Written by an eminent authority from the American Academy of Neurology's Committee on Ethics, Law, and Humanities, this book is an excellent text for all clinicians interested in ethical decision-making. The book features outstanding presentations on dying and palliative care, physician-assisted suicide and voluntary active euthanasia, medical futility, and the relationship between ethics and the law. New chapters in this edition discuss how clinicians resolve ethical dilemmas in practice and explore ethical issues in neuroscience research. Other highlights include updated material on palliative sedation, advance directives, ICU withdrawal of life-sustaining therapy, gene therapy, the very-low-birth-weight premature infant, the developmentally disabled patient, informed consent, organizational ethics, brain death controversies, and fMRI and PET studies relating to persistent vegetative state.
The definition and criterion of death have been rendered ambiguous by developments in organ support technology, particularly the positive-pressure ventilator and vasopressor medications, that uncouple the unitary loss of vital functions in death and create cases in which the brain has been destroyed while circulation and ventilation can be supported. Developing a biophilosophic analysis of the meaning of death before physicians can declare it requires four sequential steps: (1) agreement on the paradigm conditions that frame the analysis and clarify the task; (2) identifying the definition of death, which makes explicit the meaning of death that is accepted in our consensual usage of the term but that has become obscured by technology; (3) identifying the criterion of death that shows that the definition has been fulfilled, and that can be incorporated into a death statute; and (4) devising bedside tests of death for physicians to perform to satisfy the criterion. Although there is a strong consensus on death determination medical standards in countries around the world that has been enshrined into laws, and accepted by most societies and religions, there remains an active dispute among scholars on the precise definition and criterion of death.
For many years this has been a leading textbook of bioethics. It established the framework of principles within the field. This is a very thorough revision with a new chapter on methods and moral justification.
In this chapter, we use the special features of neuroimaging to illustrate research ethics issues for the clinical neurologic sciences, and focus on one particularly compelling case: studies involving first-episode schizophrenic treatment-naïve individuals (FESTNIs) (). FESTNIs are scanned prior to the administration of medication in order to control for the confounding effects of treatment. By concentrating on this program of research, we capture the distinctive ethical challenges associated with neuroimaging research overall, and foreground the issues particular to neuroimaging research involving FESTNIs that have yet to receive sufficient attention in the literature. We highlight assessment of risks and burdens, including risks associated with treatment delays and incidental findings; assessment of benefit, including direct benefit, social value, and scientific quality; subject selection; justice questions related to responsiveness and poststudy access; and, finally, issues related to consent and capacity.
A groundbreaking consideration of death from capitalism, from the seventeenth to the twenty-first century From a 2013 Texas fertilizer plant explosion that killed fifteen people and injured 252 to a 2017 chemical disaster in the wake of Hurricane Harvey, we are confronted all too often with industrial accidents that reflect the underlying attitude of corporations toward the lives of laborers and others who live and work in their companies’ shadows. Dead Labor takes seriously the myriad ways in which bodies are commodified and profits derived from premature death. In doing so it provides a unique perspective on our understanding how life and death drive the twenty-first-century global economy. James Tyner tracks a history from the 1600s through which premature death and mortality became something calculable, predictable, manageable, and even profitable. Drawing on a range of examples, including the criminalization of migrant labor, medical tourism, life insurance, and health care, he explores how today we can no longer presume that all bodies undergo the same processes of life, death, fertility, and mortality. He goes on to develop the concept of shared mortality among vulnerable populations and examines forms of capital exploitation that have emerged around death and the reproduction of labor. Positioned at the intersection of two fields—the political economy of labor and the philosophy of mortality—Dead Labor builds on Marx’s notion that death (and truncated life) is a constant factor in the processes of labor. Considering premature death also as a biopolitical and bioeconomic concept, Tyner shows how racialized and gendered bodies are exposed to it in unbalanced ways within capitalism, and how bodies are then commodified, made surplus and redundant, and even disassembled in order to accumulate capital.
Medical professionalism faces distinctive challenges in the 21st century. In this chapter, we review the history of professionalism, address specific challenges physicians face today, and provide an overview of efforts to address these issues, including behavioral and virtue ethics approaches. First, we discuss core features professions share and the development of codes of medical ethics that guide the practice of western medicine. Second, we address challenges related to the doctor–patient relationship, continuity of care, cultural competence, conflicts of interest, and the regulation of quality of care through maintenance of certification. We then explore three cultural trajectories that have deeply influenced medical practice: the technologic imperative, physicians’ collective neglect of structural factors impacting medicine, and the rise of commercialism. Finally, we describe efforts to address these challenges, focusing on the Physician Charter developed by the American Board of Internal Medicine and widely endorsed by medical boards and societies internationally.
What role should the tobacco industry have in the e-cigarette market? Should manufacturers contribute to the production of evidence on their products’ safety and efficacy? What are the environmental impacts of e-cigarette use and how should these feature in the discussion? How do e-cigarettes influence smoking-related health disparities? Should physicians recommend switching to e-cigarettes for those who smoke? How broadly applicable is the utility of e-cigarettes? And how should the discourse respond to emerging data? This volume examines the opportunities and challenges of optimizing e-cigarette regulation. The authors describe emerging evidence suggesting that restrictions on e-cigarettes can backfire by nudging consumers toward riskier alternatives. Adopting a social welfare-based approach drawing on economics, policy analysis and regulatory science, the authors then explore how optimal e-cigarette policy might balance risks and benefits, suggesting that it is possible to leverage the promise of e-cigarettes—a product that is more popular than traditional cessation aids—to protect current and future generations from the smoking-related harms, while still taking important steps to discourage use by young people and those who do not smoke. Samuel C. Hampsher-Monk is Managing Director of BOTEC Analysis, where he leads research on the regulation of tobacco, cannabis, and reduced-risk nicotine products for public and private clients, including 501(c)(3) groups and LLPs, as well as municipal and state regulators. He holds a BA in Politics and Philosophy from the University of Southampton and a MSc from the University of Edinburgh. James E. Prieger, an economist, is Professor of Public Policy at Pepperdine University and Senior Researcher at BOTEC Analysis, where he leads research on illicit tobacco markets, alternative nicotine products, and related policy issues. He has published over 50 peer-reviewed journal articles and chapters. He received his BA from Yale University and his PhD in economics from the University of California, Berkeley. Sudhanshu Patwardhan is a medical doctor working on tobacco harm reduction projects globally. He has worked in R&D in the pharma and tobacco sectors across three continents. Patwardhan qualified as a doctor from BJ Medical College Pune, India, received a Master of Business and Science from the Keck Graduate Institute, California, USA, and holds an MBA from the London Business School, UK.
In this book, James Dunson explores end-of-life ethics including physician-assisted suicide (PAS) and continuous sedation until death. He argues that ethical debates currently ignore the experience of the dying patient in an effort to focus on policy creation, and proposes that the dying experience should instead be prioritized and used to inform policy development. The author makes the case that PAS should be recognized as a legally and morally permissible option for a very particular kind of patient: terminally ill with fewer than six months to live and capable of conscious consent. Since focusing on the patient's experience of this end-of-life dilemma transforms some of the basic concepts we use to engage in the PAS debate, the argument has implications for patient care and the training of medical professionals.
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