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Long-term care can be vexing on a personal as well as social level, and it will only grow more so as individuals continue to live longer and the population of aged persons increases in the United States and around the world. This volume explores the ethical issues surrounding elder care from an ecological perspective to propose a new theory of global justice for long-term care. Care work is organized not just nationally, as much current debate suggests, but also transnationally, through economic, labor, immigration, and health policies established by governments, international lending bodies, and for-profit entities, in a manner that raises pressing questions of local as well as global responsibility. Taking an epistemological approach termed “ecological knowing,” Lisa A. Eckenwiler examines this organizational structure to show how it creates and sustains injustice against the dependent elderly and those who care for them, including a growing number of migrant care workers, and weakens the capacities of so-called source countries and their health care systems. She identifies those who are harmed by the existing long-term care system—the elderly, family caregivers, and paid care workers, especially migrants and populations in source countries—and from there offers a corrective philosophical framework. By focusing on the fact that a range of policies, people, and places are interrelated and mutually dependent, Eckenwiler is able not only to provide a holistic understanding of the way long-term care works to generate injustice, but also to find ethical and practicable policy solutions for caring for aging populations in the United States and in less well-off parts of the world. Deeply considered and empirically informed, this examination of the troubles in transnational long-term care is the first to probe the issue from a perspective that reckons with the interdependence of policies, people, and places, and the first to recommend ways policymakers, planners, and families can together develop cohesive, coherent long-term care policies around the ideal of justice.
Changing Ethical Perspectives in Biomedicine
Putting the ethical tools of philosophy to work, Ellen K. Feder seeks to clarify how we should understand "the problem" of intersex. Adults often report that medical interventions they underwent as children to "correct" atypical sex anatomies caused them physical and psychological harm. Proposing a philosophical framework for the treatment of children with intersex conditions—one that acknowledges the intertwined identities of parents, children, and their doctors—Feder presents a persuasive moral argument for collective responsibility to these children and their families.
A Catholic Perspective
For over thirty years, David F. Kelly has worked with medical practitioners, students, families, and the sick and dying to confront the difficult and often painful issues that concern medical treatment at the end of life. In this short and practical book,
Equity v. Choice
Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world—from Canada and the United States to Western Europe, Latin America, and many African and Asian countries—they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide.
Genetic research increasingly dominates medical thought and practice in the United States and in many other industrialized nations. Susan Lindee's original study explores the institutions, disciplines, and ideas that initiated the reconfiguration of genetic medicine from a marginal field in the mid-1950s to a core research frontier of biomedicine. Tracing the work of geneticists and other experts in identifying and classifying disease during the explosive period between 1950 and 1980, Lindee identifies the individual "moments of truth" that moved the field away from its eugenic past to the center of a new world view in which nearly all disease is understood to be fundamentally genetic. She suggests that these moments of truth were experienced not only by scientists but also by those who had familial, intimate, emotional knowledge of hereditary disease: patients, family members, and research subjects. Focusing on benchmarks in the field—such as the rise of neonatal testing in the 1960s, genetic studies of unique human populations such as the Amish, the development of human cytogenetics and human behavioral genetics, and the efforts to find genes for rare diseases such as familial dysautonomia—she tracks the emergence of a biomedical consensus that nearly all disease is genetic disease. Using the success of this field as a point of entry, Lindee chronicles both the production of knowledge in biomedicine and changes in the cultural meaning of the body in the late twentieth century. She suggests that scientific knowledge is a community project that is shaped directly by people in many different social and professional locations. The power to experience and report scientific truth may be much more dispersed than it sometimes appears, because people know things about their own bodies, and their knowledge has often been incorporated into the technical infrastructure of genomic medicine. Lindee's pathbreaking study shows the interdependence of technical and social parameters in contemporary biomedicine.
Ethical Issues from Diagnosis to Dying
Society today, writes Stephen Post, is "hypercognitive": it places inordinate emphasis on people's powers of rational thinking and memory. Thus, Alzheimer disease and other dementias, which over an extended period incrementally rob patients of exactly those functions, raise many dilemmas. How are we to view—and value—persons deprived of what some consider the most important human capacities? In the second edition of The Moral Challenge of Alzheimer Disease, Post updates his highly praised account of the major ethical issues relating to dementia care. With chapters organized to follow the progression from mild to severe and then terminal stages of dementia, Post discusses topics including the experience of dementia, family caregiving, genetic testing for Alzheimer disease, quality of life, and assisted suicide and euthanasia. New to this edition are sections dealing with end-of-life issues (especially artificial nutrition and hydration), the emerging cognitive-enhancing drugs, distributive justice, spirituality, and hospice, as well as a critique of rationalistic definitions of personhood. The last chapter is a new summary of practical solutions useful to family members and professionals.
Truth and Lies in the Age of AIDS
In the era of the Internet and Oprah, in which formerly taboo information is readily available or freely confided, secrecy and privacy have in many ways given way to an onslaught of confession. Yet for those who are HIV positive, decisions about disclosure of their diagnosis force them to confront intimate, fundamental, and rarely discussed questions about truth, lies, sex, and trust. Drawing from interviews with over seventy gay men and women, intravenous drug users, sex workers, bisexual men, and heterosexual men and women, the authors provide a detailed portrait of moral, social, and psychological decision making. The interviews convey the complex emotions of love, lust, longing, hope, despair, and fear that shape individual dilemmas about whether to disclose to, deceive, or trust others concerning this disease. Some of those interviewed revealed their diagnosis widely; others told no one. Some struggled and ultimately told their partners; others spoke in codes or half-truths. One woman discovered her husband's diagnosis in a diary; when confronted, he denied it. Each year in the United States, 40,000 new cases of HIV arise, yet approximately one-third of the 900,000 Americans who are infected do not know it. As treatments have improved, unsafe sexual behavior has increased and efforts at prevention have stalled. Many of those infected continue to fear and experience rejection and discrimination. Addressing broad debates about the nature of secrecy, morality, and silence, this book explores public policy questions in the light of the nuanced, private decisions that are shaping the course of an epidemic and have broader indications for all.
Vol. 1 (2011) through current issue
Narrative Inquiry in Bioethics (NIB) provides a forum for exploring current issues in bioethics through the publication and analysis of personal stories, qualitative and mixed-methods research articles, and case studies. Articles may address the experiences of patients and research participants, as well as health care workers and researchers. NIB is dedicated to fostering a deeper understanding of bioethical issues by engaging rich descriptions of complex human experiences. While NIB upholds appropriate standards for narrative inquiry and qualitative research, it seeks to publish articles that will appeal to a broad readership of health care providers and researchers, bioethicists, sociologists, policy makers, and others.
The Power of the Personal Essay in Health Policy
This anthology brings together the personal stories of patients, physicians, policy makers, and others whose writings humanize discussions and deliberations about health policy. Drawn from the popular "Narrative Matters" column in the journal Health Affairs, the essays epitomize the policy narrative, a new genre of writing that explores health policy through the expression of personal experiences. Forty-six articles focus on such topics as the hard financial realities of medical insurance, AIDS, assisted suicide, marketing drugs, genetic engineering, organ transplants, and ethnic and racial disparities in the health care system. The narratives raise ethical and moral issues that are being studied in many of our nation's medical schools. This compelling collection provides important insight into the human dimensions of health care and health policy.