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Rationalizing Unethical Medical Research
The trial of the "German doctors" exposed atrocities of Nazi medical science and led to the Nuremberg Code governing human experimentation. In Japan, Unit 731 carried out hideous experiments on captured Chinese and downed American pilots. In the United States, stories linger of biological experimentation during the Korean War. This collection of essays looks at the dark medical research conducted during and after World War II. Contributors describe this research, how it was brought to light, and the rationalizations of those who perpetrated and benefited from it.
The Promises and Perils of Genetic Modifications
The Human Genome Project, discoveries in molecular biology, and new reproductive technologies have advanced our understanding of how genetic science may be used to treat persons with genetic disorders. Greater knowledge may also make possible genetic interventions to "enhance" normal human characteristics, such as height, hair or eye color, strength, or memory, as well as the transmittal of such modifications to future generations. The prospect of inheritable genetic modifications, or IGMs, whether for therapeutic or enhancement purposes, raises complex scientific, ethical, and regulatory issues. Designing Our Descendants presents twenty essays by physicians, scientists, philosophers, theologians, lawyers, and policy analysts addressing these issues from diverse perspectives. In three sections, the authors discuss the short- and long-term scientific feasibility of IGM technology; ethical and religious issues related to safety, justice, morality, reproductive rights, and enhancement; and regulatory issues including the necessity of public input and oversight and the influence of commercialization. Their goal is to open a dialogue engaging not only scholars and scientists but also government officials and concerned citizens. The authors conclude that while IGM cannot be carried out safely and responsibly on humans utilizing current methods, it is important to begin public discussion now to determine whether, and if so how, to proceed.
Alzheimer disease afflicts more than twelve million people worldwide, and its incidence is increasing at a staggering rate. People with the disorder are living longer than have those in previous generations, and they require interventions for quality-of-life issues associated with palliative care. However, the symptoms of Alzheimer disease often fail to place such persons into settings where palliative care resources are available to them. Indeed, clinicians and other caregivers may be unsure about what constitutes effective palliation in these cases. At the same time, the ethical issues involved in providing end-of-life care to persons with Alzheimer disease remain on the margins of mainstream bioethics. In Ethical Foundations of Palliative Care for Alzheimer Disease, leading ethicists and clinicians from the United States and Europe explore ethical and scientific concerns about the diagnosis and prognosis of Alzheimer disease, challenges arising from applying palliative procedures to its symptoms, key philosophical and theological concepts central to our understanding of the disease and to end-of-life decisions, and the changing patterns of relevant medical, social, and economic policies. Cross-cultural, multidisciplinary, and state-of-the-art, this volume is a unique and important resource for bioethicists, clinicians, and policy makers everywhere. Contributors: David A. Bennahum, M.D., University of New Mexico; Pierre Boitte, Ph.D., Catholic University of Lille, France; Roger A. Brumback, M.D., Creighton University Medical Center; Wim J. M. Dekkers, M.D., Ph.D., University Medical Centre Nijmegen, The Netherlands; Elizabeth Furlong, R.N., Ph.D., J.D., Creighton University Medical Center; Eugenijus Gefenas, M.D., Ph.D., Vilnius University, Lithuania; Bert Gordijn, Ph.D., University Medical Centre Nijmegen, The Netherlands; Amy M. Haddad, R.N., Ph.D., Creighton University Medical Center; Søren Holm, M.D., Ph.D., Dr.Med.Sci., University of Manchester; Franz J. Illhardt, D.D., Ph.D., Freiburg University; Rien Janssens, Ph.D., University Medical Centre Nijmegen, The Netherlands; Givi Javashvili, M.D., Ph.D., State Medical Academy of Georgia, Tbilisi; Judith Lee Kissell, Ph.D., Creighton University Medical Center; Gunilla Nordenram, D.D.S., Ph.D., Karolinska Institute, Stockholm; Richard L. O'Brien, M.D., Creighton University Medical Center; Marcel G. M. Olde Rikkert, M.D., Ph.D., University Medical Centre Nijmegen, The Netherlands; Winifred J. Ellenchild Pinch, R.N., Ed.D., Creighton University Medical Center; Patricio F. Reyes, M.D., Creighton University Medical Center; Anne-Sophie Rigaud, M.D., Ph.D., Hôpital Broca, Paris; Linda S. Scheirton, Ph.D., Creighton University Medical Center; Jos V. M. Welie, M.Med.S., J.D., Ph.D., Creighton University Medical Center.
Institutional Review Boards and the Social Sciences, 1965–2009
University researchers in the United States seeking to observe, survey, or interview people are required first to complete ethical training courses and to submit their proposals to an institutional review board (IRB). Under current rules, IRBs have the power to deny funding, degrees, or promotion if their recommended modifications to scholars’ proposals are not followed. This volume explains how this system of regulation arose and discusses its chilling effects on research in the social sciences and humanities. Zachary M. Schrag draws on original research and interviews with the key shapers of the institutional review board regime to raise important points about the effect of the IRB process on scholarship. He explores the origins and the application of these regulations and analyzes how the rules—initially crafted to protect the health and privacy of the human subjects of medical experiments—can limit even casual scholarly interactions such as a humanist interviewing a poet about his or her writing. In assessing the issue, Schrag argues that biomedical researchers and bioethicists repeatedly excluded social scientists from rule making and ignored the existing ethical traditions in nonmedical fields. Ultimately, he contends, IRBs not only threaten to polarize medical and social scientists, they also create an atmosphere wherein certain types of academics can impede and even silence others. The first work to document the troubled emergence of today's system of regulating scholarly research, Ethical Imperialism illuminates the problems caused by simple, universal rule making in academic and professional research. This short, smart analysis will engage scholars across academia.
A Practical Guide for Aid Workers in Developing Countries
In recent years, international medicine has become a growth industry. International aid organizations, religious organizations, and medical schools all provide opportunities for health care workers to travel to developing countries to provide needed medical care to the world's poorest citizens.
Medical aid workers from the West encounter many challenges. They serve in settings with limited medical supplies, facilities, and personnel. Their patients speak different languages, have different cultures, and may even have different interpretations of disease. They have limited time in which to provide medical care to hundreds of people. In such circumstances, ethical dilemmas abound, and many health care practitioners, both novice and expert, are unprepared to manage them.
This volume provides medical aid workers with a method for identifying, analyzing, and resolving ethical issues within the context of international medicine. It also presents a series of cases, representative of the ethical issues they are likely to encounter, that illustrate the use of that method. Designating four areas in which good intentions may go awry because of miscommunication and misunderstanding between health care provider and patient - Medical Facts, Goals and Values, Norms, and Limitations - Dr. Wall develops an invaluable tool for individuals and health organizations seeking to serve in developing countries throughout the world.
This volume explores ethical issues specific to working with deaf clients, particularly matters of confidentiality, managing multiple relationships, and the clinician’s competency to provide services, particularly in communicating with and understanding deaf people. Led by editor Virginia Gutman, a unique assembly of respected mental health professionals share their experiences and knowledge in working with deaf clients. Irene Leigh commences Ethics in Mental Health and Deafness with her varied experiences as a deaf mental health practitioner, and Gutman follows with insights on ethics in the “small world” of the Deaf community. William McCrone discusses the law and ethics, and Patrick Brice considers ethical issues regarding deaf children, adolescents, and their families. In contrast, Janet Pray addresses concerns about deaf and hard of hearing older clients. Minority deaf populations pose additional ethical aspects, which are detailed by Carolyn Corbett. Kathleen Peoples explores the challenges of training professionals in mental health services specifically for deaf clients. Closely related to these topics is the influence of interpreters with deaf clients in mental health settings, which Lynnette Taylor thoroughly treats. Ethics and Mental Health in Deafness also features a chapter on genetic counseling and testing for deafness by Kathleen Arnos. The final section, written by Robert Pollard, examines ethical conduct in research with deaf people, a fitting conclusion to a volume that will become required reading for all professionals and students in this discipline.
Among Them, but Not of Them
Autism is one of the most compelling, controversial, and heartbreaking cognitive disorders. It presents unique philosophical challenges as well, raising intriguing questions in philosophy of mind, cognitive science, and philosophy of language that need to be explored if the autistic population is to be responsibly served. Starting from the "theory of mind" thesis that a fundamental deficit in autism is the inability to recognize that other persons have minds, Deborah R. Barnbaum considers its implications for the nature of consciousness, our understanding of the consciousness of others, meaning theories in philosophy of language, and the modality of mind. This discussion lays the groundwork for consideration of the value of an autistic life, as well as the moral theories available to persons with autism. The book also explores questions about genetic decision making, research into the nature of autism, and the controversial quest for a cure. This is a timely and wide-ranging book on a disorder that commends itself to serious ethical examination.
Mapping the Moral Landscape
Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed in the field capable of making the right decisions? How and why do they face moral challenge—and even compromise—as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field’s inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field’s history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics.
Disasters, both natural and manufactured, provide ample opportunities for official coercion. Authorities may enact quarantines, force evacuations, and commandeer people and supplies—all in the name of the public’s health. When might such extreme actions be justified, and how does a democratic society ensure that public officials exercise care and forethought to avoid running roughshod over human rights? In The Ethics of Coercion in Mass Casualty Medicine, Griffin Trotter explores these fundamental questions with skepticism, debunking myths in pursuit of an elusive ethical balance between individual liberties and public security. Through real-life and hypothetical case studies, Trotter discusses when forced compliance is justified and when it is not, how legitimate force should be exercised and implemented, and what societies can do to protect themselves against excessive coercion. The guidelines that emerge are both practical and practicable. Drawing on core concepts from bioethics, political philosophy, public health, sociology, and medicine, this timely book lays the groundwork for a new vision of official disaster response based on preventing and minimizing the need for coercive action.