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Abímbọ́lá, Kọ́lá, and . Culture and the Principles of Biomedical Ethics

2013, Journal of Commercial Biotechnology, 19 (3): 31-39.

Abstract: This paper examines the roles of culture in the principles of biomedical ethics. Drawing on examples from African, Navajo and Western cultures, the paper maintains that various elements of culture are indispensable to the application of the principles of biomedical ethics.

Comment: This text presents a clear introduction to questions about the application of biomedical ethical principles outside of Western medical contexts. It contains a good overview of the Western interpretation and application of autonomy, as well as other, culturally specific, interpretations of autonomy in medical contexts. This makes it useful as a text to introduce students to the way in which conflicts occur over the application of medical ethical principles in context prior to looking at specific cases (such as Jehovah's Witnesses refusal to accept blood transfusions or the well known case of the Hmong medical culture).

Chatterjee, Anjan, and . The promise and predicament of cosmetic neurology

2006, Journal of Medical Ethics 32 (2): 110-113

Abstract: Advances in cognitive neuroscience make cosmetic neurology in some form inevitable and will give rise to extremely difficult ethical issues.

Comment: This short paper introduces the ethical challenges related to cognitive enhancement. It lists some existing enhancing drugs, discusses the differences between developing drugs which treat diseases and those developed to enhance healthy individuals. The ethical challenges it considers include: safety and possible harmfulness of enhancing drugs; whether suffering and hardships are integral parts of human development and thus removing them might be problematic; whether the possibility of enhancement won't result in explicit and implicit coercive pressure to enhance, at the cost of human happiness. Chatterjee's text will serve well as an introduction to human enhancement in medical and applied ethics classes. In higher level classes it will be useful to supplement it with other, more in-depth papers engaging with specific problems.

Corrigan, Oonagh, and . Empty Ethics: The Problem with Informed Consent

2003, Sociology of Health & Illness, 25 (3): 768-792.

Abstract: Informed consent is increasingly heralded as an ethical panacea, a tool to counter autocratic and paternalistic medical practices. Debate about the implementation of informed consent is constricted and polarised, centring on the right of individuals to be fully informed and to freely choose versus an autocratic, paternalistic practice that negates individual choice. A bioethical framework, based on a principle-led form of reductive/deductive reasoning, dominates the current model of informed consent. Such a model tends to abstract the process of consent from its clinical and social setting. By fleshing out the social process involved when patients and healthy volunteer subjects consent to take part in clinical drug trials, this paper attempts to address the problem arising from the current ’empty ethics’ model. My arguments are substantiated by qualitative interview data drawn from a study I conducted on the process of consent as experienced by participants in clinical drug trials.

Comment: This text is a clear critique of the use of informed consent as a medical-ethical panacea (it could be taught alongside O'neill's "Paternalism and Partial Autonomy" for a more accessible and applied look at the problem of informed consent). It would be useful as a contrast at the end of a unit on informed consent for medical treatment or a unit on clinical research ethics. It is especially good for use in a biomedical ethics or research ethics course aimed at students interested in the health professions.

Cutas, Daniela, and . Postmenopausal Motherhood: Immoral, Illegal? A Case Study

2007, Bioethics, 21 (8): 458-463.

Abstract: The paper explores the ethics of post-menopausal motherhood by looking at the case of Adriana Iliescu, the oldest woman ever to have given birth (so far). To this end, I will approach the three most common objections brought against the mother and/or against the team of healthcare professionals who made it happen: the age of the mother, the fact that she is single, the appropriateness of her motivation and of that of the medical team.

Comment: This text presents a case study useful for a course on biomedical ethics, parenthood, or procreation. Further, the author considers a number of objections to postmenopausal motherhood and evaluates them for their ethical merit, providing a good introduction to questions of reproduction and parenting in non-traditional circumstances.

Etieyibo, Edwin, and . The Case of Competancy and Informed Consent

2013, Journal of Clinical Research and Bioethics, 4 (2): 1-4.

Abstract: Patient competence is an essential element of every doctor-patient relationship. In this paper I provide a case report involving an older Korean man in a Hawaiian hospital who refused treatment on the basis of mistaken facts or beliefs about his doctors and treatment. I discuss the case as it relates to competency and extends it to informed consent, autonomy and paternalism. I suggest and argue firstly, that the older Korean man is not fully competent, and secondly, that if he is not fully competent, then soft and weak paternalism may be justified in his case and in cases similar to his.

Comment: This text presents an introduction to the relationship between competance, informed consent, and autonomy in medical contexts through the use of a case study. As such, it would be a good text for an introductory course in health care ethics or biomedical ethics within a unit on autonomy or culturally-specific applications of medical ethical principles.

Jackson, Jennifer, and . Telling the Truth

1991, Journal of Medical Ethics 17(1): 5-9.

Abstract: Are doctors and nurses bound by just the same constraints as everyone else in regard to honesty? What, anyway, does honesty require? Telling no lies? Avoiding intentional deception by whatever means? From a utilitarian standpoint lying would seem to be on the same footing as other forms of intentional deception: yielding the same consequences. But utilitarianism fails to explain the wrongness of lying. Doctors and nurses, like everyone else, have a prima facie duty not to lie – but again like everyone else, they are not duty-bound to avoid intentional deception, lying apart; except where it would involve a breach of trust.

Comment: Useful in teaching on applied ethics issues related to trust, and general values in normative ethics. To provide an interesting narrative and selection of views, this text can be used alongside Jennifer Saul's 'Just go ahead and lie' and Clea Rees' 'Better lie!'

Kantymir, Lori, and Carolyn McLeod. Justification for Conscience Exemptions in Health Care

2013, Bioethics 28 (1): 16-23.

Abstract: Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed.

Comment: This text responds to two proposals for justifying concientious objection in the provision of health care services: genuineness and reasonableness. It would fit well within a course on medical ethics or bioethics. It also would fit well within a more general course on professional ethics, as it concerns the question of when a professional is able to justify the omission of an action that they are bound by professional duty to complete.

McLean, Sheila, and . A Patient’s Right to Know: Information Disclosure, the Doctor and the Law

1995, Aldershot: Dartmouth.

Comment: Particular issues examined include the patient's right to consent to or refuse treatment, and issues related to valid consent and its dependence on information, including full details regarding the risks associated with a particular course of treatment. Useful as further reading in applied ethics classes, or in any moral or political philosophy teaching related to consent. Additionally, can be useful in discussions on the differences and similarities between the moral and legal approaches to the issue of consent.

O'Neill, Onora, and . Medical and Scientific Uses of Human Tissue

1996, Journal of Medical Ethics 22: 5-7.

Abstract: Inevitably a policy-oriented report on issues as complex and as rapidly changing as the medical and scientific uses of human tissue can achieve neither philosophical purity nor regulatory completeness. The council’s strategy has been to begin with robust ethical principles, for which sound philosophical arguments can be given, which will (it is hoped) command widespread support. The council went on to argue for guidelines of sufficient, but not vapid, generality which could be of practical use to the various medical intermediaries, professional and regulatory bodies and research ethics committees which will carry out the tasks of detailed regulation and of making decisions that affect uses of human tissue. The council’s hope is that the recommendations of the report can be absorbed into regulatory and professional practice, and where needed into government policy. If they can, the increasing diversity of uses of human tissues need lead neither to overt nor to covert ‘commercialisation of the human body’, but will also not put unnecessary restrictions on advances in research and medical practice.

Comment: This text provides a quick introduction to, and overview of, ethical positions concerning the use of human tissue in scientific and medical research (including utilitarianism, rights, property rights, and dignity). It would be an excellent reading for introducing a unit on research concerning human tissue in a bioethics or medical ethics course. It would make sense to teach it as a framework for understanding moral and policy issues involved in the case of Henrietta Lacks or HeLa cells.

Purdy, Laura, and . Are Pregnant Women Fetal Containers?

1990, Bioethics 4(4): 273–291.

Content: Purdy offers a strong argument against overriding the decisions of pregnant women and tries to reconcile the significance of the dependence of the fetus on the mother with the mother’s right to control her own body.

Comment: Very useful as introductory or further reading on reproductive rights and/or abortion.