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Morals and Medicine

Joseph F. Fletcher

In Morals and Medicine a leading Protestant theologian comes to grips with the problems of conscience raised by new advances in medical science and technology. They arise as issues at the start or making of a life, in preserving its health, and in facing its death. They are the problems of Everyman: some are new problems of conscience, such as artificial insemination; some are old problems in new dimensions, such as euthanasia.

Modern medicine provides such a high degree of control over health and vital processes that men must inevitably shoulder the burden of intelligent decision, and shoulder it as rationally as possible. Thus far, only Roman Catholic moralists have worked out a coherent ethics of medical care. Morals and Medicine is a new and independent analysis of the morals of life and death, striking out along the line of the values of personality rather than of mere physiological life itself. It offers a modern and at the same time Christian concept of right and wrong for all who are involved: the patient, the doctor and nurse, the pastor, and the family and friends.

Originally published in 1954.

The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

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Mortal Secrets

Truth and Lies in the Age of AIDS

Robert Klitzman, M.D., and Ronald Bayer, Ph.D.

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.

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Narrative Inquiry in Bioethics

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.

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Narrative Matters

The Power of the Personal Essay in Health Policy

edited by Fitzhugh Mullan, M.D., Ellen Ficklen, and Kyna Rubin foreword by Abraham Verghese, M.D.

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.

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Neonatal Bioethics

The Moral Challenges of Medical Innovation

John D. Lantos, M.D., and William L. Meadow, M.D., Ph.D.

Neonatal intensive care has been one of the most morally controversial areas of medicine during the past thirty years. This study examines the interconnected development of four key aspects of neonatal intensive care: medical advances, ethical analysis, legal scrutiny, and econometric evaluation. The authors assert that a dramatic shift in societal attitudes toward newborns and their medical care was a stimulus for and then a result of developments in the medical care of newborns. They divide their analysis into three eras of neonatal intensive care. The first, characterized by the rapid advance of medical technology from the late 1960s to the Baby Doe case of 1982, established neonatal care as a legitimate specialty of medical care, separate from the rest of pediatrics and medicine. During this era, legal scholars and moral philosophers debated the relative importance of parental autonomy, clinical prognosis, and children's rights. The second era, beginning with the Baby Doe case (a legal battle that spurred legislation mandating that infants with debilitating birth defects be treated unless the attending physician deems efforts to prolong life "futile"), stimulated efforts to establish a consistent federal standard on neonatal care decisions and raised important moral questions concerning the meaning of "futility" and of "inhumane" treatment. In the third era, a consistent set of decision-making criteria and policies was established. These policies were the result of the synergy and harmonization of newly agreed upon ethical principles and newly discovered epidemiological characteristics of neonatal care. Tracing the field's recent history, notable advances, and considerable challenges yet to be faced, the authors present neonatal bioethics as a paradigm of complex conversation among physicians, philosophers, policy makers, judges, and legislators which has led to responsible societal oversight of a controversial medical innovation.

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No Place Like Home?

Feminist Ethics and Home Health Care

Jennifer A. Parks

"No Place Like Home? combines the rigorous scholarship of an academic feminist philosopher with the 'close to the ground' insights that come from bathing, feeding, and caring for older people as a home care aide. This book develops recent work in feminist philosophy that attends to both care and justice to propose a way to reform home care to reduce its exploitative qualities while assuring that it is more than 'bed and body' work." -- Martha B. Holstein, Visiting Scholar, Center for Research on Women and Gender at the University of Illinois, Chicago and co-editor, Ethics and Community Based Elder Care

"For a scathing critique of how American society abuses both those who receive home-based care as well as those who provide it, and a sophisticated vision of how we might move toward a more just future, there's no book like No Place Like Home?." -- James Lindemann Nelson, co-author of Alzheimer's: Answers to Hard Questions for Families

"[Jennifer Parks's] critique of current practices and institutions is thorough and accurate, benefiting both from her own experience as a homecare worker and the philosophically sophisticated tools she brings to bear on it." -- Laura Purdy, Professor of Philosophy, Wells College

In this provocative new book, Jennifer A. Parks analyzes practices in the home health care industry and concludes that they are highly exploitative of both workers and patients. Under the existing system, underpaid workers are expected to perform tasks for which they are inadequately trained, in unreasonably short periods of time. This situation, Parks argues, harms workers and puts home health care patients at risk. To the extent that the majority of patients and workers in home health care are women, she turns to feminist ethics for an alternative approach. Through an understanding of individuals as social beings with obligations to others, and of home health care as a public good, Parks explains how to develop the social benefits of good home health care and increase the role of government in providing financial support and regulatory oversight.

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Palliative Care for Infants, Children, and Adolescents

A Practical Handbook

edited by Brian S. Carter, M.D., Marcia Levetown, M.D., and Sarah E. Friebert, M.D.

There are few things requiring more expertise, delicacy, and compassion than caring for an infant, child, or young adult with a life-limiting condition. Written by leading researchers, clinicians from relevant disciplines, family members, and advocates, this practical guide provides professionals involved in pediatric palliative and end-of-life care with comprehensive information in a single volume. Thoroughly updated and expanded, this edition includes chapters addressing the unique challenges facing children with HIV / AIDS and their families, care in home and ICU settings, difficult decision-making processes, and the importance of communication with the child and family as well as completely new chapters on spiritual dimensions of care and educational and advocacy initiatives. Intended for primary care physicians, pediatric practitioners and specialists, home care and hospice personnel, pastoral counselors, and affected families, the book includes useful resource and reference material and practical, hands-on tips. With contributions from an international group of expert educators, clinicians, and parents, this book takes a truly interdisciplinary approach to pediatric palliative care, presenting best practices, clear instruction, and the latest information and research for anyone involved in pediatric palliative and end-of-life care. Praise for the first edition "An inspiring and accessible look at what end-of-life care for children should be—it is a text that should grace the shelf of every clinician facing the death of young patients."—Journal of the American Academy of Child and Adolescent Psychiatry "A great resource and learning tool . . . well written, well organized, very practical, and user friendly as a reference for all disciplines involved with palliative care."—American Academy of Pediatrics Newsletter "This book is rich with palliative care experts’ knowledge as well as humbling experiences of children and their families undergoing the latest stages of a life-threatening illness, the dying process, the death, and finally bereavement. Every chapter is written with a high degree of expertise and the authors’ compassion is ever present."—Journal of Palliative Medicine

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Personal Identity and Fractured Selves

Perspectives from Philosophy, Ethics, and Neuroscience

edited by Debra J. H. Mathews, Ph.D., M.A., Hilary Bok, Ph.D., and Peter V. Rabins, M.D., M.P.H.

This book brings together some of the best minds in neurology and philosophy to discuss the concept of personal identity and the moral dimensions of treating brain disease and injury. The contributors engage a crucial question: When an individual’s personality changes radically because of disease or injury, should this changed individual be treated as the same person? Rapid advances in brain science are expanding knowledge of human memory, emotion, and cognition and pointing the way toward new approaches for the prevention and treatment of devastating illnesses and disabilities. Through case studies of Alzheimer disease, frontotemporal dementia, deep brain stimulation, and steroid psychosis, the contributors highlight relevant ethical and social concerns that clinicians, researchers, and ethicists are likely to encounter. Personal Identity and Fractured Selves represents the first formal collaboration between the Brain Sciences Institute and the Berman Institute of Bioethics, both at the Johns Hopkins University. The book asks neuroscientists and philosophers to address important questions on the topic of personal identity in an effort to engage both fields in fruitful conversation. Contributors: Samuel Barondes, M.D., University of California, San Francisco; David M. Blass, M.D., Johns Hopkins University School of Medicine; Patrick Duggan, A.B., Johns Hopkins Berman Institute of Bioethics; Ruth R. Faden, Ph.D., M.P.H., Johns Hopkins Berman Institute of Bioethics; Michael S. Gazzaniga, Ph.D., University of California, Santa Barbara; Guy M. McKhann, M.D., Johns Hopkins University School of Medicine; John Perry, Ph.D., Stanford University; Carol Rovane, Ph.D., Columbia University; Alan Regenberg, M.Be., Johns Hopkins Berman Institute of Bioethics; Marya Schechtman, Ph.D., University of Illinois at Chicago; Maura Tumulty, Ph.D., Colgate University

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Persons, Humanity, and the Definition of Death

John P. Lizza

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.

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Potentiality

Metaphysical and Bioethical Dimensions

edited by John P. Lizza

What is the moral status of humans lacking the potential for consciousness? The concept of potentiality often tips the scales in life-and-death medical decisions. Some argue that all human embryos have the potential to develop characteristics—such as consciousness, intellect, and will—that we normally associate with personhood. Individuals with total brain failure or in a persistent vegetative state are thought to lack the potential for consciousness or any other mental function. Or do they? In Potentiality John Lizza gathers classic articles alongside newly commissioned chapters from leading thinkers who analyze the nature of potentiality in bioethics, a concept central to a number of important debates. The contributors illustrate how considerations of potentiality and potential persons complicate the analysis of the moral consideration of persons at the beginning and end of life. A number of works explicitly uncover the Aristotelian background of the concept, while others explore philosophical issues about persons, dispositions, and possibility. The common assumption that potentiality is intrinsic to whatever has the potentiality is challenged by a relational view of persons, an extrinsic account of dispositions, and attention to how extrinsic factors affect realistic possibilities. Although potentiality has figured prominently in bioethical literature, it has not received a great deal of logical, semantic, and metaphysical analysis in contemporary philosophical literature. This collection will bring these thorny philosophical issues to the fore. Incorporating cutting-edge research on the topic of potentiality, this thought-provoking collection will interest bioethicists, philosophers, health care professionals, attorneys engaged in medical and health issues, and hospital and governmental committees who advise on policy and law concerning issues at the beginning and end of life.

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