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O'Neill, Onora. Autonomy and Trust in Bioethics
2002, Cambridge University Press.
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Added by: Chris Howard, Contributed by: Simon Fokt
Publisher's Note: Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.

Comment: Parts of this book are an excellent supplement to units on autonomy and informed consent in an intermediate-advanced level medical ethics course. In particular, chapters 1, 2, and 4 would be excellent additions to a unit on autonomy, and chapter 7 would be a similarly excellent addition to a unit on informed consent.

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O'Neill, Onora. Medical and Scientific Uses of Human Tissue
1996, Journal of Medical Ethics 22: 5-7.
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Added by: Rochelle DuFord
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.

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O'Neill, Onora. Some limits of informed consent
2003, Journal of Medical Ethics 29 (1):4-7
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Added by: Simon Fokt
Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.

Comment: A great introductory text offering a short overview of the problems related to consent. The point regarding the intransitivity of consent is likely to inspire interesting discussions. As the paper is quite short, it can easily be used in conjunction with other texts.

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Peter, Elizabeth, Liaschenko, Joan. Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities, Relationships, and Responsibilites
2013, The Journal of Bioethical Inquiry. 10: 337–345.
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Added by: Chris Blake-Turner
Abstract: Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life.

Comment (from this Blueprint): Moral distress is, roughly, when a healthcare worker is institutionally constrained to act against their best moral judgement. A typical example is a nurse being prevented from giving care they deem morally required because they are hierarchically constrained by the orders of a physician. Moral distress has been much discussed in nursing ethics, but is almost entirely absent from broader bioethics syllabi and conversations. This paper examines moral distress through a lens of feminist care ethics. In doing so, it draws lessons that apply very broadly throughout professional ethics.

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Priest, Maura. Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm
2019, The American Journal of Bioethics. 19 (2): 45-59.
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Added by: Chris Blake-Turner
Abstract: In this article, I argue that (1) transgender adolescents should have the legal right to access puberty-blocking treatment (PBT) without parental approval, and (2) the state has a role to play in publicizing information about gender dysphoria. Not only are transgender children harmed psychologically and physically via lack of access to PBT, but PBT is the established standard of care. Given that we generally think that parental authority should not go so far as to (1) severally and permanently harm a child and (2) prevent a child from access to standard physical care, then it follows that parental authority should not encompass denying gender-dysphoric children access to PBT. Moreover, transgender children without supportive parents cannot be helped without access to health care clinics and counseling to facilitate the transition. Hence there is an additional duty of the state to help facilitate sharing this information with vulnerable teens.

Comment (from this Blueprint): Priest argues that the state should provide puberty-blocking treatment (PBT) for trans youth, even if their parents are not supportive. Priest’s argument is important partly because it avoids the issue of whether adolescents and children can give properly informed consent. This is a point that some of Priest’s critics seem to have missed (see, for example, Laidlaw et al. 2019. “The Right to Best Care for Children Does Not Include the Right to Medical Transition”, and Harris et al. 2019. “Decision Making and the Long-Term Impact of Puberty Blockade in Transgender Children”). Priest’s conclusion is founded instead on a principle of harm avoidance.

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Purdy, Laura. Are Pregnant Women Fetal Containers?
1990, Bioethics 4(4): 273–291.
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Added by: Carl Fox
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.

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Ray, Keisha. It’s Time for a Black Bioethics
2021, The American Journal of Bioethics. 21(2): 38–40.
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Added by: Chris Blake-Turner
Abstract: There are some long-standing social issues that imperil Black Americans' relationship with health and healthcare. These issues include racial disparities in health outcomes (Barr 2014), provider bias and racism lessening their access to quality care (Sabin et al. 2009), disproportionate police killings (DeGue, Fowler, and Calkins 2016), and white supremacy and racism which encourage poor health (Williams and Mohammed 2013). Bioethics, comprised of humanities, legal, science, and medical scholars committed to ethical reasoning is prima facie well suited to address these problems and influence solutions in the form of policy and education. Bioethics, however, so far has shown only a minimal commitment to Black racial justice.

Comment (from this Blueprint): In this short, seminal piece, Keisha Ray argues that bioethics needs to address issues of health and well-being of Black individuals. She applies Beauchamp and Childress’s famous four principles of bioethics to a particular issue: the disproportionate maternal mortality rate of Black women in the United States. Ray argues bioethics must incorporate the lens of Black bioethics, if the discipline is to remain relevant.

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Rhodes, Rosamond. The professional responsibilities of medicine
2007, In Rosamond Rhodes, Leslie Francis & Anita Silvers (eds.), The Blackwell Guide to Medical Ethics. Blackwell.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Publisher's Note: The Blackwell Guide to Medical Ethics is a guide to the complex literature written on the increasingly dense topic of ethics in relation to the new technologies of medicine. Examines the key ethical issues and debates which have resulted from the rapid advances in biomedical technology Brings together the leading scholars from a wide range of disciplines, including philosophy, medicine, theology and law, to discuss these issues Tackles such topics as ending life, patient choice, selling body parts, resourcing and confidentiality Organized with a coherent structure that differentiates between the decisions of individuals and those of social policy

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Roberts, Melinda A.. The Nonidentity Problem
2013, E. N. Zalta (ed.), Stanford encyclopedia of philosophy [electronic resource]
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Added by: Simon Fokt
Introduction: The nonidentity problem focuses on the obligations we think we have in respect of people who, by our own acts, are caused both to exist and to have existences that are, though worth having, unavoidably flawed – existences, that is, that are flawed if those people are ever to have them at all. If a person’s existence is unavoidably flawed, then the agent’s only alternatives to bringing that person into the flawed existence are to bring no one into existence at all or to bring a different person – a nonidentical but better off person – into existence in place of the person whose existence is flawed. If the existence is worth having and no one else’s interests are at stake, it is unclear on what ground morality would insist that the choice to bring the one person into the flawed existence is morally wrong. And yet at the same time – as we shall see – it seems that in some cases that choice clearly is morally wrong. The nonidentity problem is the problem of resolving this apparent paradox. The problem raises the question whether the (usually significant) good that an agent confers along with existence counterbalances the (usually limited) bad that an agent confers along with any unavoidably flawed existence in such a way that our existence-inducing act (usually) will be deemed permissible. And if it isn’t – if we think instead that obligations are left unsatisfied despite the good that comes with existence – is the moral of the story that moral obligation extends beyond what we must do for people? If we agree, in other words, that it is our obligation to create additional good, is it enough that we create additional good for each and every existing and future person? Or does the nonidentity problem show that our focus should instead be on creating additional good for the universe? As we query how to evaluate existence-inducing acts for their moral permissibility – as well as outcomes or possible futures or worlds, for their moral betterness against still other worlds – we find that some of our most deeply held intuitions regarding the nature and structure of morality are thrown into doubt.

Comment: This text offers a comprehensive introduction to the nonidentity problem and lists several illustrative thought experiments and examples used in the literature. It is a very helpful introductory or further reading for any topic which touches on the nonidentity problem.

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Satz, Debra. The Moral Limits of Markets: The Case of Human Kidneys
2008, Proceedings of the Aristotelian Society 108, 269-288
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Added by: Björn Freter, Contributed by: Anna Alexandrova

Abstract: This paper examines the morality of kidney markets through the lens of choice, inequality, and weak agency looking at the case for limiting such markets under both non-ideal and ideal circumstances. Regulating markets can go some way to addressing the problems of inequality and weak agency. The choice issue is different and this paper shows that the choice for some to sell their kidneys can have external effects on those who do not want to do so, constraining the options that are now open to them. I believe that this is the strongest argument against such markets.

Comment: A self-contained argument that introduces key concepts in philosophy of economics namely, liberty, externality, choice and markets, through the example of kidneys.

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Seavilleklein, Victoria. Challenging the Rhetoric of Choice in Prenatal Screening
2009, Bioethics 23(1): 68-77.
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Added by: Simon Fokt
Abstract: Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.

Comment: The text introduces the notion of relational autonomy and argues that an increase in pre-natal screening can in fact act so as to restrict the autonomy of pregnant women. It is best used in teaching applied ethics modules on procreation and autonomy, and as a further reading offering a critique of approaches which do not take into account contextual features of particular situations in their moral assessment.

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Sherman, Nancy. From Nuremberg to Guantánamo: Medical Ethics Then and Now
2007, Washington University Global Studies Law Review 6(3): 609-619.
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Added by: John Baldari
Abstract: On October 25, 1946, three weeks after the International Military Tribunal at Nuremberg entered its verdicts, the United States established Military Tribunal I for the trial of twenty-three Nazi physicians. The charges, delivered by Brigadier General Telford Taylor on December 9, 1946, form a seminal chapter in the history of medical ethics and, specifically, medical ethics in war. The list of noxious experiments conducted on civilians and prisons of war, and condemned by the Tribunal as war crimes and as crimes against humanity, is by now more or less familiar. That list included: high-altitude experiments; freezing experiments; malaria experiments; sulfanilamide experiments; bone, muscle, and nerve regeneration and bone transplantation experiments; sea water experiments; jaundice and spotted fever experiments; sterilization experiments; experiments with poison and with incendiary bombs. What remains less familiar is the moral mindset of doctors and health care workers who plied their medical skill for morally questionable uses in war. In his 1981 work, The Nazi Doctors, Robert Jay Lifton took up that question, interviewing doctors, many of whom for forty years continued to distance themselves psychologically from their deeds. The questions about moral distancing Lifton raised (though not the questions about criminal experiments) have immediate urgency for us now. Military medical doctors, psychiatrists and psychologists serve in U.S. military prisons in Guantánamo, Abu Ghraib, Kandahar, and, until very recently, in undisclosed CIA operated facilities around the world where medical ethics are again at issue. Moreover, they serve in top positions in the Pentagon, as civilian and military heads of command, who pass orders and regulations to military doctors in the field, and who are in charge of the health of enemy combatants, as well as U.S. soldiers. Because we recently marked the sixtieth anniversary of the judgment at Nuremberg, I want to awaken our collective memory to the ways in which doctors in war, even in a war very different from the one the Nazis fought, can insulate themselves from their moral and professional consciences.

Comment: This text is best used as an additional reading in bioethics, or in just war theory (post ad bellum).

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Sherwin, Susan. No Longer Patient: Feminist Ethics and Health Care
1992, Temple University Press.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Introduction: This book attempts to deepen common understandings of what considerations are relevant in discussions of bioethics. It is meant to offer a clearer picture of what morally acceptable health care might look like. I argue that a feminist understanding of the social realities of our world is necessary if we are to recognize and develop an adequate analysis of the ethical issues that arise in the context of health care.

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Slowther, Anne. Truth-telling in health care
2009, Clinical Ethics 4 (4):173-175.
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Abstract: This article is about the description of all the situations in which clinician find difficult to tell the truth to patients regarding their condition. Moral importance of telling the truth is recognized in both moral theory and in the practical reality of everyday living. However, empirical studies continue to show that health- care professional identify the question of truth-telling and disclosure as a source of moral and psychological discomfort in many situations. Other situation creating difficulties for clinicians are not related directly to the patient's wants or needs regarding their illness but to wider issues such as disclosure of medical error and identifying poor performance in colleagues.

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Sreenivasan, Gopal. A Human Right to Health? Some Inconclusive Scepticism
2012, Aristotelian Society Supplementary Volume 86 (1):239-265.
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Added by: Simon Fokt
Abstract: This paper offers four arguments against a moral human right to health, two denying that the right exists and two denying that it would be very useful (even if it did exist). One of my sceptical arguments is familiar, while the other is not.The unfamiliar argument is an argument from the nature of health. Given a realistic view of health production, a dilemma arises for the human right to health. Either a state's moral duty to preserve the health of its citizens is not justifiably aligned in relation to the causes of health or it does not correlate with the human right to health. It follows that no one holds a justified moral human right to health against the state.Education and herd immunity against infectious disease both illustrate this dilemma. In the former case, the state's moral duty correlates with the human right to health only if it demands too much from a cause of health; and in the latter, only if it demands nothing from a cause of health (that is, too little).

Comment: Useful in teaching on distributive justice in medicine or medical ethics in general. Can also be used as further reading in political and moral philosophy modules on human rights.

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