legitimate consent. I defend this claim by developing and defending a new understanding condition for valid consent. According to this understanding condition, a participant must understand when a consent transaction has features which violate the norms which govern the medical practice with which they are acquainted. I argue that this condition is independently plausible and best explains why participants needed to understand these aims associated with vaccine trials to validly consent. (shrink)

The medical profession, challenged by critics and reformers, is hard-pressed to give account of itself. Just what do physicians stand for? What do they revere? Where are they headed? These questions are becoming increasingly important yet increasingly difficult to answer, by established physicians and aspiring medical students alike. The perceived paralysis in the face of such questions and challenges is the central problem around which this book was written. To correct this failure, Dr. Trotter proposes the application of (...) Josiah Royce's "philosophy of loyalty" and the related thought of Alasdair MacIntyre to the practice of medicine. Uniquely qualified as both a professionally trained philosopher and an experienced physician, Trotter is the first to apply systematic philosophical precepts to this fundamentally important professional discipline. (shrink)

The Australian state of Victoria legalised voluntary assisted dying in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation has (...) received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law’s operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession’s opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years. (shrink)

The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are to be provided and the (...) interpretation of the patient–professional relationship. Commercially-focused practices threaten the fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to those accessing dental services. However, if the patient–practitioner relationship is reduced to a mere transaction in the name of enhanced consumer participation, this empowerment is but a myth. (shrink)

Consent governs innumerable everyday social interactions, including sex, medical exams, the use of property, and economic transactions. Yet little is known about how ordinary people reason about the validity of consent. Across the domains of sex, medicine, and police entry, Study 1 showed that when agents lack autonomous decision-making capacities, participants are less likely to view their consent as valid; however, failing to exercise this capacity and deciding in a nonautonomous way did not reduce consent judgments. Study 2 found (...) that specific and concrete incapacities reduced judgments of valid consent, but failing to exercise these specific capacities did not, even when the consenter makes an irrational and inauthentic decision. Finally, Study 3 showed that the effect of autonomy on judgments of valid consent carries important downstream consequences for moral reasoning about the rights and obligations of third parties, even when the consented-to action is morally wrong. Overall, these findings suggest that laypeople embrace a normative, domain-general concept of valid consent that depends consistently on the possession of autonomous capacities, but not on the exercise of these capacities. Autonomous decisions and autonomous capacities thus play divergent roles in moral reasoning about consent interactions: while the former appears relevant for assessing the wrongfulness of consented-to acts, the latter plays a role in whether consent is regarded as authoritative and therefore as transforming moral rights. (shrink)

As we move our social institutions from paper and ink based operations to the electronic medium, we invisibly create a type of surveillance society, a panopticon society. It is not the traditional surveillance society in which government officials follow citizens around because they are concerned about threats to the political order. Instead it is piecemeal surveillance by public and private organizations. Piecemeal though it is, It creates the potential for the old kind of surveillance on an even grander scale. The (...) panopticon is the prison environment described by Foucault in which prison cells are arranged in a large circle with the side facing the inside of the circle open to view. The guard tower is placed in the middle of the circle so that guards can see everything that goes on in every cell. When we contemplate all the electronic data that is now gathered about each of us as we move through our everyday lives --- intelligent highway systems, consumer transactions, traffic patterns on the internet, medical records, financial records, and so on --- there seems little doubt that we are moving into a panopticon. The social issues that arise from this are too numerous to detail here, but data retention is an important part of it. In the paper-and-ink world, documents are filed, files are boxed, boxes are put away or thrown away. The capacity for data retrieval and manipulation is, thereby, limited by the sheer difficulty and cost of storing, finding, searching, and manipulating large numbers of paper files. This inconvenience functions as a mechanism whereby the system forgets past information, not unlike the way we ourselves forget. However, the story is very different in the digital world; digital information is easy to store, easy to search and manipulate, and inexpensive to keep over extensive periods of time. Digitalized information systems tend, therefore, to collect extensive ancillary information and to retain this information indefinitely. Such lack of forgetfulness is likely to hamper the ability of individuals to shed their past, and start over with a clean slate. Concerns about data retention were expressed in the early literature on the social impact of computing, but for the most part the issue has dropped from sight. Rarely, has the social good of discarding accumulated personal data been addressed. In this paper, we want to make the case by examining diverse cases in which retention of information by either business or governmental institutions hinders the ability of individuals to start over or to act autonomously. We hope our argument for the good of forgetfulness will challenge the standard framework in which such issues have traditionally been debated. The privacy debate exemplifies the traditional framework insofar as it has been characterized as involving an inherent tension between, on the one hand, the needs of organizations and institutions for more accurate and efficient information systems so as to further their goals and, on the other hand, the desire of individuals to have information about them kept private. Regan argues against this framing of the privacy issue in favor of one that recognizes the social importance of personal privacy. We will examine the non-forgetfulness of information systems as a problem threatening not just individual interests but social good as well. Cryptography is often cited as the technology that will give us privacy and mediate against surveillance. One of the uses of cryptography, encryption, will allow us, some hope, to create confidentiality and relationships of trust that will facilitate many of the social arrangements we now have and perhaps make them even more secure than they are now. Electronic cash, for example, could be created in such a form that it would have the anonymity associated now with hard cash Others are less optimistic of the potential for cryptography to re-create relationships of trust in the new medium. One important point that already seems clear is that even if encryption technology will protect the confidentiality and integrity of electronic transactions and data, it will NOT stop the observation of traffic patterns on networks. This seems an important distinction to put on the table. Our patterns of communication will continue to be available, no matter what is encrypted, and an amazing amount of information can be gleaned from this data. In a sense, it means content integrity but no anonymity. This will indubitably impact how we interact and with whom we interact. (shrink)

The trade in human body parts can be understood as a solution to key challenges for both buyers and suppliers, as well as being a manifestation of individual property rights over one’s own body. However, it can be argued that there are serious ethical issues involved in commercializing the body in this way, despite which there has recently been a large increase in the international trade in human body parts. The most extensive transactions have concerned the trade in kidneys and (...) the services of the fertility industry. An important driver of this is the fact that the medical profession is increasingly able to facilitate exchanges of human body parts relatively smoothly. The chapter focuses on commercial surrogacy as an example of the ethical aspects of the trade in human body parts and addresses the potential interplay between markets and ethical issues. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.3 (2002) 299-303 [Access article in PDF] Bioethics Inside the Beltway What Should IRBs Consider When Applying the Privacy Rule to Research? Julie Waltz Gerlach In 1996, Congress mandated the establishment of standards for the privacy of individually identifiable health information through the Health Insurance and Portability and Accountability Act of 1996 (HIPAA). Until the establishment of HIPAA, personal health information could be distributed (...) without notice or consent for reasons that had nothing to do with a patient's medical treatment or health care reimbursement. Patient information held by a health plan could be passed on to a lender who then might deny the patient's application for a home mortgage or a credit card or to an employer who might use it for personnel decisions. Congress failed to meet its 21 August 1996 deadline established by HIPAA to pass privacy legislation; the Act passed the responsibility to Department of Health and Human Services (DHHS). On 28 December 2000, the Secretary of Health and Human Services released final privacy regulations relating to the protection of patients' individually identifiable health information. The "Standards for Privacy of Individually Identifiable Health Information" (Privacy Rule/current) took effect 14 April 2001. As required by HIPAA, the Privacy Rule established conditions for the collection, use, and disclosure of protected health information by covered entities for research purposes. Covered entities, defined as health plans, health care clearinghouses, and health care providers that engage electronically in a wide range of financial and administrative transactions related to payment and reimbursement, must comply by 14 April 2003 (DHHS 2000, p. 82462). To ensure that the provisions of the final rule provide strong privacy protection without hindering access to health care, the Department of Health and Human Services (DHHS 2002, p. 14776) has proposed modifications to the Privacy Rule.The final Privacy Rule (DHHS 2001) grants substantial rights to individuals/research participants to be informed of how their protected health information is maintained and how that information may be used or disclosed. It also defines individual's/research participants' rights with regard to gaining access to information about themselves, when such information is held by covered entities. [End Page 299]The Privacy Rule requires researchers either to receive authorization from individuals/research participants to collect, use, and disclose protected health information, or to obtain a waiver of authorization that is approved by an institutional review board (IRB) or Privacy Board, or to use de-identified data. Section 164.508 of the Privacy Rule, entitled "Use and Disclosures for Which an Authorization Is Required," describes how IRBs will be directly affected. The rule focuses not just on research but on the overall privacy of all identifiable health information. Institutions have the option of adding these required duties to IRBs or establishing "privacy boards." Privacy boards, as defined by the Privacy Rule, are to be composed of members with varying backgrounds and professional competency to review the effect of the research protocol on the individual/research participant's privacy rights. The board must include at least one member who is not affiliated with the covered entity, or any entity conducting or sponsoring the research, and not related to any person who is affiliated with such entities. Board members cannot participate in the review of any research project in which the member has a conflict of interest.The basic concepts and tenets of privacy and confidentiality are well known to IRBs in the United States, which operate under the Common Rule (45 CFR 46) and/or the Food and Drug Administration's (FDA) human subject protection regulations. Both sets of regulations require IRBs to ensure that risks (including privacy risks) are minimized. Under these regulations, IRBs must consider the confidentiality of research data and whether researchers should have access to confidential medical information. IRBs also must review the consent form as a process of communication that will inform research subjects about the research study.One noteworthy aspect of the Privacy Rule is its application to all research regardless of funding source. Currently, research funded by... (shrink)

Contemporary Americans often view politics as a necessary evil. This cogent and original work uses the ancient philosophical/political tradition of the West to rehabilitate the high vocation of the politician and the citizen in the modern world. Kane seeks to locate human beings and such philosophical notions as the public good, public virtue, public speech, and public action in the complicated middle between the bestial and the divine. To live as best we can on that middle path is, he believes, (...) our vocation as citizens. The classical tradition comes alive in fresh ways as Kane applies it to key contemporary events and figures, from Elizabeth Bouvia (who wanted medical practitioners to help her die) to Rosa Parks (who wanted equal treatment on a city bus). By paying close attention to our public transactions, Kane shows how the reality of the common good operates in our lives. Kane contends that we are more likely to rediscover our political selves not in broad national or international forums but in our local communities where character can be displayed and authentic speech and action become possible. Aimed at a broad interdisciplinary and inter-professional audience, Kane's book is accessible to the interested citizen. Weaving through the tangled web of contemporary politics, including issues of character and virtue, Kane sails against the prevailing currents of strident individualism and political cynicism. (shrink)

Problems in the field of health law often force tradeoffs between uniformity and particularity in health care decision-making. Patients are highly diverse in terms of their basic health status, willingness to accept risk or uncertainty in new treatments, and ability to pay for care. And health care experts - doctors, research scientists, insurance company reviewers, and health economists - are similarly diverse in their perception of the best treatment and payment structure choices. In a world with such persistent heterogeneity of (...) opinions and preferences, a society's choice between centralized rules for treatment and payment and a more diffuse decisional regime is both crucial and controversial. Opt for a uniform national rule - say, a federal statute governing treatment standards, drug approval, or health finance - and many beneficial autonomous transactions between doctors and patients are squelched, with possible detrimental effects on population health and medical innovation. (shrink)

Bioethical arguments conceal the coercion underlying the choice between poverty and selling ones organsIn mid-May 2006, three Palestinian prisoners detained in Israel applied to the Israeli Prison Service for permission to sell their kidneys in order to send money to their children for food. Whether truly sincere or merely propagandistic, the request was made against the background of Israel’s decision to suspend the transfer of Palestinian tax moneys to the Hamas-led Palestinian Authority, and the subsequent increasing poverty and famine in (...) the Gaza Strip.1An official decision was yet to be made when this paper was written. However, the IPS chief medical officer had already made it clear that the request is likely to be rejected. Aside from emphasising that the cost of the pertinent treatment of the prisoners could not be imposed on the IPS, especially as it would greatly exceed the sum to be obtained by the sellers , he asserted that the IPS “won’t lend a hand to endangering the prisoner”. He also reiterated the official IPS policy, according to which the prisoners’ consent to such transaction could not be valid, since they might have been threatened by people from inside or outside the prison.1This is ironic. While the IPS’ professed concerns for the welfare and best interests of the prisoners are commendable, they conceal and hence reaffirm the real coercion implicit in the dilemma the prisoners face: to sell their kidney or let their children starve. Interestingly, approval of their request would have equally concealed the coercion, this time behind concerns for either their autonomy, or the welfare of their children, or both.At present, it is unlikely that Israel will acknowledge the role of national oppression and poverty in producing this dilemma. Rather, the debate will remain focused on …. (shrink)

This chapter introduces the book by arguing that feminist and critical philosophy of race need to engage more robustly with the medical and biological sciences. It explains physiological habits as transactional, that is, as co-constituted in a dynamic relationship with the social-political world. It also argues that both race and sex/gender are biological, but not in the pre-critical sense of static, essential categories. Rather, they are biological in the critical, dynamic way in which they become biological through the embodiment (...) of racial inequalities. As the book demonstrates, sexism and racism have put down some of their toughest roots in the physiological habits of human bodies, and thus it is there that feminist philosophy and critical philosophy of race also must work. (shrink)

The U.S. health care system is ostensibly market based and therefore at least partially reliant on competition and consumer demand to regulate costs. Yet information about an essential feature of market transactions—costs—is typically obscure to patients until long after treatment. When discussing what must be disclosed for informed consent, the same list of required information is often mentioned regardless of the health care system in question, and information about costs rarely merits a place within this list. However, our assumptions about (...) what a moral principle requires need to be responsive to the realities of the health care system in which the principle is applied.This paper explores the moral foundations of disclosure and informed consent to argue that, in a market‐based system of the sort found in the United States, these same considerations support a requirement to disclose out‐of‐pocket costs before patients receive care. Next, I consider two objections to this view: first, that health care practitioners should focus solely on medical considerations in their encounters with patients and, second, that disclosing out‐of‐pocket costs would be too difficult to be mandated. I argue that medical and financial interests are inseparable within the U.S. health care system. If the difficulties in disclosing costs are deemed insurmountable, then the current system may prove unsustainable, both morally and financially, since we face the same practical impediments to implementing any meaningful consumer‐driven, market‐based health care reform. Finally, I explore some of the consequences of failing to disclose costs. The requirements of disclosing costs can be supported by the principle of respect for autonomy, regardless of the consequences, but in light of the consequences of the decision of whether to disclose, a concern about justice provides further support. (shrink)

The first topic of concern is anonymity, specifically the anonymity that is available in communications on the Internet. An earlier paper argues that anonymity in electronic communication is problematic because: it makes law enforcement difficult ; it frees individuals to behave in socially undesirable and harmful ways ; it diminishes the integrity of information since one can't be sure who information is coming from, whether it has been altered on the way, etc.; and all three of the above contribute to (...) an environment of diminished trust which is not conducive to certain uses of computer communication. Counterbalancing these problems are some important benefits. Anonymity can facilitate some socially desirable and beneficial behavior. For example, it can eliminate the fear of repercussions for behavior in contexts in which repercussions would diminish the availability or reliability of information, e.g., voting, personal relationships between consenting adults, and the like. Furthermore, anonymity can be used constructively to reduce the effect of prejudices on communications. Negative aspects of anonymity all seem to point to a tension between accountability and anonymity. They suggest that accountability and anonymity are not compatible, and they even seem to suggest that since accountability is a good thing, it would be good to eliminate anonymity. In other words, the problems with anonymity suggest that individuals are more likely to behave in socially desirable ways when they are held accountable for their behavior, and they are more likely to engage in socially undesirable behavior when they are not held accountable. I am not going to take issue with the correlation between accountability and anonymity, but rather with the claim that accountability is good. To examine this problem, let's look at a continuum that stretches from total anonymity at one end, and no anonymity at all at the other end. At the opposite extreme of anonymity is a panopticon society. The panopticon is the prison environment described by Foucault in which prison cells are arranged in a large circle with the side facing the inside of the circle open to view. The guard tower is placed in the middle of the circle so that guards can see everything that goes on in every cell. In a recent article on privacy, Jeffrey Reiman, reflecting on the new intelligent highway systems, suggests that we are moving closer and closer to a panopticon society. When we contemplate all the electronic data that is now gathered about each one of us as we move through our everyday lives- intelligent highway systems, consumer transactions, traffic patterns on the internet, medical records, financial records, and so on- we see the trend that Reiman identifies. Electronic behavior is recorded and the information is retained. While actions/transactions in separate domains are not necessarily combined, it seems obvious that the potential exists for combining data into a complete portfolio of an individual's day to day life. So it would seem that as more and more activities and domains are moved into a IT-based medium, the closer we will come to a panopticon society. A panopticon society gives us the ultimate in accountability. Everything an individual does is observable and therefore available to those to whom we are accountable. Of course, in doing this, it puts us, in effect, in prison. The prison parallel is appropriate here because what anonymity allows us is freedom; prison is the ultimate in lack of freedom. In this way the arguments for a free society become arguments for anonymity. Only when individuals are free will they experiment, try new ideas, take risks, and learn by doing so. Only in an environment that tolerates making mistakes will individuals develop the active habits that are so essential for democracy. In a world without information technology, individuals have levels or degrees and various kinds of anonymity and consequently different levels and kinds of freedom. Degrees and kinds of anonymity vary with the domain: small town social life versus urban social life, voting, commercial exchanges, banking, automobile travel, airplane travel, telephone communication, education, and so on. Drawing from our experience before IT-based institutions, we might believe that what we need is varying levels or degrees and kinds of anonymity. This seems a good starting place because it suggests an attempt to re-create the mixture that we have in the physical, non-IT-based world. Nevertheless, there is a danger. If we think in terms of levels and degrees of anonymity, we may not see the forest from the trees. We may not acknowledge that in an electronic medium, levels and kinds of anonymity mean, in an important sense, no anonymity. If there are domains in which we can be anonymous but those domains are part of a global communication infrastructure in which there is no anonymity at the entry point, then it will always be possible to trace someone's identity. We delude ourselves when we think we have anonymity on-line or off-line. Rather, what we have both places is situations in which it is more and less difficult to identify individuals. We have a continuum of situations in which it is easy and difficult to link behavior to other behavior and histories of behaviors. In the physical world, we can go places and do things where others don't know us by name and have no history with us, though they see our bodies, clothes, and behavior. If we do nothing unusual, we may be forgotten. On the other hand, if we do something illegal, authorities may attempt to track us down and figure out who we are. For example, law enforcement officials, collection agencies, those who want to sue us may take an active interest in removing our anonymity, ex post facto. Think of Timothy McVeigh and Terry Nichols-the men who apparently bombed the federal building in Oklahoma City. Much of what they did, they did anonymously, but then law enforcement officials set out to find out who had done various things, e.g., rented a car, bought explosives, etc. The shrouds of anonymity under which McVeigh and Nichols had acted were slowly removed. Is this any different than behavior on the internet? Is there a significant difference in the kind or degree of anonymity we have in the physical world versus what we have in an IT-based world? The character of the trail we leave is different; in the one case, its an electronic trail; while in the other it involves human memories, photographs, and paper and ink. What law enforcement officials had to do to track down McVeigh is quite different from tracking down an electronic law breaker. Also, the cost of electronic information gathering, both in time and money, can be dramatically lower than the cost of talking to people, gathering physical evidence, and the other minutia required by traditional detective work. We should acknowledge that we do not and are never likely to have anonymity on the Internet. We would do better to think of different levels or kinds of identity. There are important moral and social issues arising as a result of these varying degrees and kinds of identity. Perhaps the most important matter is assuring that individuals are informed about the conditions in which they are interacting. Perhaps, even more important is that individuals have a choice about the conditions under which they are communicating. In the rest of this paper we explore a few examples of levels and kinds of identity that are practical on the Internet. We discuss the advantages and disadvantages that we see for these "styles" of identity for individuals, and we examine the costs and benefits of these styles for society as a whole. (shrink)

This article is the result of an empirical research project analyzing the decision behaviour of Austrian managers in ethical dilemma situations. While neoclassical economic theory would suggest a pure economic rational basis for management decisions, the empirical study conducted by the authors put other concepts to a test, thereby analyzing their importance for managerial decision making: specific notions of fairness, reciprocal altruism, and commitment. After reviewing some of the theoretical literature dealing with such notions, the article shows the results of (...) an online survey working with scenarios depicting ethical dilemma situations. By judging such scenarios the respondents showed their preference for the named concepts, though with different degrees of confirmation. The results (with all limitations of an online survey in mind) support the theoretical work on the named concepts: Fairness elements (including Rawlsian principles of justice and an understanding of fairness as conceived by a reference transaction) play a major part in management decisions in ethical dilemma situations. Also, commitment as a behaviour that sticks to rules even if personal welfare is negatively touched, and reciprocal altruism as a cooperative behaviour that expects a reciprocal beneficial action from other persons have been concepts used by Austrian managers when analyzing ethical dilemmas. The article also tries to put the results into a comparative perspective by taking into account other studies on ethical decision factors conducted with, e.g. medical doctors or journalists, and by discussing intercultural implications of business ethics. (shrink)

IntroductionInformation and communication technologies are becoming an integral part of medical practice, research and administration and their use will grow as telemedicine and electronic medical record use become part of routine practice. Security in maintaining patient data is important and there is a statuary obligation to do so, but few health professionals have been trained on how to achieve this. There is no information on the use of computers and email by doctors and nurses in South Africa in (...) the workplace and at home, and whether their current computer practices meets legal and ethical requirements. The aims of this study were to determine the use of computers by healthcare practitioners in the workplace and home; the use and approach to data storage, encryption and security of patient data and patient email; and the use of informed consent to transmit data by email.MethodsA self-administered questionnaire was administered to 400 health care providers from the state and private health care sectors. The questionnaire covered computer use in the workplace and at home, sharing of computers, data encryption and storage, email use, encryption of emails and storage, and the use of informed consent for email communication.Results193 doctors and 207 nurses in the private and public sectors completed the questionnaire. Forty (10%) of participants do not use a computer. A third of health professionals were the only users of computers at work or at home. One hundred and ninety-eight respondents (55%) did not know if the data on the computers were encrypted, 132 (36.7%) knew that the data were not encrypted and 30 (8.3%) individuals knew that the data on the computers they were using were encrypted. Few doctors, 58 (16%), received emails from patients, with doctors more likely to receive emails from patients than nurses (p = 0.0025). Thirty-one percent of individuals did not respond to the emails. Emails were saved by 40 (69%) recipients but only 5 (12.5%) doctors encrypted the messages, 19 (47.5%) individuals knowingly did not encrypt and 16 (40.0%) did not know if they encrypted the data. While 20% of health professionals have emailed patient data, but only 41.7% gained consent to do so.ConclusionsMost health professionals as sampled in South Africa are not compliant with the National Health Act or the Electronic Communications Transactions Act of South Africa or guidelines from regulatory bodies when managing patient data on computers. Many appear ignorant or lack the ability to comply with simple data security procedures. (shrink)

The needs principle—that certain goods should be distributed according to need—has been central to much socialist and egalitarian thought. It is the principle which Marx famously takes to be that which is to govern the distribution of goods in the higher phase of communism. The principle is one that Marx himself took from the Blanquists. It had wider currency in the radical traditions of the nineteenth century. In the twentieth century it remained central to the mutualist form of socialism defended (...) by Tawney and Titmuss. The principle underlay the development and justification of the modern welfare state—thus the National Health Service is still founded upon the idea that the distribution of medical resources should be determined by medical need, not by ability to pay. One source of the power of the needs principle lies in the fact that it appears to be both a principle of justice and a principle of community or social solidarity. As a principle of justice it is offered as a corrective to the particular forms of unequal distributions of goods that can result from market transactions, and as a principle of community or social solidarity as a corrective to the possessive individualism taken to be the corollary of a market order. (shrink)

Buying and selling are the most natural activities common to human beings. In a society where profit overrides personal dignity and human rights, many people see market as a virtue-free zone. They do not believe that one can buy and sell without dishonest gains. Consequently, they are ready to do anything in the name of business: manufacturing and selling fake and substandard goods and services for originals. Today, markets are flooded with fake medical drugs, fake foods, fake drinks/water, fake (...) motor parts and fake building materials. Thus market exhibits exploitative and negative impacts on customer satisfaction. Its impact on human life and property leads to increased deaths because of poisoning, building collapses and even increased road accidents. Such market transaction lacks mutual benefit which is its telos. This paper seeks to establish that market is not a virtue-free zone. It has moral standards of excellence internal to it. (shrink)

In the book Exploiting Hope: How the Promise of New Medical Interventions Sustains Us—and Makes Us Vulnerable, Jeremy Snyder takes on the dominant theory that exploitation in research ethics involves culpable inequity in transactions between parties. He rightly dismisses that economic explanation as inadequate. His theory of exploitation argues that it happens when those who have a duty of beneficence to someone take advantage of their hope. Exploitation is not just an unfair transaction; it is a betrayal of (...) an obligation owed to the vulnerable, weak, or dependent to protect them. Snyder is persuasive. But only to a point. He helps us understand the betrayal involved in exploiting hope. But much more remains to be debated about hope and exploitation. Exploitation in health care is not just a matter of schemers and ne'er‐do‐wells playing fast and loose with ever‐hopeful patients. Sometimes it involves patient groups looking for the right to try any intervention, no matter how dangerous or outlandish, at government expense. (shrink)

The seemingly interminable debates about health care reform in the last few years have focused mainly on health care access, quality, and cost. Debates on the medical malpractice component of the issue have focused almost entirely on cost. The familiar arguments in favor of limiting liability include the financial and health costs of defensive medicine; decreased physician supply in certain specialties and geographic areas; excessive awards; and high transaction costs, including attorney and expert witness fees. The equally familiar (...) arguments in favor of maintaining tort liability include the need to promote civil justice, deter substandard care, identify incompetent practitioners, and encourage systemic quality improvement.Numerous studies have explored the possible effects of damage caps and other measures on malpractice premiums, health care costs, and other financial endpoints. One relatively under-examined aspect of the issue is how federal legislation expanding access to health care might alter the number of medical malpractice claims. With the enactment of the Patient Protection and Affordable Care Act of 2010, it is especially appropriate to consider what effect, if any, the new law will have on the rate of medical malpractice claims. (shrink)

This essay provides a brief overview of the rise of organ trade in Pakistan towards the end of the last century and the concerted, collective struggle—of physicians and medical associations aided by the media, journalists, members of civil society, and senior judiciary—in pressuring the government to bring about and implement a national law criminalizing such practices opposed by an influential pro-organ trade lobby. It argues that among the most effective measures to prevent re-emergence of organ trafficking in the country (...) is increasing ethical live donations and above all, establishing sustainable, public supported deceased donor programs. To do this, the transplant community must recognize that organ transplantation is not merely a donor-recipient-physician transaction but a complex issue in which decisions to donate an organ are influenced by indigenous values and belief systems about human illness, life and death. (shrink)

Since 2016, drones have been deployed in various development projects in sub-Saharan Africa, where trials, tests, and studies have been rolled out in countries, including Tanzania, Uganda, Rwanda, Malawi, Ghana, and the Democratic Republic of the Congo. The use cases of drones vary, ranging from imagery collection to transportation of vaccines, lab samples, blood products, and other medical supplies. A wide range of stakeholders is involved, including governments, international organizations, educational institutions, as well as industry. Based on a field (...) study conducted in 2019, this article investigates how drones are used for medical supply delivery in Malawi-a country where the community is underserved for healthcare and related infrastructure underdeveloped, while airspace is largely open and regulations generally relaxed. The objective of presenting this case study is to contribute to the evidence regarding the rapid deployment of medical cargo drones across the African continent, and to spark critical reflections over the utility, suitability, and impacts of incorporating drones in the existing health supply chain systems in resource-poor settings. The discussion revolves around two aspects: 1) the emergent “African Drone Rise”-is it ok “as it is Africa”? and 2) the normative role of technology in the aid sector-is it “a solution looking for a problem”? In conclusion, a call for more structured guidance for the systematic examination and evaluation of the medical cargo drone case is raised. (shrink)

In this paper, we seek to re-conceptualize the ethical framework through which ethicists and medical professionals view the practice of live kidney donations. The ethics of organ donation has been understood primarily within the framework of individual rights and impartiality, but we show that the ethic of care captures the moral situation of live kidney donations in a more coherent and comprehensive way, and offers guidance for practitioners that is more attentive to the actual moral transactions among donors and (...) recipients. A final section offers guidelines for the practice of live kidney transplants that emerge from an ethic of care. (shrink)

As Active Mining is a new concept among data mining and/or knowledge discovery in databases communities, in order to validate the effectiveness, it is important to carry out empirical studies using practical data. Based on the concept of Active User Reaction, this paper develops a causal model from liver function test data in a medical domain. To develop the model, we have set a problem to predict the values of ICG test from given observation data and experts' background knowledge. (...) We therefore employ a framework of meta-learning and structural equation modeling. In this paper meta-learning means learning about mined results from multiple data-mining techniques. Structural equation modeling enables us to describe flexible models from background knowledge. The construction of the causal model contains two phases: meta-learning and the model building. The meta-learning phase utilizes both the linear regression and the neural network as data mining techniques, then examines the predictability on the given data set. Mining models are n-folded learned from the training data set. Each of the prediction accuracy of the mining models is compared using with the testing data. On the model building phase, we use structural equation modeling to develop a causal model based on results of meta-learning and background knowledge. We again compare the accuracy of the causal model with each of the mining models. Consequently we have developed the causal model, which is comprehensible and have good predictive performance, via the meta-learning phase. Through the empirical study, we have got the conclusion that the framework of meta-learning is effective in data mining in a difficult medical domain. (shrink)

The borders between the physical and the virtual are ever-more porous in the daily lives of those of us who live in Internet enabled societies. An increasing number of our daily interactions and transactions take place on the Internet. Social, economic, educational, medical, scientific and other activities are all permeated by the digital in one or other kind of virtual environment. Hand in hand with the ever-increasing reach of the Internet, the digital and the virtual, go concerns about trust. (...) In the increasing numbers of cross-disciplinary attempts to understand the way that the Internet is changing our societies, ‘trust’ is a truly cross-boundary word, used just as frequently by computer scientists as it is by economists, sociologists and philosophers. Concerns in the name of trust are articulated about the objects and artefacts found, accessed or bought on the Internet, about the people with whom we interact on the interact, and about the technological systems and infrastructures that enable us to carry out activities of different types. -/- This paper reflects on the implications for trust of the way we shape our technologies and they in turn shape us, for example, in the way we trust and the extent to which we can trust ourselves as trusters. The account I am working towards is an ecological and co-evolutionary view of trust and technologies, which attempts to hold in view the complex inter-relationships between the agents and other entities within and across environments. First, I consider the ways in which problems of justifying trust are analogous to problems of justifying knowledge, and claim that trust, like knowledge, cannot be justified from an external position. Second, I outline an account of internal relations drawn from phenomenology. This is followed by a discussion of three aspects of trust which are internally related to it: value, reason and morality. (shrink)