When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

The voluntary and informed consent of subjects has been the central focus of concern in research reviews, overshadowing the importance of all other considerations. The Nuremberg Code, with its rights-based protection of the subject's autonomy above all else, made it difficult to justify research with no intended benefit when subjects are incompetent to make a valid informed choice to participate. Subsequent codes providing for research with incompetent subjects followed the lead of Nuremberg, substituting the informed authorization of a proxy for (...) the informed consent of the subject. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Book reviewed in this article: The Concept of Moral Consensus: The Case of Technological Interventions into Human Reproduction. Edited by Kurt Bayertz. Deciding Together: Bioethics and Moral Consensus. By Jonathan D. Moreno.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

When science takes man as its subject, tensions arise between two values basic to Western society: freedom of scientific inquiry and protection of individual inviolability.... At the heart of this conflict lies an age-old question: When may a society, actively or by acquiescence, expose some of its members to harm in order to seek benefits for them, for others, or for society as a whole?

Burns, C. R. Introduction.--Antiquity: Margalith, D. The ideal doctor as depicted in ancient Hebrew writings. Edelstein, L. The Hippocratic oath. Edelstein, L. The professional ethics of the Greek physician. Michler, M. Medical ethics in Hippocratic bone surgery. Maas, P. L., Oliver, J. H. An ancient poem on the duties of a physician.--The medieval era: Levey, M. Medical deontology in ninth century Islam. Bar-Sela, A., Hoff, H. E. Isaac Israeli's fifty admonitions of the physicians. Rosner, F. The physician's prayer attributed to (...) Moses Maimonides. MacKinney, L. C. Medical ethics and etiquette in the early middle ages, the persistence of Hippocratic ideals. Welborn, M. C. The long tradition, a study in fourteenth-century medical deontology.--The modern period: Larkey, S. V. The Hippocratic oath in Elizabethan England. Pleadwell, F. L. Samuel Sorbiere and his Advice to a young physician. Clark, G. Bernard Mandeville, M.D., and eighteenth-century ethics. Burns, C. R. Thomas Percival, medical ethics or medical jurisprudence? Burns, C. R. Reciprocity in the development of Anglo-American medical ethics, 1765-1865. Williams, T. F. Cabot, Peabody, and the care of the patient. (shrink)

Western society today is less unified by a set of core values than ever before. Undoubtedly, the concept of moral consensus is a difficult one in a liberal, democratic and pluralistic society. But it is imperative to avoid a rigid majoritarianism where sensitive personal values are at stake, as in bioethics. Bioethics has become an influential part of public and professional discussions of health care. It has helped frame issues of moral values and medicine as part of a more general (...) effort to find consensus about some of the most perplexing questions of our time. But why is it thought that a moral consensus is important or that it deserves respect? How does moral consensus acquire legitimacy in a society that includes diverse value systems? How is moral consensus possible and how do small groups help create or distort consensus processes? Written by a medical school professor trained in philosophy, this timely work tackles these questions from philosophical, historical, and social scientific standpoints. It begins by describing the traditional ambivalence about consensus in Western culture as well as the uncertain relationship in modernity between consensus and expertise. After outlining the current bioethical consensus, the book gives philosophical and political analyses of the idea of consensus, then assesses the role of consensus in national ethics commissions and in the ethics committee movement. Moreno constructs an original, naturalistic philosophy of moral consensus, referred to as "bioethical naturalism", and then applies sociology and social psychology to actual consensus processes. The book concludes with an account of bioethics as a consensus-oriented social reform movement. This insightful volume will be essential reading for bioethicists, philosophers, physicians, members of ethics committees, and all those concerned with ethical and social issues in health care. (shrink)

When science takes man as its subject, tensions arise between two values basic to Western society: freedom of scientific inquiry and protection of individual inviolability.... At the heart of this conflict lies an age-old question: When may a society, actively or by acquiescence, expose some of its members to harm in order to seek benefits for them, for others, or for society as a whole?

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

Science and the Quiet Art describes the experiments and the experimenters, shows how the tools of science have been applied to the study of disease through history to the present, and looks to the future. David Weatherall emphasizes the complex interplay in disease between nature, nurture, and aging and hence why, even with todays sophisticated methods, progress will be slow. Publishers Weekly describes the book as "a revealing and sobering appraisal of the successes, limitations, and promise of modern medicine.".

Consensus is growing among ethicists and lawyers that medical decision making for incompetent patients who were previously competent should be made in accordance with that person's prior wishes and desires. Moreover, this legal and ethical preference for the substituted judgment standard has found its way into the daily practice of medicine. However, what appears on the surface to be an agreement between jurists, bioethicists, and clinicians obscures the very real differences between disciplines regarding the actual implementation of the sub stituted (...) judgment standard. Ethicists and judges have carefully outlined how substituted judgments ought to be made and evaluated. Although differences arise, especially at the state court level, regarding the scope of the substituted judgment standard and its relation to other standards of surrogate decision making, agreement is fairly widespread on the priority of substituted judgment and on the necessity of sufficient evidence being available in order to support a particular substituted judgment. (shrink)