Anomaly in English law between age of children's permitted consent to treatment and much lower age of criminal responsibility.

Review of Graeme Laurie, Genetic Privacy.

Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients' refusal of consent by incorporating time limits on involuntary treatment. When these are absent, as in the provisions for long term care which have recently come into force, the justification for compulsory treatment and supervision becomes more obviously problematic. (...) Second, Anglo-American law does not normally allow the preventive detention of someone who may be dangerous but has not actually committed any crime. The justification for detaining a possibly dangerous user of mental health services without his or her consent can only be based on risk assessment, but this raises issues of moral luck. Is the psychiatrist who decides not to take out a supervision order for a possibly dangerous patient with an initial psychotic diagnosis morally at fault if that person harms someone in the community, or himself? Or is the psychiatrist merely unlucky? (shrink)

Review of Joan Callahan, Reproduction, Ethics and the Law: Feminist Perspectives.

Review of Daniel Callahan, The Troubled Dream of Life.

This book is a case of “too little, too late”: too little in that it represents voices not from the developing world as a whole but from a particular Catholic viewpoint in the Philippines, too late in that others have already gone “beyond a Western bioethics”—which, in any case, is not the unified and rigid set of principles that the authors make it out to be. The publication is a long delayed spinoff of a series of bioethics seminars held in (...) Manila and Houston under the leadership of H Tristram Engelhardt Jr, who has contributed an introduction to the volume on Western bioethics reconsidered. (As Engelhardt writes: “Like good wine, this work has come slowly into its own” (page xii). Engelhardt’s bias is evident in the phrase he uses early on in this introduction, “the customary American/western European indoctrination in …. (shrink)

Review of British Medical Association handbook on human rights and doctors.

Review of Mary Mahowald, Genes, Women, Equality.

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case (...) that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

This volume of articles, literature and case studies illustrates the central importance of human values throughout healthcare. The readings are structured around the main stages of the clinical encounter from the patient's perspective.

This edited volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organised around the main stages of the clinical encounter from the patient's perspective. This introductory chapter opens up crucial issues of methodology and of practical application in this highly innovative approach to the role of ethics in healthcare.

In this article I evaluate a resurrected French resistance movement--to biotechnological commodification. The official French view that ‘the body is the person’ has been dismissed as a ‘taboo’ by the French political scientist Dominique Memmi . Yet France has indeed resisted the models of globalised commodification adopted in US bioechnology, as, for example, when the government blocked a research collaboration between the American firm Millennium Pharmaceuticals and a leading genomics laboratory, le Centre d’Etude du Polymorphisme Humain, on the grounds the (...) ‘French DNA’ should not be given away. -/- This example, however, itself suggests why the ‘new French Resistance’ is not altogether liberating. The absolutist conception of all bodies as belonging to the French state—indeed, as constituting the body politic —is so potentially invasive that a counter-ideology of inviolability of the body is maintained assiduously. This inviolability is defended particularly strongly against commercialisation, but only at the moment when tissue is taken from the individual subject, who is not to be paid or compensated-- although commercial enterprises who subsequently use the tissue are not similarly constrained. -/- . (shrink)

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers strong counter-arguments (...) to this view that enable us to think in terms of universal standards. (shrink)

New developments in biotechnology radically alter our relationship with our bodies. Body tissues can now be used for commercial purposes, while external objects, such as pacemakers, can become part of the body. Property in the Body: Feminist Perspectives transcends the everyday responses to such developments, suggesting that what we most fear is the feminisation of the body. We fear our bodies are becoming objects of property, turning us into things rather than persons. This book evaluates how well-grounded this fear is, (...) and suggests innovative models of regulating what has been called 'the new Gold Rush' in human tissue. This is an up-to-date and wide-ranging synthesis of market developments in body tissue, bringing together bioethics, feminist theory and lessons from countries that have resisted commercialisation of the body, in a theoretically sophisticated and practically significant approach. (shrink)

This article, arising from a comparative European Commission project, analyses different national perspectives on bioethics issues.

The rise of personalised medicine can be seen as an extension of individualism and as a threat to the common good.

Correction of major error in review of Bioethics: All That Matters.

It is well known that there is a shortage of human ova for in vitro fertilization (IVF) purposes, but little attention has been paid to the way in which the demand for ova in stem-cell technologies is likely to exacerbate that shortfall and create a trade in human eggs. Because the 'Dolly' technology relies on enucleated ova in large quantities, allowing for considerable wastage, there is a serious threat that commercial and research demands for human eggs will grow exponentially from (...) the combination of these two pressures. In the absence of legal regulation in the United Kingdom, and in the context of a globalized trade in human organs, we face a 'Wild West' situation in genetic and biotechnological research that involves human ova. (shrink)

Interview by Klasien Horstman on gender and genetics. 'Unlike many gender theorists, I do not view the body as socially constructed; nor do I share postmodern and deconstructionist disquiet at the notion of a unified subject. Frankly, I think these constructions get in the way of political action and are bad for women’s rights.' -/- .

Interview on the commodified body with Donna Dickenson by Alana Cattapan.

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts widely disparaged (...) by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

This book contributes to the feminist reconstruction of political theory. Although many feminist authors have pointed out the ways in which women have been property, they have been less successful in suggesting how women might become the subjects rather than the objects of property-holding. This book synthesises political theory from liberal, Marxist, Kantian and Hegelian traditions, applying these ideas to history and social policy.

Speculative enhancement technologies are premised on the notion that I have a duty to be the best Me I can possibly be. This article takes a sceptical look at that claim.

Abstract Gender and Ethics Committees: Where’s the Different Voice? -/- Prominent international and national ethics commissions such as the UNESCO Bioethics Commission rarely achieve anything remotely resembling gender equality, although local research and clinical ethics committees are somewhat more egalitarian. Under-representation of women is particularly troubling when the subject matter of modern bioethics so disproportionately concerns women’s bodies, and when such committees claim to derive ‘universal’ standards. Are women missing from many ethics committees because of relatively straightforward, if discriminatory, demographic (...) factors? Or are the methods of analysis and styles of ethics to which these bodies are committed somehow ‘anti-female’? It has been argued, for example, that there is a ‘different voice’ in ethical reasoning, not confined to women but more representative of female experience. Similarly, some feminist writers, such as Evelyn Fox Keller and Donna Haraway, have asked difficult epistemological questions about the dominant ‘masculine paradigm’ in science. Perhaps the dominant paradigm in ethics committee deliberation is similarly gendered? This article provides a preliminary survey of women’s representation on ethics committees in Eastern and Western Europe, a critical analysis of the supposed ‘masculinism’ of the principlist approach, and a case example in which a ‘different voice’ did indeed make a difference. (shrink)

The feminist movement may seek democratization on a global scale, but women are still hampered by a democratic deficit in terms of economic and political power. On the other hand, global feminist networks and new expanded forms of non-territorial political space do appear to be increasing democratic participation for women.

The soaring promises made by personalized genetic medicine advocates are probably loftier than those in any other medical or scientific realm today. Are they justified?

Three-parent IVF is proceeding towards partial legalisation in the UK, but is this process too hasty?

The spread of liberal individualism to the family is often portrayed as deeply inimical to the welfare of children and young people. In this view, the family is the bastion of the private and the antithesis of the contractual, rights-oriented model that underpins public life. This chapter examines that proposition critically.

For a long time discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. However, a narrow focus on medical resources prevents us from seeing that there are many cases-- perhaps the majority-- in which less dramatic but equally important issues of rationing occur. The allocation of nurses' time is one such issue.

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, that of the (...) common good as a goal in medicine. (shrink)

The results of a recent survey of Nigerian women might give pause to opponents of female genital mutilation (FGM). One could well argue that if these Nigerian women themselves favour FGM, then it is ironically paternalistic to oppose it. Should Western feminists actually support FGM if it is what women in the South want? I argue in this commentary that such an argument rests on shaky statistical, psychological, medical, political and philosophical grounds. We should go on opposing female genital mutilation (...) with all our power. (shrink)

Review of Daniel Callahan's book The Troubled Dream of Life.

This article, based on a case study, examines issues of confidentiality and family impact in a diagnosis of Huntington's disease. Genetic-based illness transcends individualistic models of patient autonomy because it also involves other family members, requiring a new approach to patient confidentiality.

How can we allocate scarce health care resources justly? In particular, are markets the most efficient way to deliver health services? Much blood, sweat and ink has been shed over this issue, but rarely has either faction challenged the unspoken assumption behind the claim made by advocates of markets: that efficiency advances the interests of both individuals and society. Whether markets actually do increase efficiency is arguably a matter for economists, but the deeper ethical question is whether efficiency is the (...) correct criterion, in terms of social justice and individual needs. (shrink)

Guidelines on embryo storage prioritise 'respect for the embryo' above the wishes of the women whose labour and tissue have gone into creating the embryo in the first place, effectively making women and the female body disappear. In this article I draw a parallel between this phenomenon relating to embryo storage and other instances of a similar phenomenon that I have called 'the lady vanishes', particularly in stem cell and 'mitochondrial transfer' research. I suggest that a modified property regime could (...) protect women's interests in embryo storage, making a parallel with the Yearworth case, in which it was recognised that men had limited but actionable interests in their stored sperm.. (shrink)

Critical examination of the concept of property in the body, with particular relevance to Stephen Munzer's work on umbilical cord blood.

How heavily should ethical considerations weigh in allowing or disallowing genetic patents? The concept of 'ordre public' can be useful in offsetting a simple utilitarian view.

In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural and gender issues; (...) rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)

Should we do whatever science lets us do? This short introduction in the 'All That Matters' series shows how developments in biotechnology, such as genetics, stem cell research and artificial reproduction, arouse both our greatest hopes and our greatest fears. Many people invest the new biotechnology with all the aspirations and faith once accorded to religious salvation. But does everyone benefit equally from scientific progress? This book argues that although we've entered new scientific territory, there is no need to jettison (...) our existing moral sense. By discussing a range of real-life cases, it equips readers to make up their own minds on these important questions. Good science and good ethics needn't be contradictory. (shrink)

Review of Graeme Laurie, Genetic Privacy: A Challenge to Medico-Legal Norms.

'An alarming and illuminating book. The story of how we have allowed private corporations to patent genes, to stockpile human tissue, and in short to make profits out of what many people feel ought to be common goods is a shocking one. No one with any interest at all in medicine and society and how they interact should miss this book, and it should be required reading for every medical student,'--Philip Pullman.

There has been a troublesome anomaly in the UK between cash payment to men for sperm donation and the effective assumption that women will pay to donate eggs. Some commentators, including Donald Evans in this journal, have argued that the anomaly should be resolved by treating women on the same terms as men. But this argument ignores important difficulties about property in the body, particularly in relation to gametes. There are good reasons for thinking that the contract model and payment (...) for gametes are both inappropriate, and that a model based on altruism should be applied to both sexes. (shrink)

Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

Cosmological inflation is widely considered an integral and empirically successful component of contemporary cosmology. It was originally motivated by its solution of certain so-called fine-tuning problems of the hot big bang model, particularly what are known as the horizon problem and the flatness problem. Although the physics behind these problems is clear enough, the nature of the problems depends on the sense in which the hot big bang model is fine-tuned and how the alleged fine-tuning is problematic. Without clear explications (...) of these, it remains unclear precisely what problems inflationary theory is meant to be solving and whether it does in fact solve them. I analyze the structure of these problems and consider various interpretations that may substantiate the alleged fine-tuning. On the basis of this analysis I argue that at present there is no unproblematic interpretation available for which it can be said that inflation solves the big bang model’s alleged fine-tuning problems. (shrink)

The axiological tenet of scientific realism, “science seeks true theories,” is generally taken to rest on a corollary epistemological tenet, “we can justifiably believe that our successful theories achieve (or approximate) that aim.” While important debates have centered on, and have led to the refinement of, the epistemological tenet, the axiological tenet has suffered from neglect. I offer what I consider to be needed refinements to the axiological postulate. After showing an intimate relation between the refined postulate and ten theoretical (...) desiderata, I argue that the axiological postulate does not depend on its epistemological counterpart; epistemic humility can accompany us in the quest for truth. Upon contrasting my axiological postulate against the two dominant non-realist alternatives and the standard realist postulate, I contend that its explanatory and justificatory virtues render it, among the axiologies considered, the richest account of the scientific enterprise. (shrink)

What does it mean to respect autonomy and encourage meaningful consent to treatment in the case of patients who have dementia or are otherwise incompetent? This question has been thrown into sharp relief by the Law Lords' decision in R.v Bournewood Community and Mental Health NHS Trust, ex parte L.

This chapter critically examines two frequently found assumptions in the debate about trafficking for prostitution: 1. That the sale of sexual services is like the sale of any other good or service; 2. That by and large women involved in trafficking for prostitution freely consent to sell such services.

Does advocating women's reproductive rights require us to believe that women own property in their bodies? In this chapter I conclude that it does not. Although the concept of owning our own bodies — ‘whose body is it anyway?’ — has polemical and political utility, it is incoherent in philosophy and law. Rather than conflate the entirely plausible concept of women’s reproductive rights and the implausible notion of property in the body, we should keep them separate, so that the weakness (...) of the second concept does not contaminate the purity of the first. (shrink)

Reproductive ageing has effects on individual and public health, now and in generations to come. This volume of presentations from a conference at the Royal College of Obstetricians and Gynaecologists brings together a diverse but timely set of contributions.. in ny chapter I specifically examine the responsibilities of the College to women outside normal reproductive age.

Until very recently the question of who owns embryonic or fetal tissue was of limited importance to clinicians, but advances in stem cell research have made such tissue commercially valuable. This chapter examines the legal and ethical basis of claims to property in embryonic or fetal tissue, taking a critical stance.