Principles of Health Care Ethics E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 3176

Veröffentlichungsjahr: 2015

Beschreibung

Edited by four leading members of the new generation of medical and healthcare ethicists working in the UK, respected worldwide for their work in medical ethics, Principles of Health Care Ethics, Second Edition is a standard resource for students, professionals, and academics wishing to understand current and future issues in healthcare ethics.

With a distinguished international panel of contributors working at the leading edge of academia, this volume presents a comprehensive guide to the field, with state of the art introductions to the wide range of topics in modern healthcare ethics, from consent to human rights, from utilitarianism to feminism, from the doctor-patient relationship to xenotransplantation.

This volume is the Second Edition of the highly successful work edited by Professor Raanan Gillon, Emeritus Professor of Medical Ethics at Imperial College London and former editor of the Journal of Medical Ethics, the leading journal in this field.

Developments from the First Edition include:  The focus on ‘Four Principles Method’ is relaxed to cover more different methods in health care ethics. More material on new medical technologies is included, the coverage of issues on the doctor/patient relationship is expanded, and material on ethics and public health is brought together into a new section.

Leseprobe

Table of Contents

Cover

Title

Copyright

Contributors

Foreword: Raanan E. Gillon

Foreword: Tony Hope

Preface

REFERENCES

PART I: METHODOLOGY AND PERSPECTIVES

1: The ‘Four Principles’ Approach to Health Care Ethics

THE ORIGINS OF PRINCIPLES IN HEALTH CARE ETHICS

THE FRAMEWORK OF PRINCIPLES

THE CENTRALITY OF THE COMMON MORALITY

THE

PRIMA FACIE

CHARACTER OF PRINCIPLES AND RULES

THE SPECIFICATION OF PRINCIPLES AND RULES

CONCLUSION

REFERENCES

2: Theories of Autonomy

THE KANTIAN CONCEPTION OF AUTONOMY

PROCEDURAL THEORIES OF AUTONOMY

NEO-KANTIAN THEORIES

PSYCHOLOGICAL APPROACHES

THE IMPLICATIONS FOR HEALTH CARE ETHICS

REFERENCES

3: Beneficence

SPECIAL AND GENERAL REQUIREMENTS OF BENEFICENCE AND THEIR LIMITS

THE JUSTIFICATION OF BENEFICENCE

BENEFICENCE AND WELFARE

THE VIRTUES OF BENEFICENCE

BENEFICENCE AND HEALTH CARE

REFERENCES

4: Responsibilities for Poverty-Related Ill Health

SOCIAL INSTITUTIONS, POVERTY AND HEALTH

TREATING RECIPIENTS JUSTLY VERSUS PROMOTING A JUST DISTRIBUTION

RELATIONAL RESPONSIBILITIES

CONCLUSION

REFERENCES

5: Liberalism and Communitarianism

REFERENCES

6: How Many Principles for Bioethics?

ALTERNATIVE LISTS OF PRINCIPLES

WHAT IS THE RIGHT NUMBER OF PRINCIPLES?

REFERENCES

7: Casuistical Reasoning In Medical Ethics

FIRST STEP IN CASUISTICAL REASONING: DETERMINATION OF TOPICS

THE SECOND ACT OF CASUISTICAL REASONING: INTERPRETATION OF PRINCIPLES AND MAXIMS

THE THIRD STEP IN CASUISTICAL REASONING: ARGUMENT BY ANALOGY

REFERENCES

8: Utilitarianism and Bioethics

INTRODUCTION

THE BASIC ELEMENTS OF UTILITARIANISM

VARIETIES OF UTILITARIANISM

BIOUTILITARIANISM

EXTERNAL CRITICISMS OF BIOUTILITARIANISM

INTERNAL CRITICISMS OF BIOUTILITARIANISM

ACKNOWLEDGEMENTS

REFERENCES

9: Deontology

INTRODUCTION

COMMON SENSE MORALITY

VARIETIES OF DEONTOLOGY

DEFENDING DEONTOLOGY

REFERENCES

10: Kantian Ethics

KANT’S ETHICS

CONTEMPORARY KANTIAN ETHICS

INDIVIDUAL AUTONOMY AND PRINCIPLED AUTONOMY

CRITICISM OF KANTIAN ETHICS

BACK TO KANT?

REFERENCES

11: Feminist Approaches to Health Care Ethics

INTRODUCTION

FEMINIST APPROACHES

CONCLUSION

REFERENCES

12: Virtue Theory

THE NATURE OF VIRTUE ETHICS

CONCLUSION

REFERENCES

13: Moral Relativism

TOLERANCE

DESCRIPTIVE (MORAL) RELATIVISM

METAETHICAL RELATIVISM

REFERENCES

14: Christian Approaches to Bioethics

WHY STUDY CHRISTIAN BIOETHICS

CHRISTIAN ETHICS

TYPES OF CHRISTIAN ETHICS

CHRISTIAN BIOETHICS

A CHRISTIAN APPROACH TO BIOETHICS?

CONCLUSION

BIBLIOGRAPHY

15: Judaism and Medicine: Jewish Medical Ethics

BACKGROUND

INTRODUCTION

THE PHYSICIAN’S MANDATE TO HEAL

THE PATIENT’S RESPONSIBILITY TO STAY HEALTHY

THE PATIENT’S RESPONSIBILITY TO SEEK HEALING WHEN ILL

MEDICINE ON THE INTERNET

CONFIDENTIALITY AND THE INTERNET

THE FUTURE OF JEWISH MEDICAL ETHICS

SUMMARY AND CONCLUSION

REFERENCES

16: The Search for Islamic Bioethics Principles

ISLAMIC ETHICAL DISCOURSE

THE RATIONALIST AND TRADITIONALIST ETHICAL REASONING IN THE REVELATION

ISLAMIC PRINCIPLES OF BIOETHICS

THE PRINCIPLE OF PUBLIC INTEREST/COMMON GOOD (

MAṢLAḤA

)

THE TYPES OF ISSUES COVERED UNDER THE PRINCIPLE OF PUBLIC GOOD

THE PRINCIPLE OF ‘NO HARM, NO HARASSMENT’

REFERENCES

17: Buddhist Bioethics

BUDDHIST ETHICS

BUDDHISM AND MEDICINE

NO-PERSONHOOD ETHICS AND REINCARNATION

ABORTION

BRAIN DEATH AND ORGAN TRANSPLANTATION

SUICIDE, EUTHANASIA AND THE GOOD DEATH

SPECIESISM AND THE HUMANE TREATMENT OF ANIMALS

CONTRACEPTION, SEXUALITY, GENETIC ENGINEERING AND REPRODUCTIVE TECHNOLOGY

BRAIN SCIENCE, PSYCHOPHARMACOLOGY AND THE MYTH OF THE AUTHENTIC SELF

HEALTH CARE ACCESS AND HUMAN RIGHTS

REFERENCES

18: South Asian Approaches to Health Care Ethics

THE SOUTH ASIAN WORLDVIEW AND HEALTH CARE ETHICS

WHY ARE SOUTH ASIAN HEALTH CARE ETHICS IMPORTANT?

SOME APPLICATIONS OF THE SOUTH ASIAN APPROACH TO HEALTH CARE ETHICS

REFERENCES

19: The Specious Idea of an Asian Bioethics: Beyond Dichotomizing East and West

THE IDEA: ITS ROOTS, DISSEMINATION AND MODES OF EXPRESSION

THE SPECIOUSNESS OF THE IDEA

ACKNOWLEDGMENTS

REFERENCES

20: Narrative Ethics

INTRODUCTION

A BRIEF HISTORY AND DESCRIPTION

A PRINCIPLIST REJOINDER

CONCLUSION

REFERENCES

21: Empirical Approaches to Health Care Ethics

INTRODUCTION

DEFINING EMPIRICAL RESEARCH IN HEALTH CARE ETHICS

CURRENT TRENDS IN EMPIRICAL METHODS IN HEALTH CARE ETHICS

CONDUCTING EMPIRICAL RESEARCH IN HEALTH CARE ETHICS

CHOOSING THE APPROPRIATE METHODOLOGICAL APPROACH

CONCLUDING COMMENTS

AUTHORS’ NOTE

REFERENCES

22: Medical Sociology and the Redundancy of Empirical Ethics

ORGAN REPLACEMENT

GENETIC COUNSELLING: THE DARK SIDE OF PATIENT AUTONOMY

CONCLUSION: AVOIDING THE LINEAR MODEL

REFERENCES

23: The Use of Thought Experiments in Health Care Ethics

INTRODUCTION

THOUGHT EXPERIMENTS AND ARGUMENTS

FOUR DISTINCT WAYS IN WHICH THOUGHT EXPERIMENTS ARE USED

THE OBJECTION FROM MODALITY

THINGS WE SHOULD NOT THINK?

THE CONTINGENT CONTEXT OF HEALTH CARE ETHICS

CONCLUDING REMARKS

REFERENCES

24: Brandraising at the Organizational Level

INTRODUCTION

WHAT IS DELIBERATIVE DEMOCRACY?

TYPES OF DELIBERATIVE DEMOCRACY

CRITIQUES OF DELIBERATIVE DEMOCRACY

AN AGENDA FOR A DELIBERATIVE BIOETHICS

CONCLUSION

REFERENCES

25: Law, Ethics and Health Care

INTRODUCTION

THE RELATIONSHIP BETWEEN LAW AND ETHICS

MORALS OR LAW IN ACTION?

ETHICS OR LAW?

THE HUMAN RIGHTS ACT 1998

CONCLUSION

REFERENCES

26: Medical Humanities: An Overview

A FEW QUESTIONS FROM THE PUZZLED ONLOOKER

REFERENCES

27: Reflective Equilibrium as a Method in Health Care Ethics

INTRODUCTION

COHERENTISM

THE CIRCULARITY REPROACH

COHERENTISM NEEDS WEAK FOUNDATIONALISM

REFLECTIVE EQUILIBRIUM AND THE DEVELOPMENT OF SPONTANEOUS MORAL BELIEFS

EXAMPLE: REFLECTION ABOUT GROUNDBREAKING BIOMEDICAL TECHNOLOGIES

FOUR CHARACTERISTICS OF THE REFLECTIVE EQUILIBRIUM METHOD

CONCLUSION

REFERENCES

28: Hermeneutic Ethics between Practice and Theory

INTRODUCTION

STARTING FROM PRACTICE

MEANING-MAKING AND MOODS

PERSPECTIVE AND DIALOGUE

DELIBERATION AND NEGOTIATION

MORAL EXPERIENCE AND PHRONÈSIS

FROM THEORY BACK TO PRACTICE

REFERENCES

29: Paternalism in Health Care and Health Policy

WHAT IS PATERNALISM?

WEAK AND STRONG PATERNALISM

PURE AND IMPURE PATERNALISM

SOFT AND HARD PATERNALISM

CONCLUSIONS

REFERENCES

30: Need: An Instrumental View

‘NEED’ VERSUS ‘DEMAND’

‘NEED’, ABSOLUTE AND RELATIVE

‘NEED’ INTERPRETED INSTRUMENTALLY

EFFECTIVENESS OR COST-EFFECTIVENESS?

NEED AND THE FLOURISHING LIFE

NEED AND ALLOCATION PRINCIPLES

FIVE IMPORTANT IMPLICATIONS OF ‘NEED’

CONCLUSION

REFERENCES

31: Rights

THE CONCEPT OF A MORAL RIGHT

THE ROLE OF RIGHTS IN MORAL THINKING

THE FUTURE OF RIGHTS

REFERENCES

32: Exploitation in Health Care

THE CONCEPT OF EXPLOITATION

THE ELEMENTS OF EXPLOITATION

EXPLOITATION IN CLINICAL RESEARCH

REFERENCES

33: Competence to Consent

INTRODUCTION

CONCLUSION

REFERENCES

34: The Doctrine of Double Effect

INTRODUCTION

ORIGINS AND MORAL CONTEXT

THE DOCTRINE’S CONDITIONS

INTENTION AND ITS MORAL RELEVANCE

LEGAL APPLICATION

REFERENCES

35: Ordinary and Extraordinary Means

END OF LIFE DECISION-MAKING: ORDINARY AND EXTRAORDINARY MEANS

THE DILEMMA

A RESPONSE TO THE DILEMMA

CONCLUSIONS

REFERENCES

36: Acts and Omissions

RECOGNISING ACTS AND OMISSIONS

ACTS, OMISSIONS AND EUTHANASIA

ACTS, OMISSIONS AND BAD SAMARITANS

DECISION TIME – THE LIMITED EQUALITY OF ACTS AND OMISSIONS

REFERENCES

37: Personhood and Moral Status

INTRODUCTION: PERSONS AND HUMANS

WHY A THEORY OF PERSONHOOD?

THEORIES OF PERSONHOOD

CRITIQUES OF PERSONHOOD

CONCLUSION

REFERENCES

38: Commodification

INTRODUCING COMMODIFICATION

INSTRUMENTALIZATION

FUNGIBILITY

INDUCEMENTS AND CONSENT

SUMMARY AND CONCLUSIONS

REFERENCES

PART II: ISSUES IN HEALTH CARE PRACTICE

39: Consent and Informed Consent

CONSENT

INFORMED CONSENT

THE HISTORY OF INFORMED CONSENT

INFORMED CONSENT AS PROTECTION FROM LITIGATION

PATERNALISM AND MEDICAL DECISION-MAKING

REFERENCES

40: Treatment Decisions for Incapacitated Patients

DECISIONAL CAPACITY

ADVANCE TREATMENT DIRECTIVES

THE SUBSTITUTED JUDGEMENT STANDARD

THE BEST INTEREST STANDARD

CONCLUSION

ACKNOWLEDGEMENT

REFERENCES

41: Children’s Consent to Medical Treatment

INFORMED CONSENT

CHILDREN, PARENTS AND THE STATE

CHILDREN AND COMPETENCE

CONSENT TO AND REFUSING TREATMENT

‘SAVIOUR SIBLINGS’

CHILDREN’S CONSENT TO RESEARCH

GENETIC TESTING OF CHILDREN

CHILDREN’S RIGHTS

REFERENCES

42: Patients and Disclosure of Surgical Risk

INFORMED CONSENT AND SURGEON RISKS

AUTONOMY AS CHOICE VERSUS AUTONOMY AS AUTHORIZATION

DEFENSIVE SURGERY AND THE VALUE OF PATIENT AUTONOMY

CONCLUSION

REFERENCES

43: Confidentiality

THE IMPORTANCE OF MEDICAL CONFIDENTIALITY

IMPORTANT BUT NOT ABSOLUTE

PROTECTION OF THIRD PARTY INTERESTS/WELFARE

GENETIC TESTING

RESPECT FOR AUTONOMY AND GENETIC ‘EXCEPTIONALISM’

THE GOOD OF GENETIC INFORMATION AND ‘SHARED OWNERSHIP’

GENETIC INFORMATION: A GENERAL GOOD?

RESPECTING AUTONOMY OR UNACCEPTABLE PATERNALISM?

IS GENETIC INFORMATION SO SIGNIFICANTLY DIFFERENT AS TO WARRANT DIFFERENT TREATMENT?

REFERENCES

44: Truth Telling, Lying and the Doctor–Patient Relationship

THE TIPPING POINT

THE REALITY OF BEING A PATIENT

THE REALITY OF BEING A DOCTOR

THE DOCTOR–PATIENT RELATIONSHIP

CONTRIBUTIONS FROM THEORY IN ETHICS

PRIVACY

VIRTUE

HARM

KINDNESS AND HOPE

CHALLENGES

REFERENCES

45: Personal Beliefs and Patient Care

REFERENCES

46: Conscience and Health Care Ethics

THE IDEA OF CONSCIENCE

CONSCIENCE AS AN ‘INNER VOICE’

‘CONSCIENCE CLAUSES’

ARGUMENTS FOR RESPECTING CONSCIENTIOUS OBJECTION

RESPECT FOR REFUSAL VERSUS THE INTERESTS OF PATIENTS

CONSCIENTIOUS OBJECTION AND THE CORE VALUES OF MEDICINE

REFERENCES

47: Care in Families

TWO SYSTEMS OF ETHICS

THE FEATURES OF FAMILIES

FAMILY CAREGIVING

REFERENCES

48: The Ethics of Primary Health Care

THE DEFINITION OF PRIMARY HEALTH CARE

PRIMARY HEALTH CARE ETHICS: THE ‘INDIVIDUAL’ ACCOUNT

PRIMARY HEALTH CARE ETHICS: THE ‘COMMUNITY’ ACCOUNT

CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

49: The Nurse–Patient Relationship: A ‘Principles plus Care’ Account

MODELS OF THE NURSE–PATIENT RELATIONSHIP

CARE VERSUS PRINCIPLES?

CARE PLUS PRINCIPLES

REFERENCES

50: Dual Responsibilities: Do They Raise Any Different Ethical Issues from ‘Normal’ Therapeutic Relationships?

HOW DIFFERENT ARE THE ISSUES RAISED BY DUAL LOYALTY CONFLICTS?

HOW DUAL RESPONSIBILITIES ARISE

WHAT ETHICAL PROBLEMS DO DUAL RESPONSIBILITIES CREATE?

WHAT ETHICAL PRINCIPLES APPLY TO DUAL RESPONSIBILITIES?

COMMON PRINCIPLES IN ALL SETTINGS

EXERCISING PROFESSIONAL INDEPENDENCE

RESPECTING AUTONOMY: THE DUTY TO ENSURE THAT APPROPRIATE CONSENT IS OBTAINED

ENSURING APPROPRIATE CONFIDENTIALITY

CONCLUSION

REFERENCES

51: Violent and Abusive Patients: An Ethically Informed Response

IS HEALTH CARE A RIGHT?

MORAL RESPONSIBILITY

A CLINICAL APPROACH TO MORAL RESPONSIBILITY

BENEFICENCE AND NON-MALEFICENCE (DOING GOOD AND NOT DOING HARM)

DISTRIBUTIVE JUSTICE

CONCLUSION

REFERENCES

52: The Moral Significance of the Human Foetus

BIBLICAL APPRECIATION OF LIFE BEFORE BIRTH

CHRISTIAN TRADITION AND CATHOLIC TEACHING

CONTEMPORARY SECULAR CONCEPTS OF THE HUMAN PERSON

PHILOSOPHICAL RESPONSE TO SECULAR CONCEPTS OF THE HUMAN PERSON

HUMAN SUBJECT WITH A RATIONAL NATURE IS A PERSON

IMMATERIAL SOUL

DEFINITION OF A HUMAN PERSON

THE HUMAN FOETUS AS PERSON

IMPLICATIONS OF THE MORAL SIGNIFICANCE OF THE FOETUS AS A PERSON

CONCLUSION

REFERENCES

53: Will We Need Abortion in Utopia?

ABORTION AND SEX

VOLUNTARY AND COERCED PARENTHOOD

BODILY INTEGRITY AND PARENTAL OBLIGATION

ACKNOWLEDGEMENTS

REFERENCES

54: Maternal–Foetal Conflict

INTRODUCTION

THE MORAL CLAIMS OF THE FOETUS

THE MORAL INTERESTS OF THE PREGNANT WOMAN

CONCLUDING THOUGHTS

REFERENCES

55: Limits to Reproductive Liberty

REFERENCES

56: Disability without Denial

DOES IMPAIRMENT LEAVE PEOPLE WORSE OFF?

IMPAIRMENTS AND LIVES WORTH LIVING

REFERENCES

57: Disability and Equity: Should Difference Be Welcomed?

CHANGING ACCOUNTS OF DISABILITY

IMPAIRMENT IS PART OF THE HUMAN CONDITION

PEOPLE ADAPT WELL TO DISABILITY

DISABILITY IS A RELATIONAL ISSUE

RESPONDING TO THE DISABILITY CHALLENGE

DISABILITY AND HEALTH CARE

REFERENCES

58: Genetic Counselling

ETHOS, GOALS AND OUTCOMES

PREDICTIVE GENETIC TESTING

PRIVACY, CONFIDENTIALITY, DISCLOSURE

GENETIC TESTING OF CHILDREN AND ADOLESCENTS

DYSMORPHOLOGY ASSESSMENT AND DIAGNOSTIC LABELS

CURRENT INSTITUTIONAL ISSUES

CONCLUSION

REFERENCES

59: Ethics and Psychotherapy: An Issue of Trust

AN ETHIC OF RELATIONAL TRUST

AN ETHIC OF TRUST: STRENGTHS AND LIMITATIONS

REFERENCES

60: Mental Illness and Compulsory Treatment

MENTAL HEALTH LEGISLATION

ANTIPSYCHIATRY

ANTIPSYCHIATRY AND SUICIDE

THE MYTH OF MENTAL ILLNESS

THE MEDICAL MODEL PSYCHIATRISTS

COMPULSORY TREATMENT: JUSTIFIED PATERNALISM?

CONCLUSIONS

REFERENCES

61: Personality Disorders and Compulsory Detention

INTRODUCTION

COMPULSORY PREVENTIVE DETENTION

PERSONALITY DISORDERS

PERSONALITY DISORDERS AND COMPULSORY DETENTION

CONCLUSION AND THOUGHTS FOR THE FUTURE

REFERENCES

62: Labia mea, Domine*: Media, Morality and Eating Disorders

INTRODUCTION

ANOREXIA AND THE MEDIA

THE BODY/MIND SCHISM: ITS ORIGINS

KANT AND THE MORTIFICATION OF THE FLESH

MORAL INTEGRITY AND

HUNGER

EATING DISORDERS AND MORALITY

TWO UNRESOLVED ISSUES

IS IT UNETHICAL TO BE NORMAL SHAPED?

CONCLUSIONS

REFERENCES

63: Intellectual Disability

DEFINITION

MORAL STATUS

PREVENTION OF INTELLECTUAL DISABILITY

REFERENCES

64: Ethical Issues and Health Care for Older People

INTRODUCTION

WHO ARE OLDER PERSONS?

AGEISM

FROM AUTONOMY TO THE SITUATED PERSON

CONSENT, CAPACITY AND BEST INTERESTS

FAMILIES AND CARE

TAKING RISKS

TREATMENT DECISIONS

DEATH

CONCLUSION

REFERENCES

65: Organs and Tissues for Transplantation and Research

CONSENT

PROPERTY IN HUMAN TISSUE

HARMING THE DEAD

CONCLUDING REMARKS

REFERENCES

66: Living Donor Organ Transplantation

DO NO HARM AND AUTONOMY

INCOMPETENT DONORS

JUSTICE AND CONDITIONAL ALLOCATION

ACKNOWLEDGEMENTS

REFERENCES

67: Euthanasia and Principled Health Care Ethics: From Conflict to Compromise?

INTRODUCTION

PATRICK’S REQUEST

THE SEARCH FOR A SOLUTION I: PRINCIPLED HEALTH CARE ETHICS

THE SEARCH FOR A SOLUTION II: THE INTRINSIC VALUE OF LIFE

THE SEARCH FOR A SOLUTION III: THE INSTRUMENTAL VALUE OF LIFE

THE SOLUTION: TIME TO COMPROMISE?

CONCLUSION: GIVING CONTENT TO THE COMPROMISE?

ACKNOWLEDGEMENTS

REFERENCES

68: Understanding and Misunderstanding Death

INTRODUCTION

MODERN SCIENCE, DEATH AND MEDICAL CONFUSION

THE EMERGENCE OF BRAIN DEATH

BRAIN DEATH AND FURTHER SOURCES OF MISUNDERSTANDING

PUBLIC ANXIETY CONCERNING BRAINRELATED CONCEPTS OF DEATH

A DEFINITION MUST REFER TO A RECOGNIZABLE AND IRREVERSIBLE PHYSICAL TRANSFORMATION

A DEFINITION OF DEATH MUST BE SELECTIVE

A DEFINITION MUST BE UNIVERSAL AND HOLISTIC

CONCLUSION

REFERENCES

69: Ethics without Boundaries: Medical Tourism

INTRODUCTION

HEALTH CARE AS A PUBLIC SERVICE

CONDITIONS FOR ACCEPTABLE CROSS-BORDER HEALTH CARE

BENEFITS OF MEDICAL TOURISM FOR THE PROVIDING COUNTRY

DISADVANTAGES AND RISKS OF MEDICAL TOURISM

HOW TO PREVENT THE EXISTING SYSTEM FROM DETERIORATING?

BENCHMARKS OF FAIRNESS

REPRODUCTIVE TOURISM, PERSONAL AUTONOMY AND LAW EVASION

CONCLUSIONS

REFERENCES

70: Ethics of Performance Enhancement in Sport: Drugs and Gene Doping

CURRENT GUIDELINES AND POLICY ON DOPING IN SPORT

A PROPOSAL

SEVEN MISCONCEPTIONS ABOUT DRUGS IN SPORT

CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

71: Training Good Professionals: Ethics and Health Care Education

ASKING THE QUESTION

MORAL PERCEPTION

MORAL IMAGINATION, MORAL JUDGEMENT AND THE DEVELOPMENT OF MORAL CHARACTER

IN PRACTICE

CONCLUSION

ACKNOWLEDGEMENT

REFERENCES

72: Ethics Consultation and Ethics Committees

INTRODUCTION

HISTORY

FUNCTIONS AND SCOPE OF ETHICS CONSULTANTS AND ETHICS COMMITTEES

SOME KEY ISSUES FOR DEBATE IN ETHICS CONSULTATION

ACCOUNTABILITY AND LEGITIMACY OF ETHICS CONSULTATION AND ETHICS COMMITTEES

EVALUATION

FUTURE DEVELOPMENTS

REFERENCES

PART III: MEDICINE IN SOCIETY

73: The Concepts of Health and Illness

INTRODUCTION

THE BASIC THEORIES OF HEALTH

SOME ISSUES IN CONTEMPORARY PHILOSOPHY OF HEALTH

REFERENCES

74: Community in Public Health Ethics

COMMUNITY: THE LOST TRADITION OF PUBLIC HEALTH

THE MILLIAN PARADIGM

REFERENCES

75: Health Promotion, Society and Health Care Ethics

THE ILL DEFINITION OF HEALTH PROMOTION

HEALTH PROMOTION, SOCIAL SCIENCE AND ETHICS

CONCLUSION

REFERENCES

76: Preventing Disease

ETHICAL ISSUES

MEDICALIZATION AND CONCERNS ABOUT THE GOOD LIFE

THE SCOPE OF OBLIGATIONS TO AVOID CAUSING ILLNESS

CONCLUSION

REFERENCES

77: Quantitative Methods for Priority-Setting in Health: Ethical Issues

INTRODUCTION

CEA AND CBA

THE ROLE OF CBA AND CEA IN PRIORITY-SETTING

REFERENCES

78: Economics, Political Philosophy and Ethics: The Role of Public Preferences in Health Care Decision-Making

WELFARE THEORY

LIBERTARIANISM AND EGALITARIANISM

TRADITIONAL ETHICS

THE EMPIRICAL APPROACH

ETHICS AND SOCIAL SCIENCE

CONCLUSION

REFERENCES

79: Decision Analysis: The Ethical Approach to Most Health Decision Making

INTRODUCTION

ETHICS AND DECISIONS

DECISION ANALYSIS

DECISION ANALYSIS AND ETHICS

DECISION ANALYSIS AND THE ETHICS OF COHERENCE

EVALUATING DECISION TECHNOLOGIES

REFERENCES

80: Health Inequities and the Social Determinants of Health

INTRODUCTION

INEQUALITIES AND INEQUITIES

HEALTH EQUITY

HEALTH EQUITY, SOCIAL JUSTICE AND RIGHTS

THE SOCIAL DETERMINANTS OF HEALTH

THEORETICAL RESPONSE TO THE MORAL IMPLICATIONS OF HEALTH INEQUALITIES

PRACTICAL RESPONSES AND REASONS TO ACT

CONCLUSION

REFERENCES

81: Organizational Ethics in Health Care

THEORY

PRACTICAL ASPECTS

REFERENCES

82: Ethical Issues in Epidemiology

INTRODUCTION

RECENT HISTORY AND BACKGROUND

ETHICAL ISSUES IN EPIDEMIOLOGY

SUMMARY AND CONCLUSIONS

REFERENCES

83: Screening: Ethical Aspects

INTRODUCTION

WHAT IS SCREENING?

WHY SCREENING?

SCREENING – WHAT AND WHEN?

SCREENING – HOW?

CONCLUSIONS

ACKNOWLEDGEMENT

REFERENCES

84: Vaccination Ethics

INTRODUCTION

HARMS AND BENEFITS

HARM TO OTHERS

THE ‘BEST INTERESTS’ ARGUMENT

COMPULSION?

CONCLUSIONS

REFERENCES

85: The Patient as Victim and Vector: Bioethics and the Challenge of Infectious Diseases

INFECTIOUS DISEASES: BIOLOGICAL BASICS AND DISTINCTIVE FEATURES FOR BIOETHICS

NEW PARADIGMS FOR BIOETHICS: EMBEDDED AUTONOMY

RESPECT, COMPENSATION AND RECIPROCITY: DEVELOPING A POSITIVE THEORY OF THE OBLIGATIONS OF PEOPLE TO EACH OTHER IN A WORLD OF TRANSMISSIBLE INFECTIOUS DISEASES

REFERENCES

86: Bioterrorism, Society and Health Care Ethics

INTRODUCTION

HISTORICAL BACKGROUND

BIOTERRORISM AND HEALTH CARE ETHICS

FOR FURTHER STUDY

REFERENCES

87: Drug Addiction, Society and Ethics

SCEPTICAL VIEWS OF ADDICTION

NEUROBIOLOGICAL THEORIES OF ADDICTION

ADDICTION AND PATERNALISM

ETHICAL ASPECTS OF CONTROVERSIAL ADDICTION POLICY OPTIONS

PREDICTIVE TESTING OF GENETIC RISK OF ADDICTION

THE PREVENTIVE USE OF A NICOTINE VACCINE

THE TASKS AHEAD FOR ETHICISTS

REFERENCES

88: Smoking: Is Acceptance of the Risks Fully Voluntary?

REFERENCES

89: Doctors and Human Rights

HUMAN RIGHTS

DOCTORS AND THE JUSTIFICATION OF HUMAN RIGHTS

DOCTORS AND THE TYPE OF HUMAN RIGHTS

DOCTORS AND THE IMPLEMENTATION/ENFORCEMENT OF HUMAN RIGHTS

DOCTORS AND THE LIMITS OF HUMAN RIGHTS

HUMAN RIGHTS AND PUBLIC HEALTH

CONCLUSION

REFERENCES

90: Duties to Refugees and Asylum Seekers in Host Countries’ Medical Systems

INTRODUCTION

BACKGROUND

ASSESSMENT OF CLAIMS FOR ASYLUM

RESETTLING REFUGEES

ETHICAL IMPLICATIONS FOR PRACTICE

REFERENCES

91: Medical Aid in Disaster Relief

INTRODUCTION

ETHICAL THEORY AND DISASTER RELIEF

THE REQUIREMENTS OF JUSTICE AND BENEFICENCE

WILFUL IGNORANCE

THE KLEPTOCRATIC EXCUSE

USING RELIEF FOR POLITICAL ENDS AND THE NEUTRALITY OF HELPERS

OBLIGATIONS TO DONORS

TRIAGE IN DISASTERS

THE SPECIFIC OBLIGATIONS OF HEALTH CARE PROFESSIONALS

REFERENCES

Part IV: RESEARCH ETHICS AND ETHICS OF NEW TECHNOLOGIES

92: The Ethics and Governance of Medical Research

RESEARCH AS A TOPIC OF SOCIAL CONCERN

A HISTORICAL CONTEXT FOR STRUGGLES OVER MEDICAL RESEARCH IN SOCIAL CONTEXT

PROFESSIONAL-ORIENTED RESPONSES

PROCESS-ORIENTED APPROACHES

A BRIEF HISTORY OF RESEARCH ETHICS COMMITTEES IN THE UNITED KINGDOM

RESEARCH ETHICS COMMITTEES AND THE REGULATION OF RESEARCH

EVALUATING AND MEASURING RECS

THE MORAL AND THE REGULATORY DISCOURSES OF RESEARCH ETHICS COMMITTEES

CONCLUSION

REFERENCES

93: On The Ethics of Animal Research

INTRODUCTION

BACKGROUND

MORAL STATUS

THE ISSUE OF BENEFITS

HARMS AND COSTS

SOME DIFFERING IMPLICATIONS

WHAT ABOUT ALTERNATIVES?

SOME SUGGESTIONS

REFERENCES

94: The Ethical Requirement for Systematic Reviews for Randomized Trials

INTRODUCTION

THE SCIENCE AND PRACTICE OF SYSTEMATIC REVIEWS

ETHICS, RANDOMIZED TRIALS AND SYSTEMATIC REVIEWS

SYSTEMATIC REVIEWS IN THE DESIGN OF RANDOMIZED TRIALS

SYSTEMATIC REVIEWS IN THE REPORTING OF RANDOMIZED TRIALS

CONCLUSION

REFERENCES

95: Informed Consent for Research

INTRODUCTION

UNDERSTANDING THE PURPOSE OF RESEARCH

UNDERSTANDING VOLUNTARINESS

UNDERSTANDING PROTOCOL DESIGN AND RANDOMIZATION

UNDERSTANDING OF RISKS AND BENEFITS

THE EFFECT OF DEMOGRAPHICS ON UNDERSTANDING

INTERVENTIONS TO IMPROVE UNDERSTANDING

THE EFFECTIVENESS OF INTERVENTIONS

CONCLUSION

DISCLAIMER

REFERENCES

96: Evaluating Benefits and Harms in Clinical Research

INTRODUCTION

THE INFLUENCE OF THE NATIONAL COMMISSION ON CURRENT SPECIFICATION OF THE PRINCIPLE OF BENEFICENCE

POLITICAL TRUST AS THE FOUNDATION OF

BELMONT

PRINCIPLES AS APPLIED TO THE STATE

COMPONENT ANALYSIS AS SPECIFICATION OF THE PRINCIPLE OF BENEFICENCE

CONCLUDING REFLECTIONS

ACKNOWLEDGEMENTS

REFERENCES

97: Patients’ Obligations?

THE COMMON GOOD PROPOSAL

REFERENCES

98: Standard of Care Owed to Participants in Clinical Trials: Different Standards in Different Countries?

THE CONTROVERSY OVER THE PERINATAL HIV TRANSMISSION STUDIES

THE CENTRAL ELEMENTS OF THE CONTROVERSY

EXAMPLES OF TRIALS PROVIDING LESS THAN THE UNIVERSAL STANDARD OF CARE

REVISIONS OF GUIDELINES

CONCLUDING REMARKS

DISCLAIMER AND ACKNOWLEDGEMENT

REFERENCES

99: Justice and Priority Setting in International Health Care Research

INTRODUCTION

THE GLOBAL SETTING FOR RESEARCH

THE UNDERLYING CHALLENGE

JUSTICE IN THE ALLOCATION OF RESOURCES

NARROWING INJUSTICE – IS IT POSSIBLE?

CONCLUSIONS

REFERENCES

100: Obligations of the Pharmaceutical Industry

INTRODUCTION

COMPANIES’ CORPORATE SOCIAL RESPONSIBILITIES

NEGLECTED DISEASE RESEARCH

AFFORDABLE ACCESS TO LIFE-SUSTAINING DRUGS

COMPANIES’ POST-TRIAL OBLIGATIONS TO PARTICIPANTS IN DEVELOPING COUNTRIES

CONCLUSIONS

ACKNOWLEDGEMENT

REFERENCES

101: Ethics and Medical Publishing

INTRODUCTION

BIASED UNDER-REPORTING OF CLINICAL RESEARCH

PEER REVIEW

AUTHORSHIP AND CONTRIBUTORSHIP

CONFLICTS OF INTEREST

RESEARCH MISCONDUCT

REFERENCES

102: Human Reproductive Cloning

CLONING: A BRIEF HISTORY

THE INTERNATIONAL RESPONSE TO CLONING

A MISTRUST OF SCIENTISTS?

WHY CLONE A HUMAN BEING?

THE CASE AGAINST CLONING

CONCLUDING REMARKS

REFERENCES

103: Obtaining Human Eggs for Stem Cell Research: Ethical Issues

EGG SHARING ARRANGEMENTS

EGG SHARING FOR THE PURPOSES OF STEM CELL RESEARCH

ENCOURAGING ALTRUISTIC EGG DONATION FOR STEM CELL RESEARCH

CONCLUSIONS

REFERENCES

104: The Ethics of Xenotransplantation

INTRODUCTION

VIOLATION OF THE NATURAL ORDER

RISKS TO THE XENOGRAFT RECIPIENT

THE ANIMAL RIGHTS OBJECTION

RISK TO PUBLIC HEALTH

CONCLUSION

REFERENCES

105: Pharmacogenomics

PHARMACOGENETICS AND PHARMACOGENOMICS

POSSIBILITIES

PATIENT GROUPS

PRODUCTS

PREREQUISITES

PRINCIPLES

NEW ETHICS?

REFERENCES

106: Ethical Issues in Human Gene Transfer: A Historical Overview

ETHICAL ISSUES IN SOMATIC CELL GENE TRANSFER RESEARCH

RISKS AND BENEFITS

THE PROBLEM OF ‘COMPASSIONATE USE’

THE PROBLEM OF LATROGENIC RISKS

SELECTION OF SUBJECTS

RESPECTING THE RIGHTS OF SUBJECTS

ETHICAL ISSUES IN HUMAN GERM-LINE GENE TRANSFER

SCIENTIFIC UNCERTAINTIES

ALLOCATION OF RESOURCES

SOCIAL RISKS

HUMAN RIGHTS CONCERNS

ACKNOWLEDGEMENTS

REFERENCES

107: The Ethics of Ageing, Immortality and Genetics

OVERPOPULATION

THE RIGHT TO LIFE: A RIGHT WITH A DEADLINE?

WHAT JUSTICE REQUIRES AND WHAT IT DOES NOT REQUIRE

CONCLUSION

REFERENCES

108: Ethical Issues of Enhancement Technologies

THE MORAL VALUE OF ENHANCEMENT

ENHANCEMENT AND HUMAN NATURE

ENHANCEMENT AND JUSTICE

ENHANCEMENT AND AUTHENTICITY

CONCLUSION

REFERENCES

109: Psychosurgery and Neuroimplantation: Changing What is Deep Within a Person

ARISTOTLE ON THE SOUL

PSYCHOSURGERY

NEUROIMPLANTATION

NEURAL REPAIR AND CLINICAL ETHICS

A CLUSTER OF CLINICAL ETHICAL PROBLEMS IN NEURAL REPAIR

CYBORGS

THE SCHISM – BIOLOGY AND THE PSYCHE

REFERENCES

110: Resisting Addiction: Novel Application of Vaccines

DRUG VACCINATION

ETHICAL ISSUES

CONCLUSION

REFERENCES

Index

End User License Agreement

Guide

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List of Illustrations

20: Narrative Ethics

Figure 20.1 Four Levels of Narrative in Medicine.

Figure 20.2 Four Levels, Applied to Case of Melanie Begay

Figure 20.3 Intersection of Life Narratives in the Case of Melanie Begay.

79: Decision Analysis: The Ethical Approach to Most Health Decision Making

Figure 79.1. Basic decision tree.

Figure 79.2. Basic decision tree populated and rolled back to identify optimal choice.

89: Doctors and Human Rights

Figure 89.1. Human rights topics

96: Evaluating Benefits and Harms in Clinical Research

Figure 96.1. The ethical analysis of benefits and harms in research by the REC. Reproduced with permission from Miller and Weijer (2004).

100: Obligations of the Pharmaceutical Industry

Figure 100.1. Performance of UK and German pharmaceuticals and their relevant markets (source: Abbey National Asset Managers, own calculations).

List of Tables

64: Ethical Issues and Health Care for Older People

Table 64.1. Some Issues in old age

70: Ethics of Performance Enhancement in Sport: Drugs and Gene Doping

Table 70.1. Performance enhancers. Examples of prohibited performance enhancers for which athletes have been banned

Table 70.2. Examples of legal performance-enhancers

Table 70.3. Examples of prohibited performance enhancements for which no athlete has tested positive, but believed to be in use

81: Organizational Ethics in Health Care

Table 81.1 Drivers of ethics initiatives

Table 81.2 Components of an ethics programme

Table 81.3 Key questions for addressing an organizational ethics dilemma

Table 81.4 Common issues in organizational ethics, by category

89: Doctors and Human Rights

Table 89.1. Ethical codes and principles for doctors

Table 89.2 Prominent human rights declarations

98: Standard of Care Owed to Participants in Clinical Trials: Different Standards in Different Countries?

Table 98.1 Two possible outcomes of the trial in two different populations with different death rates utilizing the local standard of care

PRINCIPLES OF HEALTH CARE ETHICS

Second Edition

Edited by

Richard E. Ashcroft

Queen Mary, University of London, Barts and the London Medical School, Institute of Health Sciences Education, London, UK

Angus Dawson

Centre for Professional Ethics, School of Law, Keele University, Staffordshire, UK

Heather Draper

Centre for Biomedical Ethics, University of Birmingham, Birmingham, UK

John R. McMillan

Philosophy Department, The University of Hull, Hull, UK

Copyright © 2007

John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England

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Library of Congress Cataloging-in-Publication Data

Principles of health care ethics. – 2nd ed. / edited by Richard E.

Ashcroft… [et al.].

p.; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-470-02713-4

1. Medical ethics. I. Ashcroft, Richard E.

[DNLM: 1. Ethics, Clinical. 2. Bioethical Issues. 3. Biomedical

Technology–ethics. 4. Delivery of Health Care–ethics.

5. Professional-Patient Relations–ethics. 6. Social Medicine. WB 60 P957 2007]

R724.P69 2007

174.2–dc22

2006038748

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 978-0-470-02713-4

Contributors

TINEKE A. ABMA Professor, Department of Health Ethics and Philosophy, PO Box 616, Faculty of Health Sciences, Universiteit Maastricht, 6200 MD Maastricht, The Netherlands. Email: [email protected]

PASCALE ALLOTEY Chair in Race and Diversity, School of Health Sciences and Social Care, and, Centre for Public Health Research, Brunel University, Uxbridge UB8 3PH, UK. Email: [email protected]

DAVID W. ARCHARD Director, Institute for Philosophy & Public Policy (IPPP), Furness College, Lancaster University, Lancaster LA1 4YG, UK. Email: [email protected]

ADRIENNE ASCH Edward and Robin Milstein Professor of Bioethics, Wurzweiler School of Social Work, Albert Einstein College of Medicine, Yeshiva University, 2495 Amsterdam Avenue, New York, NY 10033, USA. Email: [email protected]

RICHARD E. ASHCROFT Professor of Biomedical Ethics, Queen Mary University of London, Barts and the London Medical School, Institute of Health Sciences Education, 38–40 New Road, London E1 2AX, UK. Email: [email protected]

NAFSIKA ATHANASSOULIS Lecturer in Ethics, Centre for Professional Ethics, School of Law, Keele University, Staffordshire, ST5 5BG, UK. Email: [email protected]

MARGARET P. BATTIN Distinguished University Professor, Division of Medical Ethics, 260 Central Campus Drive, Room 341, University of Utah, Salt Lake City, UT 84112-9156, USA. Email: [email protected]

TOM L. BEAUCHAMP Professor of Philosophy, Department of Philosophy, Georgetown University, New North 215–37th and O Streets, NW Washington, DC 20057, USA. Email: [email protected]

GRAHAM M. BEHR Consultant Psychiatrist and Honorary Senior Lecturer in Psychiatry, South Paddington Team, Central and North West London Mental Health NHS Trust, 7A Woodfield Road, London, W9 2NW, UK. Email: [email protected]

SOLOMON R. BENATAR Professor of Medicine, Director Bioethics Centre, Department of Medicine, University of Cape Town, J Floor Old Main Building, Groote Schuur Hospital, Observatory 7925, Western Cape, South Africa. Email: [email protected] or [email protected]

PIERS BENN Lecturer, Division of Epidemiology, Public Health and Primary Care, Imperial College London, Reynolds Building, St Dunstan’s Road, London W6 8RP, UK. Email: [email protected]

REBECCA BENNETT Senior Lecturer in Bioethics, The Centre for Social Ethics and Policy, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Email: [email protected]

TIM BOND Reader in Counselling and Professional Ethics, Graduate School of Education, University of Bristol, 35 Berkeley Square, Bristol, BS8 1JA. Email: [email protected]

ANNETTEE J. BRAUNACK-MAYER Associate Professor, Discipline of Public Health, The University of Adelaide, Mail Drop 207, Adelaide SA 5005, Australia. Email: [email protected]

DAN W. BROCK Frances Glessner Lee Professor of Medical Ethics at Harvard Medical School and Chair of the Division of Medical Ethics, Harvard Program in Ethics and Health, Harvard Medical School, 641 Huntington Avenue, 4th Floor, Boston, MA 02115, USA. Email: [email protected]

HOWARD BRODY University Distinguished Professor, Family Practice, Philosophy, and Centre for Ethics and Humanities in the Life Sciences, B100 Clinical Center, Michigan State University, East Lansing, MI 48824, USA. Email: [email protected]

LINDA S. CARR-LEE Research Associate/Course Coordinator, Division of Medical Ethics, LDS Hospital, 8th Ave and C Street, Salt Lake City, UT 84143, USA. Email: [email protected]

ADRIAN CARTER Office of Public Policy and Ethics, Institute for Molecular Bioscience, and The Queensland Brain Institute, University of Queensland, Ritchie Building (64A) (C Wing), St Lucia, QLD, 4072, Australia. Email: [email protected]

RUTH CHADWICK Professor, CESAGen: ESRC Centre for Economic and Social Aspects of Genomics: a Lancaster-Cardiff collaboration, Cardiff Law School, Cardiff University, Museum Avenue, Cardiff CF10 3XJ, UK. Email: [email protected]

IAIN CHALMERS Editor, James Lind Library, The James Lind Initiative, Summertown Pavillion, Middle Way, Oxford OX2 7LG, UK. Email: [email protected]

JAMES F. CHILDRESS Hollingsworth Professor, Institute for Practical Ethics and Public Life, University of Virginia, PO Box 400800, Charlottesville, VA 22904, USA. Email: [email protected]

ANGUS CLARKE Department of Medical Genetics, University Hospital of Wales, Health Park, Cardiff CF14 4XN, UK. Email: [email protected]

MIKE CLARKE Professor, Director, UK Cochrane Centre, NHS R&D Programme, Summertown Pavillion, Middle Way, Oxford OX2 7LG, UK. Email: [email protected], [email protected]

STEVEN S. COUGHLIN Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE (K-55), Atlanta, GA 30341, USA. Email: [email protected]

HAROLD COWARD Director, Centre for Studies in Religion and Society, University of Victoria, PO Box 3045, Victoria, BC V8W 3P4 Canada. Email: [email protected]

ALAN CRIBB Professor of Bioethics and Education, Centre for Public Policy Research, King’s College London, Strand, London WC2R 2LS, UK. Email: [email protected]

GARRETT CULLITY Associate Professor, Department of Philosophy, The University of Adelaide, Adelaide SA 5005, Australia. Email: [email protected]

ANTHONY J. CULYER Chief Scientist, Institute for Work & Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada. Email: [email protected]

DANIELA CUTAŞ Research Fellow, CSEP/IMLAB, School of Law, University of Manchester, Williamson Building, Oxford Road, M13 9PL, UK. Email: [email protected]

MARION DANIS Head, Section on Ethics and Health Policy, Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, Building 10 Room 1C118, National Institutes of Health, Bethesda, MD 20892-1156, USA. Email: [email protected]

ANGUS DAWSON Senior Lecturer in Ethics and Philosophy, Centre for Professional Ethics, School of Law, Keele University, Staffordshire, ST5 5BG, UK. Email: [email protected]

DAVID DEGRAZIA Professor of Philosophy, Department of Philosophy, George Washington University, Phillips 525, Washington DC 20052, USA. Email: [email protected]

JACK DOWIE Emeritus Professor of Health Impact Analysis, Public Health and Policy Dept, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Email: [email protected]

HEATHER DRAPER Reader in Biomedical Ethics, Centre for Biomedical Ethics, Department of General Practice and Primary Care, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Email: [email protected]

REBECCA S. DRESSER Daniel Noyes Kirby Professor of Law and Professor of Ethics in Medicine, School of Law and School of Medicine, Washington University in St Louis, Law School-Box 1120, One Brookings Drive, St Louis, MO 63130, USA. Email: [email protected]

STEVEN D. EDWARDS Centre for Philosophy, Humanities and Law in Healthcare, School of Health Science, University of Wales, 7th Floor Vivian Building, Swansea SA2 8PP, UK. Email: [email protected]

EZEKIEL EMANUEL Chair, Department of Clinical Bioethics at the Warren G. Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Building 10, Room 1C118, Bethesda, MD 20892-1156, USA. Email: [email protected]

J.S. EMMANUEL Consultant Psychiatrist and Honorary Senior Lecturer in Psychiatry, Central and North West London Mental Health NHS Trust, 7A Woodfield Road, London, W9 2NW, UK.

VERONICA ENGLISH Deputy Head of Medical Ethics Department, British Medical Association, BMA House, Tavistock Square, London WC1H 9JP, UK. Email: [email protected]

MARTYN EVANS Professor of Humanities in Medicine, Centre for Arts and Humanities in Health and Medicine, University of Durham, Dawson Building, Science Site, South Road, Durham DH1 3HP, UK. Email: [email protected]

JAMES FLORY MD Student, School of Medicine, University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104-6055, USA.

BENNETT FODDY Research Student, Centre for Applied Philosophy and Public Ethics, University of Melbourne, Victoria 3010, Australia; and Australian Stem Cell Centre, Monash University, Victoria 3800, Australia. Email: [email protected]

NORMAN MICHAEL FORD Director, Caroline Chisholm Centre for Health Ethics, East Melbourne; Senior Honorary Research Fellow, Bioethics, Monash University, Melbourne; Lecturer in Bioethics, Melbourne College of Divinity, Australia. Email: [email protected]

LESLIE P. FRANCIS Alfred C. Emery Professor of Law, S.J. Quinney College of Law, University of Utah, 332 South 1400 East, Salt Lake City, UT 84112-0730, USA. Email: [email protected]

JIM GALLAGHER Centre for Ethics in Public Policy and Corporate Governance, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK. Email: [email protected]

KERRY A. GALVIN Junior Research Fellow, Department of Anatomy and Structural Biology, University of Otago, PO Box 913, Dunedin, New Zealand.

GRANT GILLETT Neurosurgeon and Professor of Medical Ethics, Dunedin Hospital and Otago Bioethics Centre, University of Otago Medical School, Dunedin PO Box 913, New Zealand. Email: [email protected]

SIMONA GIORDANO Lecturer, The Centre for Social Ethics and Policy, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Email: [email protected]

ROBERT E. GOODIN Research School of Social Sciences, Building 09, Australian National University, Canberra ACT 0200, Australia. Email: [email protected]

HANNAH GRANKVIST Tema Health and Society, The Department of Health and Society – IHS, Linköping University, SE-581 83 Linköping, Sweden. Email: hannah. [email protected]

WAYNE HALL Director, Office of Public Policy and Ethics, Institute for Molecular Bioscience, and School of Population Health, University of Queensland, St Lucia QLD 4072, Australia. Email: [email protected]

JOHN HARRIS Sir David Alliance Professor of Bioethics, The Centre for Social Ethics and Policy, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Email: [email protected]

ANDREAS HASMAN Research Associate, PPIP Profect Manager for Technology Appraisals, National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Email: [email protected]

MATTI HÄYRY Professor of Bioethics and Philosophy of Law, Centre for Social Ethics and Policy, The University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Email: [email protected]

ADAM HEDGECOE Senior Lecturer, Department of Sociology, School of Social Sciences, University of Sussex, Falmer, Brighton BN1 9QN, UK. Email: [email protected]

ROGER HIGGS Professor of General Practice and Primary Care, Population Sciences & Health Care Research, Guy’s, King’s & St Thomas’ School of Medicine, 5 Lambeth Walk, London SE11 6SP, UK. Email: [email protected]

SØREN HOLM rofessorial Fellow in Bioethics, Cardiff Law School, Cardiff University, Law Building, Museum Avenue, Cardiff CF10 3AX, UK. Email: [email protected]

JAMES HUGHES Public Policy Studies, Trinity College, 300 Summit Street, Hartford, CT 06106, USA. Email: [email protected]

JONATHAN HUGHES Director, Centre for Professional Ethics, School of Law, Keele University, Staffordshire ST5 5BG, UK. Email: [email protected]

JULIAN C. HUGHES Honorary Clinical Senior Lecturer, Psychiatry of Old Age Service, North Tyneside General Hospital, Rake Lane, North Shields NE29 8NH, UK. Email: [email protected] or [email protected]

RICHARD HUXTABLE Senior Lecturer in Medical Law and Ethics/Deputy Director, Centre for Ethics in Medicine, University of Bristol, 73 St Michael’s Hill, Bristol BS2 8BH, UK. Email: [email protected]

JENNIFER JACKSON Park House, Leathley, Nr Otley, North Yorkshire LS21 2JU, UK. Email: [email protected]

JAY A. JACOBSON Professor of Internal Medicine, Chief of the Division of Medical Ethics, LDS Hospital, 8th Ave and C Street, Salt Lake City, UT 84143, USA. Email: [email protected]

BRUCE JENNINGS Director, Center for Humans and Nature, 109 West 77th Street, Suite 2, New York, NY 10024, USA. Email: [email protected]

STEPHEN D. JOHN Lecturer, Department of History and Philosophy of Science, University of Cambridge, Free School Lane, Cambridge, CB2 3RH, UK. Email: [email protected]

VANESSA JOHNSTON School of Population Health, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria 3010, Australia. Email: [email protected]

MONIQUE F. JONAS Centre for Professional Ethics, School of Law, Keele University, Staffs ST5 5BG, UK. Email: [email protected]

D. GARETH JONES Professor and Head of Department of Anatomy and Structural Biology, University of Otago, PO Box 913, Dunedin, New Zealand. Email: [email protected]

ALBERT R. JONSEN 1333 Jones St., Apt. 502, San Francisco, CA 94109, USA. Email: [email protected]

ERIC T. JUENGST Director, Center for Genetic Research Ethics and Law, Department of Bioethics, School of Medicine, Tower Annex 211, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4976, USA. Email: [email protected]

NIKLAS JUTH Lecturer, Department of Philosophy, Göteborg University, Box 200, SE-40530 Göteborg, Sweden. Email: [email protected]

JACOB E. KURLANDER Medical Student, School of Medicine, University of Michigan, 1500 E. Medical Center Drive Ann Arbor, MI 48109, USA. Email: [email protected]

DAVID LAMB 294 Leigh Road, Chandlers Ford, SO5 3AU, UK. Email: [email protected]

LAURENS LANDEWEERD PhD Student, Department of Health Ethics and Philosophy, Faculty of Health and Science, University of Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands. Email: [email protected]

REIDAR K. LIE Senior Investigator, Department of Clinical Bioethics, National Institutes of Health, Building 10, Room 1C118, Bethesda, MD 20892, USA. Email: [email protected]

HILDE LINDEMANN Associate Professor, Philosophy Department, Michigan State University, 503 South Kedzie Hall, East Lansing, MI 48824, USA. Email: [email protected]

PEKKA LOUHIALA Director of Research, Department of Public Health, Faculty of Medicine, University of Helsinki, PO Box 41 (Mannerheimintie 172), FIN-00014, Finland. Email: [email protected]

NEIL C. MANSON Lecturer, Institute for Philosophy & Public Policy (IPPP), Furness College, Lancaster University, Lancaster LA1 4YG, UK. Email: [email protected]

SARAH MARCHAND Independent Scholar. Email: [email protected]

MATT MATRAVERS Head, Department of Politics, University of York, Room: D/D205, York YO10 5DD, UK. Email: [email protected]

JOHN MCKIE Research Fellow, Centre for Health Economics, Faculty of Business and Economics, Monash University, Victoria 3800, Australia. Email: [email protected]

SHEILA A.M. MCLEAN Director, Institute of Law and Ethics in Medicine, The School of Law, Stair Building, 5–8 The Square, University of Glasgow, Glasgow G12 8QQ, UK. Email: [email protected]

JOHN R. MCMILLAN Senior Lecturer, Philosophy Department, The University of Hull, Room: L173 (Larkin Building - West), Hull HU6 7RX, UK. Email: [email protected]

DAVID A. MCNAUGHTON Department of Philosophy, Florida State University, Tallahassee, FL 32306-1500, USA. Email: [email protected]

PAUL B. MILLER Department of Philosophy, University of Toronto, 215 Huron Street, 9th Floor Toronto, Ontario M5S 1A2, Canada. Email: [email protected]

CHRISTIAN MUNTHE Head of Department of Philosophy, Göteborg University, Box 200, SE-40530 Göteborg, Sweden. Email: [email protected]

THOMAS H. MURRAY President, The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10524-5555, USA. Email: [email protected]

AINSLEY J. NEWSON Lecturer in Biomedical Ethics, Centre for Ethics in Medicine, University of Bristol, 3rd Floor, Hampton House, Cotham Hill, Bristol BS6 6AU, UK. Email: [email protected]

JING-BAO NIE PhD Lecturer, Otago Bioethics Centre, University of Otago Medical School, PO Box 913, Dunedin, New Zealand. Email: [email protected]

LISBETH NIELSEN EU ENHANCE Project Manager, Centre for Ethics in Medicine, University of Bristol, Hampton House, Cotham Hill, Bristol BS6 6AU, UK. Email: [email protected]

LENNART Y. NORDENFELT Professor, Department of Health and Society, Linköping University, 58183 Linköping, Sweden. Email: [email protected]

JUSTIN OAKLEY Director, Centre for Human Bioethics, School of Philosophy and Bioethics, Monash University, Victoria 3800, Australia. Email: [email protected]

ONORA O’NEILL Principal, Newnham College, Sidgwick Avenue, Cambridge, CB3 9DF, UK. Email: [email protected]

MICHAEL PARKER Professor of Bioethics and Director, The Ethox Centre, Department of Public Health and Primary Health Care, University of Oxford, Gibson Building/Block 21, Radcliffe Infirmary, Woodstock Road, Oxford OX3 6HE, UK. Email: [email protected]

ROBERT A. PEARLMAN Chief, Ethics Evaluation Service, Veterans Administration Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA. Email: [email protected]

GUIDO PENNINGS Department of Philosophy and Moral Science, Ghent University, Blandijnberg 2, B-9000 Gent, Belgium. Email: [email protected]

HILARY PICKLES Director of Public Health and Medical Director, Hillingdon Primary Care Trust, Kirk House, 97-109 High Street, Yiewsley, West Drayton, Middlesex UB7 7HJ, UK. Email: [email protected]

THOMAS W. POGGE Professorial Research Fellow, Centre for Applied Philosophy and Public Ethics, The Australian National University, LPO Box 8260, Canberra, ACT 2601, Australia. Email: [email protected]

DAVID P.T. PRICE Professor of Medical Law, De Montfort Univesity, The Gateway, Leicester, LE1 9BH, UK. Email: [email protected]

J. PIERS RAWLING Department of Philosophy, Florida State University, Tallahassee, FL 32306-1500, USA. Email: [email protected]

JEFF RICHARDSON Professor and Foundation Director, Centre for Health Economics, Faculty of Business and Economics, Monash University, Victoria 3800, Australia. Email: [email protected]

WENDY ROGERS Associate Professor Medical Ethics & Health Law, Department of Medical Education, Flinders University, GPO Box 2100, Adelaide 5001, South Australia. Email: [email protected]

FRED ROSNER Attending Physician, Mount Sinai Services at Elmhurst Hospital Center, Elmhurst, New York and Professor of Medicine, Mount Sinai School of Medicine, New York; 750 Elvira Avenue, Far Rockaway, NY 11691, USA. Email: [email protected]

J. P. RUDDOCK Crisis Resolution Service Manager, Central and North West London Mental Health NHS Trust, 7A Woodfield Road, London, W9 2NW, UK.

ABDULAZIZ SACHEDINA Frances Myers Ball Professor of Religious Studies, Department of Religious Studies, University of Virginia, PO Box 400126, Charlottesville, VA 22904-4126, USA. Email: [email protected]

JULIAN SAVULESCU Director, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes Street, Oxford OX1 1PT, UK. Email: [email protected]

DORIS SCHROEDER Acting Head of Centre, Centre for Professional Ethics, University of Central Lancashire, Preston PR1 2HE, UK. Email: [email protected]

UDO SCHUKLENK Head of Centre for Ethics in Public Policy and Corporate Governance, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK. Email: [email protected]

ROSAMUND SCOTT Reader in Law, Centre of Medical Law and Ethics, King’s College London, The Strand, London, WC2R 2LS, UK. Email: [email protected]

MICHAEL J. SELGELID Centre for Applied Philosophy and Public Ethics (CAPPE), and Menzies Centre for Health Policy, LPO Box 8260, The Australian National University, Canberra ACT 2601, Australia. Email: [email protected]

TOM SHAKESPEARE Research Fellow, Policy, Ethics and Life Sciences Research Centre (PEALS), University of Newcastle upon Tyne, Bioscience Centre, Times Square, Newcastle NE1 4EP, UK. Email: [email protected]

MARK SHEEHAN Research Fellow, Program on Ethics and the New Biosciences, Suite 7, Littlegate House, 16/17 St. Ebbes Street, Oxford OX1 1PT, UK. Email: [email protected]

SUSAN SHERWIN University Research Professor, Department of Philosophy, Dalhousie University, Halifax, NS B3H 4P9, Canada. Email: [email protected]

ANNE SLOWTHER Medical Education, Warwick Medical School, Medical Teaching Centre, Gibett Hill Campus, Room 103B, Coventry CV4 7AL, UK. Email: [email protected]

CHARLES B. SMITH 159 W Broadway #411, Salt Lake City, Utah 84101-1926, USA.

RICHARD SMITH Co-founder, Committee on Publication Ethics, 35 Orlando Road, London SW4 0LD, UK. Email: [email protected]

ANN SOMMERVILLE Head of Medical Ethics Department, British Medical Association, BMA House, Tavistock Square, London WC1H 9JP, UK. Email: [email protected]

TOM SORELL John Ferguson Professor of Global Ethics, Director of the Centre for the Study of Global Ethics, Department of Philosophy, School of Social Sciences, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Email: [email protected]

NATALIE STOLJAR Department of Philosophy, Leacock Building, McGill University, 855 Sherbrooke Street West, Montreal, Quebec H3A 2T7, Canada. Email: [email protected]

JEREMY SUGARMAN Phoebe R. Berman Bioethics Institute, Johns Hopkins University, Hampton House 351, 624 N. Broadway, Baltimore, MD 21205, USA. Email: [email protected]

TUIJA TAKALA Lecturer in Bioethics and Moral Philosophy, School of Law, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK; and Department of Social and Moral Philosophy, University of Helsinki, Finland. Email: [email protected],

TESSA TAN TORRES Coordinator, Global Programme on Evidence for Health Policy, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. Email: [email protected]

HOLLY TAYLOR Health Policy and Management, Faculty Research, Johns Hopkins Bloomberg School of Public Health, Hampton House 353, 624 N. Broadway, Room 493 Baltimore, MD 21205, USA. Email: [email protected]

RUUD H.J. TER MEULEN Chair/Director, Centre for Ethics in Medicine, University of Bristol, Hampton House, Cotham Hill, Bristol BS6 6AU, UK. Email: [email protected]

COLIN TYLER Senior Lecturer in Political Theory, Department of Politics and International Studies, University of Hull, Cottingham Road, Hull HU6 7RX, UK. Email: [email protected]

SUZANNE UNIACKE Reader in Applied Ethics, Philosophy, Room L171, Larken Building – West, University of Hull, Hull HU6 7RX, UK. Email: [email protected]

THEO VAN WILLIGENBURG Kant Academy, Oudegracht 291, 3511 PA Utrecht, The Netherlands. Email: [email protected]

ROBERT M. VEATCH Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057, USA. Email: [email protected]

MARCEL VERWEIJ Senior Researcher and Lecturer, Ethics Institute, Utrecht University, Postbus 80.103, 3508 TC Utrecht, The Netherlands. Email: [email protected]

ADRIAN WALSH Acting Head of School and Senior Lecturer, School of Social Science, The University of New England, Armidale, NSW 2351, Australia. Email: [email protected]

CHARLES WEIJER Canada Research Chair (Tier I), Associate Professor of Philosophy and Medicine, Department of Philosophy, Talbot College, University of Western Ontario, London, Ontario N6A 3K7, Canada. Email: [email protected]

DAVID WENDLER Head of the Unit on Vulnerable Populations, Department of Clinical Bioethics, National Institutes of Health, 10 Center Drive Building 10, Room 1C118, Bethesda MD 20892-1156, USA. Email: [email protected]

ALAN P. WERTHEIMER Senior Research Fellow, Clinical Bioethics Department, National Institutes of Health (NIH), Building 10 – Magnuson CC, Room 1C118, 10 Center Drive, Bethesda, MD 20892-1156, USA. Email: [email protected]

GUY A.M. WIDDERSHOVEN Professor, Department of Health Ethics and Philosophy, PO Box 616, Faculty of Health Sciences, Universiteit Maastricht, 6200 MD Maastricht, The Netherlands. Email: [email protected]

HEATHER WIDDOWS Senior Lecturer in Global Ethics, Centre for the Study of Global Ethics, University of Birmingham, Edgbaston Park Road, Edgbaston, Birmingham B15 2TT, UK. Email: [email protected]

DANIEL WIKLER Mary B. Saltonstall Professor of Ethics and Population Health, Department of Population & International Health, Harvard School of Public Health (Bldg 1, Room 1210), 665 Huntington Avenue, Boston, MA 02115, USA. Email: [email protected]

STEPHEN WILKINSON Professor of Bioethics, Centre for Professional Ethics, School of Law, Keele University, Staffordshire ST5 5BG, UK. Email: [email protected]

TIMOTHY M. WILKINSON Senior Lecturer, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand. Email: [email protected]

JAMES G.S. WILSON Centre for Professional Ethics, School of Law, Keele University, Keele, Staffs ST5 5BG, UK. Email: [email protected]

SIMON WOODS Director of Learning, Policy Ethics and Life Sciences Research Institute, University of Newcastle, Bioscience Centre, Times Square, Newcastle upon Tyne, NE1 4EP, UK. Email: [email protected]

Foreword: Raanan E. Gillon

It is such a