|
|
| |
| ||
The hallmark of contemporary American medical ethics is the claim that physicians need to respect patient autonomy. While no one doubts the need to consider patient autonomy, some critics are concerned that we rely too much on this principle to the neglect of other important moral considerations. The first of the two selections below outlines the history of patient autonomy and how it has transformed American medicine; the second reading suggests that by overly relying on the concept of patient autonomy, medical ethics has become bankrupt.
The Triumph of Autonomy in American Bioethics (by Paul Root Wolpe)
The Limitations of Secular Medical Ethics (by Gary S. Fischer)
While some medical decisions are a matter of controversy even among physicians, many others are not. Thus, it is always disturbing to a doctor when a patient chooses to forgo treatment which the physician considers to be both uncontroversial and medically necessary. What is the doctor to do, especially when the decision is not made by the patient, but by a parent.
Parental preferences vs. a child's best interest
Perhaps the ultimate conflict that can occur between a patient (or patient's family) and doctor is when hospital physicians believe that a patient has died, but family members refuse to accept the modern medical definition of death. The following case study describes just such a cultural conflict.
Brain death and the optimistic family
A number of physicians have shied from treating patients with AIDS out of fear of contracting the disease itself. Is this a reasonable fear? Even if such fears are well founded, can a physician ethically refuse to treat a patient in need?
AIDS and the duty to treat
Can the sanctity of the doctor patient relationship be maintained within a managed care setting which requires the doctor to serve not only the patient, but an employer or insurer who is trying to reduce costs in order to maintain a profit margin.
Restoring the sanctity of the patient-physician relationship (by Joel R. Cooper)
Restoring the doctor-patient relationship (The Heritage Foundation)
|
Return to top of
section
|
[Special note: There is an almost endless number of postings on the Internet on euthanasia. While the following listings barely begin to scratch the surface, they should provide enough readings and associated links to satiate anyone's soul.]
The following posting, presented by the Ontario Consultants on Religious Tolerance, provides a nice overview of the topic. While the Center does not actively promote the use of euthanasia, it does call for tolerance toward those who choose to practice it.
An introductory look at euthanasia
The Voluntary Euthanasia Society of Scotland (VESS) provides an almost endless, but well organized set of reading materials on the topic of euthanasia. Not surprisingly, most of the readings on this page actively support making euthanasia a readily available option.
Links and readings in support of euthanasia
Currently, probably the best starting point for finding material and links opposed to euthanasia is a page maintained by the Internationally Anti-euthanasia Task Force.
Links and readings in opposition to euthanasia
In many cases, death is brought about through a decision not to treat. Patients themselves can authorize such decisions in advance either through the use of an advance directive or by granting someone durable power of attorney with regard to health care. The American Bar Association provides some helpful advise concerning constructing such documents.
10 legal myths about advance medical directives (by Charles P. Sabatino)
Doctors might decide not to treat if they consider any further medical care to be futile (a term that has become increasingly popular in medical circles). The word "futility" suggests that a medical judgment is being made: that is, that a proposed medical procedure will not bring about any medical benefit. Such decisions are ones that should be left to the expert: the doctor. Both of the following authors argue, however, that this innocent appearing word can hide the fact that value judgments matter are being made. Value judgments are not a purely medical matter and for that reason the patient or family must be consulted. It is not for the doctor alone to decide.
Futility and its uses (by Bradley E. Wilson)
In the best interests of... futility and intensive care (by Paul Byrne)
|
Return to top of
section
|
Organ transplants have been a medical alternative since the 1960's. Unfortunately, despite the best efforts of the United Network for Organ Sharing (UNOS), the United States has experienced a shortage of organs available for transplant purposes. That has led some to suggest that the United States adopt a policy similar to one chosen by the European countries: namely, that one can presume a person has consented to having his or her organs donated unless the person expressly states otherwise. Others have suggested using incentives to encourage more people to donate. The following readings consider three such alternatives, noting the advantages and the drawbacks of each.
(Note: These readings are posted in an older "gopher" format. Netscape has the capability of accessing documents in this format; the Internet Explorer does not.)
Securing organs through presumed consent
Securing organs through the use of financial incentives
Securing organs through offering preferred status to donors
In 1992, the liver of a baboon was transplanted into a human. This suggests a fourth possibility for securing needed organs: namely, taking them from animals. The following two readings describe the technology that might be used in securing xenographs (organs from other species) and the public policy issues that these possibilities raise:
Some urge caution with xenographs (The Scientist magazine)
Lion heart? The brave new world of xenotransplantation (by Marvin Miller)
Not surprisingly, xenographs have drawn the interest of animal rights groups. The following pair of articles consider xenographs from this perspective. The first gives a mild endorsement to exploring whether animals can and should be used for this purpose; the second is very concerned about the possibility.
Ethics issues in xenotransplantation (by Arvind Koshal)
Transplantation through a glass darkly (by James Lindemann Nelson)
|
Return to top of
section
|
In 1978, Drs. Edwards and Steptoe announced the birth of Louise Brown (not the child's real name, but one used to protect her identity and the identity of her parents), the first child to be conceived outside of the womb. (Taken literally, IVF means "fertilized in glassware.") At the time, the idea that any child should be conceived this way was controversial; now, it is common practice. The following selection gives a short synopsis of how the practice works, success rates, and list of ethical issues that the practice still raises despite its commoness.
Treating infertility: it's a brave new world (by Diane M. Yoakam)
Because of the relatively low success rate of implanting embryos that have been conveived in vitro back into the womb, it has become a standard practice for clinics to freeze extra embryos (a practice called cryopreservation) for possible later use. What happens to the embryos that are not needed? The following selection outlines the difficulties in answering this question.
Embryo Overpopulation (by Gino Maranto)
Shuttle to top of page
Return to top of section
The Genetics Revolution
Some Early Lessons
"Those who are ignorant of history are destined to repeat it."
A look back at eugenics (by Philip R. Reilly)
Sickle cell testing: past and present (by Dorothy Wertz)
Genetic Engineering
We are rapidly gaining the ability to alter a person's genetic make-up. Once we have that ability, how shall we use it? Should we restrict the use of "genetic engineering" to therapeutic purposes (that is, addressing diseases); or, should we also allow people to use genetic engineering techniques for enhancement purposes (such as, increasing personal intelligence or athletic ability)? Are the dangers of misuse so great that we should cease investigating the human genetic make-up altogether. The following pair of articles address what we should and can do. (Note: both readings are linked to sets of reader comments.)
If gene therapy is the cure, what is the disease? (by Arthur Caplan)
Genetics and intergenerational concerns (by Alex Mauron)
Cloning
Surprise. That characterizes how the scientific world reacted to the news that a Scottish researcher, Ian Wilmut, had successfully cloned an adult sheep. The following article explains why the cloning of a sheep came as such a surprise to the scientific world. That explanation is followed by a discussion of the pros of cloning sheep and the cons of cloning humans.
Can humans be cloned like sheep? (by Ray Bohlin)
While the scientific world reacted with surprise to the fact that a sheep had been cloned, the general public reacted with horror over the prospect that a human clone might follow. The first of the following pieces suggests that most of this horror is based upon misunderstandings as to what a human clone would be. The author goes on to suggest that what the public should really worry about is genetic engineering , not cloning. In the second article, Richard Dawkins (the tireless advocate of Darwinism) provides his own comments on cloning. While he recognizes possible dangers, he also finds the idea rather intriguing. Finally, in the last of these three pieces, Ian Wilmut gets to speak for himself about the import of his own accomplishment.
Genetic encores: the ethics of human cloning (by Robert Wachbroit)
Thoughts on cloning humans (by Richard Dawkins)
Dr. Frankenstein, I presume (by Andrew Ross)
The above is just a small selection of the almost boundless postings on cloning to be found on the Internet. "DreamTech" (a fictional enterprise from which you can currently order a clone) has an excellent page of links. While there you might check out some of DreamTech's own pages: some of them are serious, some are spoofs.
Cloning links (brought to you by DreamTech, building a better future you)
Not Telling Patients About Their Genetic Future
Should patients be told about threats in their genetic make-up if doctors cannot do anything about it? Would not telling them be nothing more than old fashion paternalism?
Discovering knowledge: Issues in genetic testing (by Robert Wachbroit)
Genetics and Food Production
A separate area of controversy is whether we ought be using the advances in genetic technology to develop new agriculture products. Proponents of such research argue that the human race stands to benefit from the introduction of better agricultural products. Opponents consider the development of products to be dangerous.--that we ought not be fooling around with mother nature. The National Center for Genome Resources has nicely summarized the arguments on each side.
Advocates of food biotechnology
Critics of food biotechnology
Return to top of section
Human Experimentation
Everyone would like to see advancements in medicine continue, but, if that is to happen, on whom will we test the newest drugs and procedures? If people are not ill (or, at least not seriously ill), they would just as soon take a pass on becoming the next guinea pig. If, however, they are desperately (perhaps terminally) ill, they might be all too anxious to try the next miracle drug and thus vulnerable to exploitation. The Department of Health, Education, and Welfare appointed a special commission to investigate moral issues connected with using human subjects in medical research; the final report of this commission became known as the Belmont Report:
Ethical principles and guidelines for the protection of human subjects of research
In 1994, it became apparent that, during the height of the cold war, many Americans had been exposed to radiation in experiments designed to learn more about its effects; moreover, many of these citizens had not been made fully aware of the risks. What would lead scientists to do this? The following excerpt from a special committee appointed to study the affair gives a fascinating insight into the motivations of those involved.
The debate over intentionally exposing humans to radiation
While the long term impact over the revelation of the human radiation experiments has yet to be measured, two other events have already had a lasting impact upon medical experimentation with human subjects in America. The first was a shameful clinical trial in which blacks from an impoverished region of the south with left untreated with syphilis so that researchers could study the differential effects of the disease on Afro-Americans. The first of the listings below describes the experiment itself; the second notes how knowledge of the experiment still deters blacks from volunteering for medical experiments.
The Tuskegee syphilis experiment
Research: Distrust runs deep; medical comunity seeks solution
The second event involved the release of a drug which was sold in Europe and Canada under different brand names but is now known by the single name of thalidomide. Before the drug gained FDA approval, it was discovered that the drug was causing horrific side effects, most notoriously birth defects. This episode solidified the FDA's policy of go slow before approving any drug no matter what its potential for good. The first of the readings below (written by an association of Canadian survivors who were victimized by the side effects of the drug) describes the drug itself; the second argues that despite, the terrible tragedy, FDA adopted the wrong policy.
What is thalidomide?
The right lesson to learn from thalidomide (by Stephen B. Hariis)
Finally, in the pair of listings below, the Federal Drug Administration's (FDA) explains and , to some extent, attempts to justify its currnent procedures and policies concerning the testing of experimental drugs.
Testing drugs in people
Why the FDA is encouraging drug testing in children
Return to top of section
Religion, Culture, Medicine
Despite proclamations to the contrary by the postmodernists, most medical practitioners believe that the science of medicine transcends culture. The actual practice of medicine, however, is a different matter. No one denies that culture influences how medical science is put to use. The following essay is a nice case study in that it describes the impact of Japanese culture upon the modern practice of medicine.
Bioethics and Japanese culture (by Masahiro Morioka)
Other Sites of Interest
Discussions in Bioethics
Dr. Maurice Bernstein maintains a biomedical ethics discussion page on the Internet. A span of topics are covered via case studies, short commentaries, and opinion polls. Readers are invited to send in their own comments for posting. Highly recommended.
Bioethics discussion page (maintained by Dr. Maurice Bernstein)
Newsletter for those working on the front line
The University of Pittsburgh Center for Medical Ethics and the Hospital Council of Western Pennsylvania have combined forces to provide a newsletter concerning questions and issues in medical ethics. The newsletter is oriented toward those actually working in the field. The newsletter nicely ties together theoretical issues with practical experience. (Note: Once you reach the site listed below, click on the "News" option to see a list of topics that have been covered in the newsletter.)
Community Bioethics Newsletter
Searching for More
The MacLean Center for Clinical Medical Ethics at the University of Chicago has posted the most complete listing of Internet resources for biomedical ethics. The thoroughness of this page provides an obvious benefit if one is trying to conduct an exhaustive search for appropriate materials on the Internet. The same thoroughness, however, can also be frustrating in that many of the pages will be directed toward a different audience than the surfer.
Biomedical ethics links
Return to top of section
Notes for the Accidental Tourist
While this page was created for use within an undergraduate biomedical ethics course (course syllabus) , none of the linked readings require an extensive philosophical or medical background. Thus, anyone with an active curiosity concerning the topics covered might find this page of interest.
All links are to active sites that contain either useful information or informed opinions. None of the links connect to sites containing nothing more than bibliographical lists. While such sites can be of tremendous use to the student or scholar, this particular site is designed for persons wanting to learn something while still sitting at the computer.
This page is edited and maintained by Roger J. Rigterink
RIGTERINK (editor's) home page
Shuttle to top of page