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Abímbọ́lá, Kọ́lá. Culture and the Principles of Biomedical Ethics
2013, Journal of Commercial Biotechnology, 19 (3): 31-39.
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Added by: Rochelle DuFord
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).

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Allen, Anita L.. Mental Disorders and the “System of Judgmental Responsibility”
2010, Boston University Law Review 90: 621-640.
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Added by: Simon Fokt
Diversifying SyllabiThesis: Those affected by mental disorders whose actions are episodically influenced by their disorder are often overlooked by philosophers of moral and ethical responsibility. Allen gives us reasons for thinking it is inappropriate to either: a) “summarily exclude people with mental problems out of the universe of moral agents, reducing them to the status of rocks, trees, animals, and infants” b) “include the group on the false assumption that their moral lives are precisely like the paradigmatic moral lives of the epistemically-sound and well-regulated people never personally touched by a mental condition” We must explore a revised approach to moral and ethical responsibility and obligation for this group.

Comment: This text is useful in teaching in two main contexts: (1) in discussing ethical issues related to mental disorders; and (2) to provide a challenging case in classes on blame and responsibility. The text can be also used in the context of the free will and determinism debate, and as a further reading in classes on moral agency.

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Ashley, Florence. Gatekeeping Hormone Replacement Therapy for Transgender Patients is Dehumanising
2019, The Journal of Medical Ethics. 45: 480-482.
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Added by: Chris Blake-Turner
Abstract: Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care.

Comment (from this Blueprint): Ashley draws on their own experiences as a trans person, as well as that of the trans community more broadly, to argue against assessment and referral requirements for hormone-replacement therapy (HRT). Ashley argues instead for an informed consent model, on which providers of HRT are not gatekeepers of transness, but facilitators of thoughtful decision-making.

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Bok, Sissela. The Limits of Confidentiality
1983, Hastings Center Report 13 (1):24-31.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Introduction: Doctors, lawyers, and priests have traditionally recog nized the duty of professional secrecy regarding what individuals confide to them: personal matters such as alcoholism or depression, marital difficulties, corporate or political problems, and indeed most concerns that patients or clients want to share with someone, yet keep from all others.' Accountants, bankers, social workers, and growing numbers of professionals now invoke a similar duty to guard confidences. As codes of ethics take form in old and new professions, the duty of confidentiality serves in part to reinforce their claim to professional status, and in part to strengthen their capacity to offer help to clients.

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Bordo, Susan. Anorexia Nervosa: Psychopathology as the Crystallization of Culture
1993, In her Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley: University of California Press.
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Added by: Simon Fokt
Diversifying Syllabi: Bordo claims that the recent increase in women with Anorexia is a symptom of the “central ills” of our culture. Bordo discusses three sources of this “cultural illness” which leads to anorexia: the dualist axis, the control axis, and the gender/power axis. She spends the bulk of the paper discussing each “axis” or problematic component of society which is reflected back to us in the increasing diagnosis of anorexia. These “psychopathogolgies” are expressions of the culture, she claims.

Comment: This text is most readily applicable in teaching feminist theory and social philosophy. However, it is also very useful in at least three other contexts: (1) as a critical approach to mind-body dualism, especially when teaching on Descartes or Plato's Phaedo; (2) in teaching on the ethics of mental illness and the anti-psychiatry movement, as an example of socially constructed disorders; and (3) more broadly in teaching on personal and collective moral responsibility.

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Bortolotti, Lisa, John Harris. Disability, Enhancement and the Harm-Benefit Continuum
2006, In John R. Spencer & Antje Du Bois-Pedain (eds.), Freedom and Responsibility in Reproductive Choice. Hart Publishers
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Added by: Simon Fokt, Contributed by: Nils-Hennes Stear
Abstract:

Suppose that you are soon to be a parent and you learn that there are some simple measures that you can take to make sure that your child will be healthy. In particular, suppose that by following the doctor’s advice, you can prevent your child from having a disability, you can make your child immune from a number of dangerous diseases and you can even enhance its future intelligence. All that is required for this to happen is that you (or your partner) comply with lifestyle and dietary requirements. Do you and your partner have any moral reasons (or moral obligations) to follow the doctor’s advice? Would it make a difference if, instead of following some simple dietary requirements, you consented to genetic engineering to make sure that your child was free from disabilities, healthy and with above average intelligence? In this paper we develop a framework for dealing with these questions and we suggest some directions the answers might take.

Comment: This is a paper that gives an account of enhancement and disability in terms of one's relative position on a harmed and benefitted continuum, and defends enhancement on completely general moral grounds according to which the pro tanto duty to enhance is the same as the pro tanto duty not to disable. It pairs well with criticisms of the 'new eugenics', such as Robert Sparrow's 'A Not-So-New Eugenics' (2011) and more generally with consequentialist or specifically harm-based accounts of moral obligation.

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Brazier, Margaret Rosetta. Exploitation and enrichment: The paradox of medical experimentation
2008, Journal of Medical Ethics 34 (3):180--183.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Abstract: Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the ``unethical'' experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical research.

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Chadwick, Ruth F.. Cloning
1982, Philosophy 57 (220):201-209.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Abstract: Every body cell of an animal or human being contains the same complete set of genes. In theory any of these cells can be used to start a new embryo. The technique has been employed in the case of frogs. The nucleus is taken out of a body cell of a frog and implanted in an enucleated frog's egg. The resulting egg cell is stimulated to develop into a normal frog, and will be an exact copy of that frog which provided the nucleus with all the genetic information. In normal sexual reproduction, two parents each contribute half their genes, but in the case of cloning, one parent passes on all his or her genes

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Chatterjee, Anjan. The promise and predicament of cosmetic neurology
2006, Journal of Medical Ethics 32 (2): 110-113
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Added by: Simon Fokt
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.

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Corrigan, Oonagh. Empty Ethics: The Problem with Informed Consent
2003, Sociology of Health & Illness, 25 (3): 768-792.
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Added by: Rochelle DuFord
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.

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Cutas, Daniela. Postmenopausal Motherhood: Immoral, Illegal? A Case Study
2007, Bioethics, 21 (8): 458-463.
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Added by: Rochelle DuFord
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.

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Etieyibo, Edwin. The Case of Competancy and Informed Consent
2013, Journal of Clinical Research and Bioethics, 4 (2): 1-4.
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Added by: Rochelle DuFord
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.

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Galgut, Elisa. Raising the Bar in the Justification of Animal Research
2015, Journal of Animal Ethics 5 (1):5-19
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Added by: Simon Fokt, Contributed by: Anonymous
Abstract: Animal ethics committees (AECs) appeal to utilitarian principles in their justification of animal experiments. Although AECs do not grant rights to animals, they do accept that animals have moral standing and should not be unnecessarily harmed. Although many appeal to utilitarian arguments in the justification of animal experiments, I argue that AECs routinely fall short of the requirements needed for such justification in a variety of ways. I argue that taking the moral status of animals seriously—even if this falls short of granting rights to animals—should lead to a thorough revision or complete elimination of many of the current practices in animal experimentation.

Comment: This paper can be used in a course on animal research ethics.

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Haksar, Vinit. The responsibility of psychopaths
1965, The philosophical quarterly 15(59): 135-145.
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Added by: Simon Fokt
Content: The paper examines various arguments looking at the responsibility psychopaths bear for their immoral actions, using neurological knowledge about psychopathy.

Comment: Useful in teaching about the 'mad or bad' dilemma, and about responsibility and issues in psychiatric ethics in general.

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Heal, Jane. Mental disorder and the value(s) of ‘autonomy’
2012, In Autonomy and Mental Disorder, Lubomira Radoilska (ed.). New York: Oxford University Press, 3-25.
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Added by: Jamie Robertson
Abstract: Summary (from Introduction of Autonomy and Mental Disorder, Radoilska ed.): In 'Mental disorder and the value(s) of autonomy', Jane Heal identifies and critically examines a form of thought which is implicit in discussions about what we, as a society, owe to people with mental disorder. This form of thought builds upon intuitions which link respect for a person with respect for a person's autonomy. In light of these intuitions, the issue of how to treat a person with mental disorder may seem to revolve around the question whether or not this person has the capacity for autonomy. However, Heal argues, inquiries that share this logical form are methodologically inappropriate and potentially unhelpful in answering either of the questions they put together: what we owe to people with mental disorder and what is involved in autonomy as a capacity. The reason for this is twofold. Firstly, the apparent consensus about autonomy as a capacity for self-determination that ought to be protected from interference by a corresponding right to self-determination is too shallow to ground a coherent course of action in terms of respect for autonomy. Even if we work with the assumption that autonomy is part of the Enlightenment project, we face an important dilemma since we have to choose between a Kantian or rationality oriented and a Millian or well-being oriented take on the nature and significance of autonomy. Secondly, even if we were to reach a substantive consensus on the concept of autonomy, it would arguably require an intricate array of mental capacities, outside the reach of at least some people with mental disorder. Getting clearer on what autonomy is will not help us find out what it means to treat these people respectfully.

Comment: This text would be a good candidate for inclusion in a course about autonomy, philosophy of disability, or the ethics or political philosophy of mental health or aging (due to discussion of dementia). If assigned as part of a course on autonomy, students will benefit from considering Heal's approach to breaking down the logical components of the concept and her nuanced discussion of the limitations of autonomy as a moral principle for understanding our obligations toward people with mental disorders. This second element is the central question of the paper and would be of interest when examining disability or mental health from a philosophical perspective.

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