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In this riveting and timely work, John P. Lizza presents the first comprehensive analysis of personhood and humanity in the context of defining death. Rejecting the common assumption that human or personal death is simply a biological phenomenon for biologists or physicians to define, Lizza argues that the definition of death is also a matter for metaphysical reflection, moral choice, and cultural acceptance. Lizza maintains that defining death remains problematic because basic ontological, ethical, and cultural issues have never been adequately addressed. Advances in life-sustaining technology and organ transplantation have led to revision of the legal definition of death. It is generally accepted that death occurs when all functions of the brain have ceased. However, legal and clinical cases involving postmortem pregnancy, individuals in permanent vegetative state, those with anencephaly, and those with severe dementia challenge the neurological criteria. Is "brain death" really death? Should the neurological criteria be expanded to include individuals in permanent vegetative state, with anencephaly, and those with severe dementia? What metaphysical, ethical, and cultural considerations are relevant to answering such questions? Although Lizza accepts a pluralistic approach to the legal definition of death, he proposes a nonreductive, substantive view in which persons are understood as "constituted by" human organisms. This view, he argues, provides the best account of human nature as biological, moral, and cultural and supports a consciousness-related formulation of death. Through an analysis of legal and clinical cases and a discussion of alternative concepts of personhood, Lizza casts greater light on the underlying themes of a complex debate.
Women, Precancer, and Prophylactic Surgery
Modern scientific tools can identify a genetic predisposition to cancer before any disease is detectable. Some women will never develop breast or ovarian cancer, but they nevertheless must decide, as a result of genetic testing, whether to have their breasts and ovaries removed to avoid the possibility of disease. The striking contrast between the sophistication of diagnosis and the crudeness of preventive surgery forms the basis of historian Ilana Löwy’s important study. Löwy traces the history of prophylactic amputations through a century of preventive treatment and back to a long tradition of surgical management of gynecological problems. In the early twentieth century, surgeons came to believe that removing precancerous lesions—a term difficult to define even today—averted the danger of malignancy. This practice, Löwy finds, later led to surgical interventions for women with a hereditary predisposition to cancer but no detectable disease. Richly detailed stories of patients and surgeons in the United States, France, and the United Kingdom allow Löwy to compare the evolution of medical thought and practice—and personal choice—in these different cultures. Preventive Strikes aims to improve our understanding of professional, social, and cultural responses to cancer in the twenty-first century and to inform our reflections about how values are incorporated into routine medical practices.
Individualism and Society in the Era of Biomedical Enhancement
Few would question the necessity of artificial limbs for amputees. But what of surgery to lengthen the legs of children who are merely shorter than average? Hardly anyone would challenge the decision to prescribe Aricept to people with dementia. But is it acceptable to give the same medication to airline pilots seeking sharper mental focus on long-haul flights? Humans have engaged in biological self-improvement since long before recorded history, from the impotence-curing wild lotus brew of the ancient Egyptians to the herbal energy drink favored by early Olympians. Now biomedical enhancements are pushing the boundaries of possibility and acceptability. Where do we draw the line? How do we know the true ramifications of pioneering medicine? What price are we willing to pay for perfection? Maxwell J. Mehlman’s provocative examination of these issues speaks to fundamental questions of what it means to be human. He finds public officials ill-equipped to handle the ethical, scientific, and public policy quandaries of biomedical enhancement. Instead of engaging difficult questions of morality, access, fairness, and freedom, elected officials have crafted toothless and counterproductive laws and regulations. Mehlman outlines policy options to boost the societal benefits and minimize the risks from these technologies. In the process, he urges the public to face the ethical issues surrounding biomedical enhancement, lest our quest for perfection compromise our very humanity.
Ethical Standards and the Marketing of Prescription Drugs
The pharmaceutical industry has come under intense criticism in recent years. One poll found that 70% of the sample agreed that drug companies put profits ahead of people. Is this perception accurate? Have drug companies traded ethics for profits and placed people at risk?
In Profits before People? Leonard J. Weber exposes pharmaceutical industry practices that have raised ethical concerns. Providing systematic ethical analysis and reflection, he discusses such practices as compensating physicians for serving as speakers or consultants, providing incentives to physicians to enroll patients as subjects in clinical research, and advertising prescription drugs to the public through the mass media. Weber's critique of the industry is stern. While acknowledging that new industry guidelines are promising, he finds much room for improvement in the way drug companies market their products. Yet Weber makes a strong case that profits and ethics can coexist and that they are not mutually exclusive.
In an effort to understand the proper place of commerce in disseminating information about new drugs, the book aims to clarify basic responsibilities and to help identify sound ethical practices. It recognizes that ethics and law are not the same, that "having a right" is different from "doing the right thing," and that taking ethics seriously means recognizing that the law does not answer all questions about what is right. Weber points the way to more demanding standards and better practices that might begin to restore confidence in the drug industry.
LSD from Clinic to Campus
LSD's short but colorful history in North America carries with it the distinct cachet of counterculture and government experimentation. The truth about this mind-altering chemical cocktail is far more complex—and less controversial—than generally believed. Psychedelic Psychiatry is the tale of medical researchers working to understand LSD’s therapeutic properties just as escalating anxieties about drug abuse in modern society laid the groundwork for the end of experimentation at the edge of psychopharmacology. Historian Erika Dyck deftly recasts our understanding of LSD to show it as an experimental substance, a medical treatment, and a tool for exploring psychotic perspectives—as well as a recreational drug. She recounts the inside story of the early days of LSD research in small-town, prairie Canada, when Humphry Osmond and Abram Hoffer claimed incredible advances in treating alcoholism, understanding schizophrenia and other psychoses, and achieving empathy with their patients. In relating the drug’s short, strange trip, Dyck explains how concerns about countercultural trends led to the criminalization of LSD and other so-called psychedelic drugs—concordantly opening the way for an explosion in legal prescription pharmaceuticals—and points to the recent re-emergence of sanctioned psychotropic research among psychiatric practitioners. This challenge to the prevailing wisdom behind drug regulation and addiction therapy provides a historical corrective to our perception of LSD’s medical efficacy.
Diagnosis in Contemporary Society
Over a decade after medical sociologist Phil Brown called for a sociology of diagnosis, Putting a Name to It provides the first book-length, comprehensive framework for this emerging subdiscipline of medical sociology. Diagnosis is central to medicine. It creates social order, explains illness, identifies treatments, and predicts outcomes. Using concepts of medical sociology, Annemarie Goldstein Jutel sheds light on current knowledge about the components of diagnosis to outline how a sociology of diagnosis would function. She situates it within the broader discipline, lays out the directions it should explore, and discusses how the classification of illness and framing of diagnosis relate to social status and order. Jutel explains why this matters not just to doctor-patient relationships but also to the entire medical system. As a result, she argues, the sociological realm of diagnosis encompasses not only the ongoing controversy surrounding revisions to the Diagnostic and Statistical Manual of Mental Disorders in psychiatry but also hot-button issues such as genetic screening and pharmaceutical industry disease mongering. Both a challenge and a call to arms, Putting a Name to It is a lucid, persuasive argument for formalizing, professionalizing, and advancing longstanding practice. Jutel’s innovative, open approach and engaging arguments will find support among medical sociologists and practitioners and across much of the medical system.
Law, Policy, and Ethical Issues
From the cloning of Dolly the sheep a decade ago to more recent advances in embryonic stem cell research, new genetic technologies have often spurred polemical, ill-informed debates. Perhaps nowhere is this more evident than in the field of reproductive genetics, where difficult bioethical issues are distilled into sound bites and far-fetched claims for easy public consumption. The underlying complexities of reprogenetic research and practice are often drowned out by the noise. In this thoughtful and informed collection, Lori P. Knowles and Gregory E. Kaebnick bring together bioethicists from the United States, Canada, and the United Kingdom to examine the ethical and policy quandaries created by new genetic technologies. Featuring an overview of the field’s history (including lessons to be learned from eugenics), comparisons of international and domestic governmental regulations, and discussions of how the market and public opinion affect research, this book considers both the risks and the benefits of combining genetic and reproductive technologies. Concluding with a cautionary call for increased regulation, Reprogenetics introduces fact, history, and reason into a public discussion of complex and vexing issues.
Beyond the Bad-Apple Approach
Public Policy, Biotechnology, and the Kass Council
Several presidents have created bioethics councils to advise their administrations on the importance, meaning and possible implementation or regulation of rapidly developing biomedical technologies. From 2001 to 2005, the President's Council on Bioethics, created by President George W. Bush, was under the leadership of Leon Kass. The Kass Council, as it was known, undertook what Adam Briggle describes as a more rich understanding of its task than that of previous councils. The council sought to understand what it means to advance human flourishing at the intersection of philosophy, politics, science, and technology within a democratic society. Briggle's survey of the history of U.S. public bioethics and advisory bioethics commissions, followed by an analysis of what constitutes a “rich” bioethics, forms the first part of the book. The second part treats the Kass Council as a case study of a federal institution that offered public, ethical advice within a highly polarized context, with the attendant charges of inappropriate politicization and policy irrelevance. The conclusion synthesizes the author's findings into a story about the possible relationships between philosophy and policy making. A Rich Bioethics: Public Policy, Biotechnology, and the Kass Council will attract students and scholars in bioethics and the fields of science, technology, and society, as well as those interested in the ethical and political dilemmas raised by modern science.
Heated debates are not unusual when confronting tough medical issues where it seems that moral and religious perspectives often erupt in conflict with philosophical or political positions. In The Sanctity of Human Life, Jewish theologian David Novak acknowledges that it is impossible not to take into account the theological view of human life, but the challenge is how to present the religious perspective to nonreligious people. In doing so, he shows that the two positions—the theological and the philosophical—aren't as far apart as they may seem. Novak digs deep into Jewish scripture and tradition to find guidance for assessing three contemporary controversies in medicine and public policy: the use of embryos to derive stem cells for research, socialized medicine, and physician-assisted suicide. Beginning with thinkers like Plato, Aristotle, Kant, and Nietsche, and drawing on great Jewish figures in history—Maimonides, Rashi, and various commentators on the Torah (written law) and the Mishnah (oral law)—Novak speaks brilliantly to these modern moral dilemmas. The Sanctity of Human Life weaves a rich and sophisticated tapestry of evidence to conclude that the Jewish understanding of the human being as sacred, as the image of God, is in fact compatible with philosophical claims about the rights of the human person—especially the right to life—and can be made intelligible to secular culture. Thus, according to Novak, the use of stem cells from embryos is morally unacceptable; the sanctity of the human person, and not capitalist or socialist approaches, should drive our understanding of national health care; and physician-assisted suicide violates humankind's fundamental responsibility for caring for one another. Novak's erudite argument and rigorous scholarship will appeal to all scholars and students engaged in the work of theology and bioethics.