Highlights of this edition include: / Important new material addressing federal privacy regulations, disclosure of medical errors, limits on residents'...

Major depressive disorder is not only the most widespread mental disorder in the world, it is a disorder on the rise. In cases of particularly severe forms of depression, when all other treatment options have failed, the use of electroconvulsive therapy (ECT) is a recommended treatment option for patients. ECT has been in use in psychiatric practice for over 70 years and is now undergoing something of a restricted renaissance following a sharp decline in its use in the 1970s. Despite (...) its success in treating severe depression there is continued debate as to the effectiveness of ECT: in some studies, it is argued that ECT is marginally more effective than sham ECT. In addition, there is still no clear explanation of how ECT works; among the range of hypotheses proposed it is claimed that ECT may work by harnessing placebo effects. In light of the uncertainties over the mechanism of action of ECT and given the risk of serious side effects that ECT may produce, I contend that the process of informed consent must include comprehensive accounts of these uncertainties. I examine the possible consequences of providing adequate information to potential ECT patients, including the consideration that ECT may still prove to be effective even if physicians are open about the possibility of it working as a placebo. I conclude that if we value patient autonomy as well as the professional reputation of medical practitioners, a fuller description of ECT must be provided to patients and their carers. (shrink)

I thank Julie Hersh for her thoughtful and valuable comments on the use of electroconvulsive therapy .1 Discussions with those who have experience of treatments is of the utmost importance when debating issues such as informed consent. I am therefore very pleased to be given this opportunity to respond. Hersh offers three main criticisms of my paper but I hope to show that the tenets of the paper are not undermined by her commentary.Hersh's first criticism stems from her personal experience: (...) she claims that, ‘The results of ECT for me were miraculous’. She argues that ECT ‘works’ and we have ‘70 years of remarkably positive experience’ to support this fact. In response, I agree that there are certainly patients who believe that ECT has been a highly effective intervention: but equally, there are others who have experienced intolerable side effects as a result.2 ECT is a controversial treatment precisely because of the serious long-term risk of memory loss.3 ,4 If we are to strive for the best healthcare possible, we cannot base our conclusions merely on positive cases: we need to consider all cases . Thus, I reject her conclusion that ECT is ‘remarkably positive’ for all patients: studies do not unequivocally support Hersh's fortunate experiences. In addition, I must also challenge the assumption that ECT ‘works’. Counterintuitive as …. (shrink)

would suspect him of murdering them and would not spare him. So he too killed himself. Gods were very much disturbed by this sad incident and realized the ...

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)