Selected by Choice Magazine as an Outstanding Academic Title What is so special about human life? What is the relationship between flesh and blood and the human soul? Is there a kind of life that is worse than death? Can a person die and yet the human organism remain in some real sense alive? Can souls become sick? What justifies cutting into a living human body? These and other questions, writes neurosurgeon and philosopher Grant Gillett, pervade hospital wards, clinical offices, (...) and operating rooms. In Bioethics in the Clinic: Hippocratic Reflections, Gillett brings the tools of philosophy to bear on some of the most pressing issues confronting bioethicists today. Gillett draws on many schools of thought, including analytic, moral, and postmodern philosophy; utilitarianism; classical ethical theory; phenomenology; and metaphysics. He engages the reasoning of such philosophers as Aristotle, Nietzsche, Wittgenstein, Foucault, Habermas, Levinas, and Martha Nussbaum, and offers both practical and clinical insights into such topics as the principle of "Do no harm," informed consent, confidentiality, cloning, and euthanasia. Opening with an explanation of the axioms to be traced throughout succeeding discussions, with special emphasis on Hippocratic principles, Gillett focuses on general and specific problems of clinical practice, particularly as they affect the physician-patient relationship. The author then goes on to address ethical problems related to both the end of life, including euthanasia, and the beginning of life, such as embryo and stem cell research. Rigorous and elegant, this book will be of interest to those in medical fields, to students and scholars of philosophy, and to lay readers interested in the profound ethical dramas played out in hospitals and doctors' offices every day. (shrink)

The concept of futility is sometimes regarded as a cloak for medical paternalism in that it rolls together medical and value judgments. Often, despite attempts to disambiguate the concept, that is true and it can be applied in such a way as to marginalize the real interests of a patient. I suggest we replace it with a conceptual toolkit that includes physiological futility, substantial benefit (SB), and the risk of unacceptable badness (RUB) in that these concepts allow us to articulate (...) what is at stake in ethical judgments where outcomes are crucial in determining what should be done. (shrink)

Elective ventilation (EV) is ventilation applied, not in the interest of patients, but in order to secure transplantable organs. It carries with it a small risk that patients who would otherwise have died will survive in a persistent vegetative state. Is EV ever justifiable? We argue: (1) The only thing which can justify exposing patients to risk not taken for their benefit is their consent, and we cannot rely on implied consent or third party consent in the case of EV. (...) Thus, absent explicit consent of patients, EV is not justifiable. (2) It is not clear that explicit consent should be sought, or where it is offered honoured, given the potential EV has for deterring organ donors and causing stress to staff and families. (shrink)

It has recently been argued by Miller and Truog (2008) that, while procuring vital organs from transplant donors is typically the cause of their deaths, this violation of the requirement that donors be dead prior to the removal of their organs is not a cause for moral concern. In general terms, I endorse this heterodox conclusion, but for different and, as I think, more powerful reasons. I end by arguing that, even if it is agreed that retrieval of vital organs (...) causes the deaths of those who provide them, that does not pose any new substantive difficulties for efforts to justify “opt-out” organ procurement systems. (shrink)