In this essay, I will use a minimalist standard of decision-making capacity (DMC) to ascertain two cases in the medical ethics literature: the 1978 case of Mary C. Northern and a more recent case involving a paranoid war veteran (call him Jack). In both cases the patients refuse medical treatment out of denial that they are genuinely ill. I believe these cases illustrate two matters: (1) the need of holding oneself to a minimal DMC standard so as to make as (...) salient as possible the patient's own reasons for sometimes unusual treatment denials; (2) the need for clinicians and other relevant parties to exercise great sensitivity toward engaging, on the patient's own terms, idiosyncratic treatment refusals through regard for what I will call the patient’s conditional preferences. These are particularly relevant matters when a patient’s DMC is questionable yet he/she registers what may well be his/her settled preferences. (shrink)

To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original research articles while (12) (...) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues. (shrink)

The twentieth century saw the emergence of a new episteme of death that fundamentally revolutionized values relating to mortality and life. Previously this revolution has been seen primarily in terms of the sequestration and denial of death, but it is necessary to go farther and recognize that these are really just an aspect of the industrialization ‐the Fordism ‐ of death. This takes two major institutional forms: the militarization, and the medicalization of death. Both ensure that death is administered on (...) an industrial scale and in accord with institutional and bureaucratic imperatives and values. The total mobilization of the Great War was the prototype that revealed the potential of this approach. With the subsequent medical revolution of the middle decades of the century the approach was quickly rationalized and refined into a new episteme of administered death, with ‘administer’ being understood in its twin senses of ‘to manage’ and ‘to dispense’ — the two characteristic orientations to death in contemporary society. This new episteme quickly displaced traditional values derived predominantly from religious, philosophical, mythological and traditional sources and has advanced far beyond their responsive capacity, as the many interminable debates around issues of bioethics reveal. While this new episteme might enhance the human condition, it also has great potential for the impoverishment of the human spirit, and for the further reduction of human beings to the status of mere components and functions to be administered within medico‐technological systems that are themselves parts of an increasingly globalized economic system. (shrink)

The Kennedy Krieger lead paint study is a landmark case in human experimentation and a classic case in research ethics. In this paper I use the lead paint study to assist in the analysis of the ethics of research on less expensive, less effective interventions. I critically evaluate an argument by Buchanan and Miller who defend both the Kennedy Krieger lead paint study and public health research on less expensive, less effective interventions. I conclude that Buchanan and Miller’s argument is (...) flawed but that does not mean that research designed to find less effective interventions cannot be justified in some situations. Based on my analysis, I suggest questions to ask when considering such research and I offer some principles to guide us. In the process, light is shed on the various debates and issues raised by the lead paint study; e.g. standards of care, researchers’ responsibilities to research subjects, the distinction between treatment and research and the question of what it is that legitimizes public health research. (shrink)

A pattern of social behavior usually refers to the relatively permanent, recurrent and objective social behavior of human beings that emerge as a reality in interacting with one another as members of society. However, it is not possible for all human beings to be the same regarding age, gender, taste, physical structure, face and appearance, personality, skin color, intellectual and social characteristics, etc. Although people in general realize their situation and characters, some characteristics become justified by them as undesirable and (...) social stigmas appear. This study was conducted in Gopalpur village of Natore district. The objective of this study was to explore the patterns of social stigma among rural women in Bangladesh. Several methods such as social survey method through scheduled interview, focus group discussions, informal meetings, spot observations have been used to explore and gain a critical view of overall aspects of social stigma in the study area. The study found that all of the women were stigmatized on the basis of one issue or another. Social stigma may occur in many different forms. The most common forms that occur are related to socio-cultural identity, family, poverty, ignorance, physical structure, gender, skin color, disease etc. In this study women who had been stigmatized felt as if they had been transformed from a whole person into a tainted one. They felt themselves as different and devalued by others. Social policies should promote inclusion of all people in socioeconomic activities and prevent the processes of stigmatization and social exclusion. (shrink)

Leading accounts of personal autonomy are content-neutral: they insist that there are no a priori constraints on the content of the desires or values that might motivate an autonomous action. In Gerald Dworkin's provocative words, ‘the autonomous person can be a tyrant or a slave, a saint or sinner, a rugged individualist or champion of fraternity, a leader or follower.’ ‘There is nothing in the idea of autonomy that precludes a person from saying, “I want to be the kind of (...) person who acts at the command of others. I define myself as a slave and endorse those attitudes and preferences. My autonomy consists in being a slave.” ’ John Christman similarly claims that ‘any desire, no matter how evil, self-sacrificing, or slavish it might be’ could be autonomously formed. The same seems to apply to Harry Frankfurt's view, that actions are autonomous if they stem from second-order volitions that reflect what the agent cares about; it puts no constraints on the content of what a person might care about. All of these accounts hold that the mere content of a desire or value is never sufficient to rule out that it might be autonomously acted on by someone. (shrink)