Providing health care in the most cost-effective way has become a priority in recent years. This book tackles the important issue of the potential conflict between economic expediency and the welfare of individual patients. Contributors examine different attitudes to this complex problem, along with a variety of legal and historical perspectives. The book addresses particular aspects of health care, such as medical expert systems, general practice, medical education, and clinical decision-making where the direct involvement of doctors in allocating (...) scarce and expensive resources is perhaps most obvious. (shrink)

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of (...) Bioethics International Congress (June, 2010). (shrink)

This work presents the diverse fields of expertize, various viewpoints, ideas and rich experiences in this field. This collection stresses on importance of the perception of Gift of Life in a Pluralistic Society .

Philosophers should be wary of using the methods they use in philosophy when engaging in discussions about policy makingThe beginning of November last year was a busy time in the bioethics calendar with four conferences taking place in New Zealand and Australia. The Fifth International Conference on Priorities in Health Care took place in Wellington; the Fifth Feminist Approaches to Bioethics congress, the Seventh World Congress of Bioethics, and the meeting of the Australasian Bioethics Association were all in Sydney.One of (...) the interesting features of these meetings was a move to a deeper exploration of the relations between ethics and political theory and political philosophy. The factors that drive this exploration are manifold but the four most important seem to be: 1) that ethicists often comment on, or propose political action and regulation; 2) that there is a growing awareness that the basic national and international societal and legal structures profoundly influences ethical issues; 3) the growing interest in global and third world issues, and 4) the move in many countries toward greater public participation in decision making concerning ethically contentious issues. All of these developments move the focus from the traditional subject matter of medical ethics—that is, the individual ethically charged action, to the question of how ethics should influence political action and regulation.To …. (shrink)

I Conceptual Foundations Ethical problems emerging from modern medical technology have been evaluated on an issue-by-issue basis. ...

Proceedings of the NATO Advanced Research Workshop, Athens, Greece, January 10-12, 1985.

In lieu of an abstract, here is a brief excerpt of the content:A Brief History of Medical Ethics Code in PolandJacek A. Piątkiewicz (bio)On March 15, 1934 a Parliamentary Act authorized the General Medical Chambers, a body incorporating all Polish physicians, to establish general rules of medical ethics. These rules governed medical conduct in Poland until 1950, when the Communist government dissolved the General Medical Chambers.From 1950 to 1989 the only medical organization in Poland (...) tolerated by the Communist government was the Polish Medical Association, which included about 30% of the country's physicians. In 1967 this group produced the "Collection of Ethico-deontological principles of the Polish Physician" which constituted a kind of code of medical ethics. This collection was a compromise between objective ethical principles and the demands of the Communist regime. For example, Principle 1 of the Collection stated that the physician "had to observe the ethico-deontological principles obligatory in socialist society."During round-table talks in early 1989 with representatives of the Communist government, the Solidarity movement argued for the revival of autonomous medical organizations like the Medical Chambers. On May 17, 1989 an Act of Parliament re-established the group. The Act (article 33, part 1) also stipulated that the National Congress of Physicians, the legislative body of Medical Chambers, establish rules of medical ethics. The Act (article 15, part 1) also states that all practicing Polish physicians are obliged to observe these rules.When the revived Chambers began its work in January 1990, its governing body—the General Medical Council—created a Commission to prepare a draft of a medical ethics code. After a year and a half of work, the Commission completed its draft, which received preliminary acceptance by the General Medical Council. [End Page 361]On December 13-14, 1991 the Extraordinary Second National Congress of Physicians was held in Bielsko-Biala (South Poland) and one of the main items on the agenda was the Code. Every article of the Code was discussed exhaustively throughout the second day of the meeting, and close to midnight the Code, including the Physician' Oath, was approved by an overwhelming majority (449 for, 75 against, 58 abstaining).Some of the liveliest discussion centered on Article 37, which relates to abortion. The delegates realized that the Code was inconsistent with a 1956 Act on abortion then under discussion in the Parliament which was not as restrictive as the Code. They decided to defer implementation of the Code for five months, until May 3, 1992. As described in the following text by Robert Baker, Article 37 has now been appealed and a decision resolving the discrepancy would have to come from Poland's Constitutional Tribunal or its Parliament. [End Page 362]Jacek A. Piątkiewicz Jacek A. Piątkiewicz, M.D., Ph.D., is Chairman of the Legislative Commission of the General Medical Council of Poland in Warsaw.Copyright © 1993 The Johns Hopkins University Press... (shrink)

This volume reflects on questions of human rights in the context of globalization. The essays responding to this subject are rich and varied: they focus on legal acceptance as well as consequences of human rights with regard to social rights and the necessary protection of the environment connected or close to those rights. Another approach to the subject featured in the volume is the legal recognition and the consideration of human rights as moral rights. With concepts on universality, a new (...) cosmopolitism, cultural pluralism and perspectives on religious variants and technological advances the debate on human rights is concluded. Index / Indice I. The Foundation of Rights / El fundamento de los derechos: J. Rubio Carracedo: El legalismo occidental: un problema para la universalizacion de los derechos humanos J. A. Seoane: El caracter juridico de las leyes injustas M. Borowski: Classifying and qualifying properties of fundamental rights J. von Platz: Faith in reason: questioning practical reason as fact, norm, end, and function of human rights R. Cruft: Policy implications of the philosophical foundations of human rights Maria Gabriela Scataglini: Derechos humanos: otra mirada sobre la cuestion de su universalidad II. A New Cosmopolitism / Un nuevo cosmopolitismo: V. de P. Barreto: Derecho cosmopolita y derechos humanos Luis Fernando Barzotto: Reconocimiento y fraternidad A. R. Bernstein: Justifying universal human rights via Rawlsian public reason H. Khatchadourian: Democracy and the globalization of human rights Milagros Otero Parga: Derechos humanos y globalizacion Halim Bepari: Human rights and the United Nations Miracy B. S. Gustin: Rescate de los derechos humanos en situaciones adversas de paises perifericos III. Multiculturism and Pluralism of Values /Multiculturalidad y pluralismo de valores: M. Herrero / M. Saralegui: Dogmatismo politico y pluralismo religioso Berry Tholen: Migration, justice, and Europe's identity. The relevance of special ties for EU's migration policy C. M. Alvarez Chicano: Implicaciones de la inconmensurabilidad de los valores en la aplicacion de principios de orden etico y juridico L. Perez Conejo: Axiologia juridica y pluralismo de valores: algunas consideraciones sobre la nocion de 'inconmensurabilidad' S-I. Liu: Fundamental legal values and globalization with regard to historical experience in freedom of speech L. C. Amezua: Libertad natural y esclavitud voluntaria: reflexiones de F. Suarez sobre la esclavitud IV. Rights and Gender / Derechos y genero: J.M. Gil Ruiz: La violencia de genero en el contexto familiar y la agresion de la ciencia juridica A. Goiriena Lekue: El interes superior del/la nino/a, coparentalidad y neutralidad de genero en la atribucion de la guarda y custodia de los hijos e hijas P. Garcia Guevara: Las politicas de genero en los paises globalizados del 'Tercer Mundo' V. Technological Impact and New Generation Rights / Impacto tecnologico y nuevas generaciones de derechos: M. Ahteensuu: Understanding the precautionary principle in the light of the traditional weak-strong distinction: a critical comment Cristina Monero Atienza: Bases para una teoria de los derechos en el siglo XXI M. Kitahara: Personal data processing and business ethics: personal data processing and personal data protection in business A. D. Oliver Lalana: El lado empirico de la legitimidad comunicativa: sobre la publicidad organizativa del derecho de proteccion de datos en internet J. Ebbesson / M. Zamboni: Transbordering democracy? The case of environment protection Sagrario Moles Nieto: El impacto medioambiental de los cultivos transgenicos VI. Bioethics and Law / Bioetica y derecho: M. Cruz Diaz de Teran: Principios para una biojuridica global C. Faralli / S. Tugnoli: Bioethics between law and science: the Italian law on medically assisted procreation (Law No. 40, February 19, 2004) N. Zeegers: The working of power in communicative regulation: the case of research with human embryos J. A. Fernandez Suarez: La bioetica en la era de la globalizacion F. J. Blazqez Ruiz: Privacidad y discriminacion genetica: propuestas bioeticas y juridicas ante los desafios de un mundo globalizado. (shrink)

In his deliciously funny book, Medicare Meets Mephistopheles, Professor David Hyman argues that Medicare corrupts our most base impulses. It urges us, for example, to grab for more than our fair share of benefits while offering providers “the prospect of staggering amounts of money – even as…actuaries were promising Congress that the Medicare program would be easily affordable.” Modeled on C.S. Lewis’ The Screwtape Letters, Professor Hyman's satirical examination of Medicare takes the form of a memo to Satan from an (...) underling demon in the Department of Illness and Satanic Services, reporting on the success of Satan's diabolical plot to corrupt humanity. Sprinkled with political cartoons, absurd stories of Medicare's over-the-top fraud enforcement efforts, and a historical account of Medicare's genesis, Medicare Meets Mephistopheles gives us a well-researched and easy-to-read primer on the biggest pot of gold in medicine. (shrink)

"The Bush administration and Congress are in concert on the goal of developing a fleet of unmanned aircraft that can reduce both defense costs and aircrew losses in combat by taking on at least the most dangerous combat missions. Unmanned combat aerial vehicles (UCAVs) will be neither inexpensive enough to be readily expendable nor-- at least in early development-- capable of performing every combat mission alongside or in lieu of manned sorties. Yet the tremendous potential of such systems is widely (...) recognized, and allies as well as potential adversaries are moving quickly to mount their own research and development programs. The United States is committed to fielding UCAV capabilities by 2010, principally for the missions of suppression of enemy air defense and deep strike, which are among the highest risk tasks for the Air Force and naval aviation."--Overview. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 51-52 [Access article in PDF] Congress Considers Incentives for Organ Procurement Alexander S. Curtis [Tables]During the 108th Congressional session, several bills pertaining to ethical incentives for organ donation likely will be introduced. In some cases, they will be similar to bills before the 107th Congress (see Table 1). Bills in both the House of Representatives and the Senate address the establishment and (...) maintenance of donor registries, financial reimbursements for medical and nonmedical expenses incurred by qualifying donors, the presentation of commemorative medals, and tax credits.A bill entitled "Gift of Life Congressional Medal Act" (introduced last year by Senate majority leader Bill Frist (R-TN) as Senate Bill 325), and its corresponding bill of the same title (passed in the House of Representatives last year as H.R. 708), would establish a congressional commemorative medal honoring "any organ donor, or the family or family member of any organ donor." The medal is to be designed and struck with "suitable emblems, devices, and inscriptions" by the Secretary of the Treasury. The eligible donor or donor's family member would be presented with the medal by the Secretary of Health and Human Services. This bill would establish qualifying donations as those of human kidneys, livers, hearts, lungs, pancreases, or any other organ, but excludes corneas and eyes.Another bill, introduced by Representative Michael Bilirakis (R-FL) entitled "Organ Donation Improvement Act" (H.R. 624), would award grants or contracts to states, transplant centers, and qualified organ procurement organizations for the purpose of providing travel, subsistence, and incidental nonmedical expenses to individuals who make living donations. In order to receive reimbursement, the donating individuals must reside in states other than the states in which the intended recipients reside and the annual income of those receiving the organs cannot exceed $35,000. The bill also would appropriate $15,000,000 to make grants to states and public and nonprofit entities for the purpose of carrying out studies, public education demonstrations, and outreach activities "designed to increase the number of organ donors within the state." The bill would be effective from time of enactment through 2005. [End Page 51]Two other bills proposed within the House of Representatives in 2002 called for amendment to the Internal Revenue Code. The "Gift of Life Tax Credit Act (introduced as H.R. 1872 by Representative James Hansen (R-UT)) and the "Help Organ Procurement Expand Act" (introduced as H.R. 2090 by Representative Chris Smith (R-NJ)) present a refundable credit to individuals or to the estates of those who agree either to be living donors or to donate their organs upon death. The "Gift of Life Tax Credit Act" refunds $10,000 to the estates of eligible individuals "for the taxable year which includes the date of the individual's death." The "Help Organ Procurement Expand Act" offers a refund of $2,500 to qualified persons. Donations of kidneys, livers, pancreases, islet cells, lungs, and intestines are accepted, however several conditions restrict permissible donors. The "Gift of Life Tax Credit Act" requires that the legally competent individual's death not be due to a suicide and that the intention to donate was clearly declared. The "Help Organ Procurement Expand Act" prohibits donations from individuals who were killed with physician assistance, died as a result of a suicide, have been indicted or convicted of a felony or a misdemeanor offense, or are actively under criminal investigation for a possible felony offense. The "Help Organ Procurement Expand Act" also restricts procuring organs from unborn children or human fetuses and under circumstances in which the living donor would be subject to "unacceptable levels of medical risk of death or permanent debilitation." Alexander S. Curtis is a research assistant at the Kennedy Institute of Ethics, Georgetown University, Washington, DC. He received his bachelor's degree from Miami University.... (shrink)

This text provides a comprehensive and timely examination of the most pertinent factors affecting institutional ethics committees, for ethicists, trustees, administrators, physicians, clergy, nurses, social workers, attorneys and others with an interest in ethics committees.

A genuine bioethics would be fiercely devoted to human life (bios) and would express that devotion by articulating as well as advocating moral virtues that rigorously protect that value against the temptation to see life in purely instrumental terms. In my view, no genuine bioethics exists today. In what follows, I will question two fundamental assumptions often presumed in discussions of euthanasia and assisted suicide. These are (i) the agent does will her victim (i.e., her putative beneficiary) some significant human (...) good, e.g., relief from pain, escape from becoming a burden to loved ones, a dignified death, or simply self-determination; (ii) in purposely helping someone to kill herself or in killing her for her own good, the agent wills her no serious harm. Put differently, I question the assumption of ‘mercy’ in so-called ‘mercy-killing’. (shrink)

Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve quality of care, reduce (...) healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differenc... (shrink)

The BiDil controversy in America coincides with a renewed interest in the linkages between race and therapeutics, whether in the medical history of the United States itself, or in the colonial world. During the colonial era in South Asia, many anthropological and medical researchers conducted research which compared the European and “colonial” body, contrasting everything from blood composition to brain weight between the races of the Indian Empire. This, as Mark Harrison has shown, was fundamentally a phenomenon of (...) the 19th century, arguing that “[i]t was only after 1800 that racial identities came to be fixed and that India was viewed with terror, as a reservoir of filth and disease.” Racist attitudes in British Indian colonial medicine are not hard to discover. They underpinned, for instance, campaigns to improve the appallingly high maternal and infant mortality rates in which the blame was placed squarely upon the women and the indigenous midwives who delivered them rather than the poverty in which they lived. As such, Peers Dimmock, a professor of gynecology and obstetrics at the Calcutta Medical School, opened his address to the First Indian Medical Congress in 1894 with a diatribe against “the unclean and repulsive traditionary [sic] methods of the native midwives.”. (shrink)

Washington, D.C.’s City Council has recently taken the first step towards legalizing the use of “medical marijuana” in accordance with the provisions of the Legalization of Marijuana for Medical Treatment Initiative of 1998. This action was not overruled by the United States Congress within the 30-day deadline imposed by the District of Columbia’s Home Rule Statute. The Council is now crafting regulations that will govern the therapeutic and palliative use of this drug with the goal of avoiding some (...) of the problems faced by the other states that have legalized medical marijuana; however, the proposed rules do not establish criteria for legitimate medical practice when medical marijuana is recommended. If the enabling regulations are passed by the D.C. Council and not rejected by the Congress, the District of Columbia will join over onequarter of the states in legalizing medical marijuana. On the other hand, if the D.C. Council fails to act favorably on the final regulations, then the effective legalization of medical marijuana will die and not be reconsidered until next year. (shrink)

A wide range of conflicting established moral viewpoints makes development of public policy related to infertility difficult. Where there are pluralities of viewpoints and no single established moral approach, uniform solutions are questionable. The Office of Technology Assessment (OTA), is a nonpartisan analytic support agency that serves the United States Congress by providing objective analyses of major public policy issues related to scientific and technological change. Because analysis of ethical issues is an important part of technology assessment, OTA included a (...) thematic analysis of ethical issues in the report, Infertility: Medical and Social Choices . A consideration of whether infertility is a disease was an important conceptual starting point, and religious perspectives were reviewed as possible sources of moral and ethical insight. Keywords: infertility, U.S. Congress, Office of Technology Assessment, infertility, right to reproduce, embryo CiteULike Connotea Del.icio.us What's this? (shrink)

Over the past decades the mortality rate in the United States has decreased and life expectancy has increased. Yet a number of recent studies have drawn Americans attention to the fact that racial and ethnic disparities persist in health care. It is clear that the U.S. health care system is not only flawed for many reasons including basic injustices, but may be the cause of both injury and death for members of racial and ethnic minorities.In 2002, an Institute of Medicine (...) report requested by Congress listed more than 100 studies documenting a wide range of disparities in the United States health care system. This report found that people belonging to racial and ethnic minorities often receive lower quality of health care than do people of European descent, even when their medical insurance coverage and income levels are the same as that of the latter. (shrink)

Genetic engineering, the latest offshoot of biotech, furnishes medical sciences with an ability to design and invent living organisms as well as to observe and analyze their function However, this genetic engineering leading to process of cloning, stem-cell research and reproduction innovations, which are being heralded as new age wonders in bio-medical technology need to be contemplated with an ethical-philosophic vision to ponder over the pertinent query, Whether we are crossing thresholds into improved existence of a long and (...) very healthy living or are we metaphorically opening Pandora’s box? In my paper, I have tried to raise a few concerns that need to be deliberated upon by lawyers, policy makers, scientist, researchers, common public and academics before new life forms and world view become an actual socio-cultural reality. The queries about values and virtues in the context of the quality and dignity of life and human relationship in relation to the continued research and advancement in bio- medical technology i.e., in genetic cloning form the integral part of this paper. (shrink)

The United States is in its fifth year of what is now widely referred to as “the new medical malpractice crisis.” Although some professional liability insurers have begun to report improvements in their overall financial margins, there are few signs that the trend toward higher costs is reversing itself - particularly for doctors and hospitals. In 2003-2004, the presidential election and tort reform proposals in Congress brought heightened public attention to the need for some type of policy intervention to (...) ease the effects of the crisis.The darling of tort reformers at both the federal and state levels has been legislation to limit, or “cap,” damages awarded to plaintiffs in malpractice cases. Health care provider groups, liability insurers, and the Bush Administration have all seized on the example of California's MICRA law, which since 1975 has capped noneconomic damages in malpractice cases at a flat $250,000, as the path to financial recovery. (shrink)

The 3rd Pan-African Ethics Human Rights and Medical Law (3rd EHRML) conference was held in Johannesburg on July 7, 2013, as part of the Africa Health Congress. The conference brought together bioethicists, researchers and scholars from South Africa, Zimbabwe, Kenya and Nigeria working in the field of bioethics as well as students and healthcare workers interested in learning about ethical issues confronting the African continent. The conference which ran with a theme of "Bioethical and legal perspectives in biomedical research (...) and medical practice in Africa with a focus on: Informed consent, HIV-AIDS & Tuberculosis, leadership & organizational ethics, patients and healthcare workers rights," was designed to expand the dialogue on African bioethics beyond the traditional focus on research ethics and the ethical dilemmas surrounding the conduct of biomedical research in developing countries. This introductory article highlights some of areas of focus at the conference including issues of leadership, organizational ethics and patients and healthcare workers rights in Africa. We analyze the importance of free speech, public debate of issues, argumentation and the need to introduce the teaching and learning of ethics to students in Africa in accordance with UNESCO guidelines. This article also focuses on other challenges confronting Africa today from an ethical standpoint, including the issues of poor leadership and organizational ethics which are main contributors to the problems prevalent in African countries, such as poverty, poor education and healthcare delivery systems, terrorism, social inequities, infrastructural deficits and other forms of 'structural violence' confronting vulnerable African communities. We believe that each of the eight articles included in this supplement, which have been rigorously peer-reviewed are a good example of current research on bioethics in Africa, and explore some new directions towards broadening the African bioethics agenda as we move forward to a new dawn for Africa in the 21st century. (shrink)

Genetic discrimination is becoming an increasingly important problem in the United States. Information acquired from genetic tests has been used by insurance companies to reject applications for insurance policies and to refuse payment for the treatment of illnesses. Numerous states and the United States Congress have passed or are considering passage of laws that would forbid such use of genetic information by health insurance companies. Here we argue that much of this legislation is severely flawed because of the difficulty in (...) distinguishing genetic from nongenetic tests. In addition, barring the use by insurance companies of a genetic test but not a nongenetic test (conceivably for the same multifactorial disease) raises issues of fairness in health insurance. These arguments suggest that ultimately the problems arising from genetic discrimination cannot be solved by narrowly focused legislation but only by a modification of the entire health care system. (shrink)

Decision-making adhering to the “principle of autonomy" takes place within the wider context of decision-making processes in modern society. Within the medical area, as regards the decision through informed consent, the patient's intention assumes vital importance. The principle of autonomy is derived from the modern thought that the essence of human being is the reason. It becomes difficult, however, to rely on decision-making based on the principle of autonomy when a person’s intention is not clear and the opinions of (...) those who are involved differ from each other. Here, I think that the principle of consensus, which seeks the agreement of those who are concerned, becomes as important as the principle of autonomy. This paper examines the problems of certainty, reliability, andcreativity of medical action through the consideration of the principle of consensus. (shrink)

English translation by Glenn H. Shepard Jr. Revision by Matthew MeyerThis article reports on the recent “International Congress of Traditional Medicine, Interculturality, and Mental Health” held by the Takiwasi Center in Tarapoto in the Peruvian Amazon. The event united 218 researchers and indigenous and religious representatives from 22 countries to present results of scientific discussions and engage in political and ethical debates surrounding the increasingly globalized, transnational, and biomedicalized reach of indigenous medical practices, especially ayahuasca-based therapy and religious practice. (...) The author interviewed several key researchers and representatives present at the event, and presents several important controversies in the field of ayahuasca and traditional medicine. She also reports on the colorful and eclectic nonacademic sessions at the event which included Inca chiropractics, ayahuasca sessions, and various forms of indigenous medicine. The text also reflects on the tragic events that unfolded in nearby Bagua, Peru, on the evening of the meeting, bringing a special urgency to the event's focus on indigenous cultural heritage. (shrink)

In Rethinking Applied Ethics Today, this paper would like to advance the concept of Ethics Consulting as a means of applying Applied Ethics in the practice of Bioethics. Applied Ethics is frequently described as a discipline of Philosophy that concerns itself with the application of moral theories such as deontology andutilitarianism to real world dilemmas. These applications however often remain restricted to the academic world and rarely reach the actual practice of those in urgent need of ethical guidance. Ethics Consulting (...) is an emerging concept in the field of Applied Ethics, but has already shown great potential in extending the gains of academic thought to everyday deliberations on ethical dilemmas. Connected to the Coherence and Common-Morality Theories in Bioethics, the focusof Ethics Consulting has since the mid-1980’s shifted from issues of content to those of process - from what the ethicist knows to what the ethicist does or enable. This shift not only remodelled the ethicist’s role to that of a facilitator in an inherently social process of moral inquiry, but also added the responsibility of keeping moral reflective spaces open where sound and shared processes of ethical deliberation can take place. Applying these developments in the Namibian context has already proved to be of great value to patients and Medical Aid Funds and also holds great potential in addressing the ethical demands placed on medical practitioners and clinics. (shrink)

Ethics of privacy is not a new but rather well developed topic especially in such areas as medical ethics and genome research. However it is safe to say that this problem is far less explored in moral philosophy. Namely there is a lack of consensus on Meta ethical status of privacy as moral value. This essay suggests some clarifications on the notion of privacy in the ethics of ICT and considers possible approaches to research on privacy issues in ethics. (...) Moral relativism suggests that privacy is a conventional value and it is possible to accept that it may become obsolete if confronted with changing social and cultural environment. Such approach also contributes to the view that privacy is an individual value and it may come in contradiction with societal values. Naturalistic approach on the other hand suggests that privacy is a value intrinsic to human nature, as it is deeply interrelated with phenomena of self-identity. Thus privacy is a crucial value not only to individual but to society as well. (shrink)

From a giant of health care policy, an engaging and enlightening account of why American health care is so expensive -- and why it doesn't have to be. Uwe Reinhardt was a towering figure and moral conscience of health care policy in the United States and beyond. Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging and enlightening account of today's U.S. health care (...) system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it. The problem, Reinhardt says, is not one of economics but of social ethics. There is no American political consensus on a fundamental question other countries settled long ago: to what extent should we be our brothers' and sisters' keepers when it comes to health care? Drawing on the best evidence, he guides readers through the chaotic, secretive, and inefficient way America finances health care, and he offers a penetrating ethical analysis of recent reform proposals. At this point, he argues, the United States appears to have three stark choices: the government can make the rich help pay for the health care of the poor, ration care by income, or control costs. Reinhardt proposes an alternative path: that by age 26 all Americans must choose either to join an insurance arrangement with community-rated premiums, or take a chance on being uninsured or relying on a health insurance market that charges premiums based on health status. An incisive look at the American health care system, Priced Out dispels the confusion, ignorance, myths, and misinformation that hinder effective reform. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managed Health Care: New Ethical Issues for All*Martina Darragh (bio) and Pat Milmoe McCarrick (bio)Changes in the way that health care is perceived, delivered, and financed have occurred rapidly in a relatively short time span. The 50-year period since World War II encompasses enormous growth in medical technology, soaring health care costs, and significant fragmentation of the two-party patient- physician relationship. This relationship first grew to include the (...) third-party payer, the health insurance industry, and now “with great speed and relatively little public awareness, a significant change has occurred in the way some decisions are made about a patient’s medical care” (III, Institute of Medicine 1989).The new means of providing health care bring an increasing number of parties into clinical decision-making processes. With this change, ethical issues that once concerned only health care professionals, the physician or the nurse, have expanded to include the patient and the groups who “manage” care—e.g., health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service groups (POSs), independent practice associations (IPAs), insurance reviewers, hospital administrators, institutional managers, and, the most recent players, purchasers of group health care who base their decisions on competitive pricing.The term “managed care” refers to a variety of continually adapting and developing arrangements that involve four groups. These groups, which have been labeled by the world of business, not health, are the “consumer” (once the patient), the “provider” (the physician and other health care professionals), the “insurer” (the reimburser for any care), and the “purchaser of care” or the primary buyer of health services (the large employer organization). Capitation is a common way to pay for health services in managed care systems. A certain dollar amount is negotiated for health services for a specified number of patients whether the care is delivered or not; the provider shares with the [End Page 189] insurer any financial risk for the actual cost of care (III, Centers for Disease Control 1995).When the Clinton administration’s health care reform movement failed to gain support in the U.S. Congress, the use of managed care to control rising health care costs accelerated. The literature on managed care and its effect on the patient-physician relationship reflects this shift. During the era of health care reform, “debate centered on how managed care could control costs, on the use of technology and patient satisfaction, [and] on access and barriers to care” (IV, Emanuel and Dubler 1995). When managed care organizations began contracting with physicians to provide health care services subject to the plans’ provisions, these plans became agents in clinical decision making on a wide-spread basis. HMO enrollment grew to 51 million persons by 1994 (III, Centers for Disease Control 1995). This “corporatization” of health care has sparked a plethora of articles about the effects of the marketplace on the physician’s ability to do what is best for the patient, and on the patient’s ability to trust the physician to do so.Many authors make it clear that managed care itself is not the problem, but rather the development of for-profit managed care plans by “corporate conglomerates with billions of dollars in assets that compensate their executives as grandly as basketball players” (V, Kassirer 1995) “in a marketplace that is largely unregulated” (I, Zoloth-Dorfman and Rubin 1995). “Some, mostly older plans that were created when cost containment was an unexpected benefit rather than their central purpose, deliver high-quality care economically. Unfortunately, others cut costs by recruiting the healthiest patients, excluding the sickest, rationing care by making it inconvenient to obtain, and denying care by a variety of mechanisms” (V, Kassirer 1995).These cost-containment features now play an intimate role in clinical practice. When a managed care plan contracts with a physician, the doctor becomes a “double agent” with contractual obligations to the plan to provide a preset amount of services and professional responsibilities to each patient to authorize necessary treatment (V, Angell 1993). This duality can undermine the physician’s fiduciary responsibility to the patient wherein the physician “has power over the affairs of [the patient]...and is required by law to act on that person’s... (shrink)

In this article, I will analyse the conduct of the Brazilian legislative process regarding new reproductive technologies, mainly the moral assumptions of three categories that are essential to the debate: the status of the child generated by these techniques; the number of embryos transferred in each cycle ; and the issue of women’s eligibility for such techniques. The analysis will be a sociological study of the Brazilian legislative debate, using feminist perspectives in ethics as the theoretical reference. The focus will (...) be the bills in progress in the Brazilian National Congress, the public and official declarations of legislators involved in the issue and the regulation of the medical class, which has influenced the legislative process. Aside from the analysis of the legislative process, I include a section on the justification of these bills, since that is where the legislator exposes what he/she believes is the moral support for the bill. (shrink)

How is a terminally ill patient treated by the surrounding people in the U.S. and Japan? How does a terminally ill patient decide on his or her own treatment? These questions will be examined in a study of intensive medical care, received by a terminally ill Japanese cancer patient in the U.S. and Japan. This casereflects the participant observation by a Japanese anthropologist for about 8 years in the United States and Japan on one patient who was hospitalized in (...) both countries on and off for about eight years. The objective of this study is to illuminate the different concept of personhood between the U.S. and Japan that appeared in different cultural practices of both countries and in the subject’s own decision making process. The significant differences appeared between theU.S. and Japan in the concepts of (1) science, (2) suffering, (3) Power of Attorney and Doisho (Consent Form), and (4) organized care. The interpretation of such differences indicates that seemingly universal practices across countries suggest cultural specific concepts and their management. Therefore, ethical norms appeared differently accordingly to each country. (shrink)

It has been pending in Congress for twelve years, despite the support of the last two presidential Administrations and the National Institutes of Health. It has been the subject of extensive affirmative lobbying by academic medical centers, pharmaceutical and biotech companies, genetic disease advocacy groups, and civil rights organizations. It has overcome vehement objections by employers and insurers. Its final passage, however, has been thwarted by a few Congressional leaders, who have prevented enactment despite overwhelming bipartisan support in both (...) houses of Congress.Based on this legislative history, one could not help but assume that the Genetic Information Nondiscrimination Act is a revolutionary piece of legislation that, if finally enacted, would provide extensive, effective, and comprehensive protection against genetic discrimination in health insurance and employment Unfortunately, such an assessment would be incorrect. Indeed, GINA may be a case of too much ado about too little. (shrink)

The opinion of Mr. Justice Francis of the English High Court which denied the parents of Charlie Gard, who had been born with an extremely rare mutation of a genetic disease, the right to take their child to the United States for a proposed experimental treatment occasioned world wide attention including that of the Pope, President Trump, and the US Congress. The case raise anew a debate as old as the foundation of Western medicine on who should decide and on (...) what standard when there is a conflict between a family and the treating physicians over a possible treatment. This paper will explore the different approaches of the British and American courts on the issue and the various proposals from that of John Rawls in his A Theory of Justice to a processed-based approach for resolving such disputes. As carefully crafted as the opinion of Mr Justice Nicholas Francis in the Gard case proved to be, it left commentators unsatisfied. A widespread criticism, captured in an article by Michael Dougherty in The National Review was for the state to ‘get out of the way of the parents trying to act in the best interests of the child’.1 Although he conceded the parents could be adding to the suffering of the child by taking Charlie to America for an experimental therapy and agreed that such a choice ‘may be the wrong decision,’ in Dougherty’s view, it should still be ‘their decision’. Dougherty’s stand was the popular response to the question of ‘Who should decide?’ It fails, however, to propose any rationale for the decision. It provided no norms, no standards and no guidelines for the parents. Their motive could equally well be indifference to the suffering of the child as concern for his well-being. Furthermore, even good, loving parents may make …. (shrink)