Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

Knud Ejler Løgstrup’s _The Ethical Demand_ is the most original influential Danish contribution to moral philosophy in this century. This is the first time that the complete text has been available in English translation. Originally published in 1956, it has again become the subject of widespread interest in Europe, now read in the context of the whole of Løgstrup’s work. _The Ethical Demand_ marks a break not only with utilitarianism and with Kantianism but also with Kierkegaard’s Christian existentialism and with (...) all forms of subjectivism. Yet Løgstrup’s project is not destructive. Rather, it is a presentation of an alternative understanding of interpersonal life. The ethical demand presupposes that all interaction between human beings involves a basic trust. Its content cannot be derived from any rule. For Løgstrup, there is not Christian morality and secular morality. There is only human morality. _The Ethical Demand _is of the highest relevance to contemporary debate, especially around those issues raised by Levinas. It will exert a steadily increasing influence both in theology and philosophy. (shrink)

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

Few issues affecting the therapeutic professions are as much discussed and as little understood as informed consent. This book, written from the combined perspectives of a physician, a lawyer, and a social scientist, is the first reference work to provide a concise overview of informed consent with particular emphasis on the practical issues facing professionals. After introducing the ethical theories behind this principle, the authors describe the history and current status of the law, detailing all legal requirements for practitioners. They (...) consider the problems faced when these theories and laws are applied in a clinical setting, offering suggestions for simplifying the interaction between doctor and patient and for making it clinically meaningful. The stress throughout is on ways to improve practitioners' performance in meeting these ethical and legal mandates. The book will be valuable for all professionals working in areas where issues of informed consent are likely to arise, including medicine, mental health care, social work, dentistry and law. (shrink)

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

This review essay examines H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics, a contemporary nonfeminist text in mainstream biomedical ethics. It focuses upon a central concept, Engelhardt's idea of the moral community and argues that the most serious problem in the book is its failure to take account of the political and social structures of moral communities, structures which deeply affect issues in biomedical ethics.