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Bioethics

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An Interdisciplinary Reader

This book discusses some of the most critical ethical issues in mental health care today, including the moral dimensions of addiction, patient autonomy and compulsory treatment, privacy and confidentiality, and the definition of mental illness itself. Although debates over these issues are ongoing, there are few comprehensive resources for addressing such dilemmas in the practice of psychology, psychiatry, social work, and other behavioral and mental health care professions. This book meets that need, providing foundational background for undergraduate, graduate, and professional courses.

Topics include central questions such as evolving views of the morality and pathology of deviant behavior; patient competence and the decision to refuse treatment; recognizing and treating people who have suffered trauma; addiction as illness; the therapist’s responsibility to report dangerousness despite patient confidentiality; and boundaries for the therapist’s interaction with patients outside of therapy, whether in the form of tennis games, gift-giving, or social media contact. For the most part the selections address contemporary issues in contemporary terms, but the book also offers a few historic or classic essays, including Thomas S. Szasz’s controversial 1971 article “The Ethics of Addiction.” Contributors include Laura Weiss Roberts, Frederic G. Reamer, Charles P. O’Brien, and Thomas McLellan.

Beyond the Bad-Apple Approach

Federal regulations that govern research misconduct in biomedicine have not been able to prevent an ongoing series of high-profile cases of fabricating, falsifying, or plagiarizing scientific research. In this book, Barbara Redman looks critically at current research misconduct policy and proposes a new approach that emphasizes institutional context and improved oversight.

Current policy attempts to control risk at the individual level. But Redman argues that a fair and effective policy must reflect the context in which the behavior in question is embedded. As journalists who covered many research misconduct cases observed, the roots of fraud “lie in the barrel, not in the bad apples that occasionally roll into view.” Drawing on literature in related fields—including moral psychology, the policy sciences, the organizational sciences, and law—as well as analyses of misconduct cases, Redman considers research misconduct from various perspectives. She also examines in detail a series of clinical research cases in which repeated misconduct went undetected and finds laxity of oversight, little attention to harm done, and inadequate correction of the scientific record. Study questions enhance the book’s value for graduate and professional courses in research ethics.

Redman argues that the goals of any research misconduct policy should be to protect scientific capital (knowledge, scientists, institutions, norms of science), support fair competition, contain harms to end users and to the public trust, and enable science to meet its societal obligations.

Downloadable instructor resources available for this title: answers to study

Exploring the Controversy

An estimated 100 million nonhuman vertebrates worldwide--including primates, dogs, cats, rabbits, hamsters, birds, rats, and mice--are bred, captured, or otherwise acquired every year for research purposes. Much of this research is seriously detrimental to the welfare of these animals, causing pain, distress, injury, or death. This book explores the ethical controversies that have arisen over animal research, examining closely the complex scientific, philosophical, moral, and legal issues involved.

Defenders of animal research face a twofold challenge: they must make a compelling case for the unique benefits offered by animal research; and they must provide a rationale for why these benefits justify treating animal subjects in ways that would be unacceptable for human subjects. This challenge is at the heart of the book. Some contributors argue that it can be met fairly easily; others argue that it can never be met; still others argue that it can sometimes be met, although not necessarily easily. Their essays consider how moral theory can be brought to bear on the practical ethical questions raised by animal research, examine the new challenges raised by the emerging possibilities of biotechnology, and consider how to achieve a more productive dialogue on this polarizing subject. The book’s careful blending of theoretical and practical considerations and its balanced arguments make it valuable for instructors as well as for scholars and practitioners.

An Introduction with Readings
Edited by Martha J. Farah

Neuroscience increasingly allows us to explain, predict, and even control aspects of human behavior. The ethical issues that arise from these developments extend beyond the boundaries of conventional bioethics into philosophy of mind, psychology, theology, public policy, and the law. This broader set of concerns is the subject matter of neuroethics. In this book, leading neuroscientist Martha Farah introduces the reader to the key issues of neuroethics, placing them in scientific and cultural context and presenting a carefully chosen set of essays, articles, and excerpts from longer works that explore specific problems in neuroethics from the perspectives of a diverse set of authors. Included are writings by such leading scientists, philosophers, and legal scholars as Carl Elliot, Joshua Greene, Steven Hyman, Peter Kramer, and Elizabeth Phelps. Topics include the ethical dilemmas of cognitive enhancement; issues of personality, memory and identity; the ability of brain imaging to both persuade and reveal; the legal implications of neuroscience; and the many ways in which neuroscience challenges our conception of what it means to be a person.

Neuroethics is an essential guide to the most intellectually challenging and socially significant issues at the interface of neuroscience and society. Farah's clear writing and well-chosen readings will be appreciated by scientist and humanist alike, and the inclusion of questions for discussion in each section enhances the book's appeal for classroom use.

Contributors: Zenab Amin, Ofek Bar-Ilan, Richard G. Boire, Philip Campbell, Turhan Canli, Jonathan Cohen, Robert Cook-Degan, Lawrence H. Diller, Carl Elliot, Martha J. Farah, Rod Flower, Kenneth R. Foster, Howard Gardner, Michael Gazzaniga, Jeremy R. Gray, Henry Greely, Joshua Greene, John Harris, Andrea S. Heberlein, Steven E. Hyman, Judy Iles, Eric Kandel, Ronald C. Kessler, Patricia King, Adam J. Kolber, Peter D. Kramer, Daniel D. Langleben, Steven Laureys, Stephen J. Morse, Nancey Murphy, Eric Parens, Sidney Perkowitz, Elizabeth A. Phelps, President's Council on Bioethics, Eric Racine, Barbara Sahakian, Laura A. Thomas, Paul M. Thompson, Stacey A. Tovino, Paul Root Wolpe

Moral Dilemmas of Medicine and War

Is medical ethics in times of armed conflict identical to medical ethics in times of peace, as the World Medical Association declares? In Bioethics and Armed Conflict, the first comprehensive study of medical ethics in conventional, unconventional, and low-intensity war, Michael Gross examines the dilemmas that arise when bioethical principles clash with military necessity—when physicians try to save lives during an endeavor dedicated to taking them—and describes both the conflicts and congruencies of military and medical ethics.

Gross describes how the principles of contemporary just war, unlike those of medical ethics, often go beyond the welfare of the individual to consider the collective interests of combatants and noncombatants and the general interests of the state. Military necessity plays havoc with such patients' rights as the right to life, the right to medical care, informed consent, confidentiality, and the right to die. The principles of triage in battle conditions dictate not need-based treatment but the distribution of resources that will return the greatest number of soldiers to active duty. And unconventional warfare, including current "wars" on terrorism, challenges the traditional concept of medical neutrality as physicians who have sworn to "do no harm" are called upon to lend their expertise to "interrogational" torture or to the development of biological or chemical weapons. Difficult dilemmas inevitably arise during armed conflict, and medicine, Gross concludes, is not above the fray. Medical ethics in time of war cannot be identical to medical ethics in peacetime.

Governments, health professionals, patients, research institutions, and research subjects look to bioethicists for guidance in making important decisions about medical treatment and research. And yet, argues Jonathan Baron in Against Bioethics, applied bioethics lacks the authority of a coherent guiding theory and is based largely on intuitive judgments. Baron proposes an alternative, arguing that bioethics could have a coherent theory based on utilitarianism and decision analysis. Utilitarianism holds that the best option is the one that does the most expected good. Decision analysis provides a way of thinking about the risks and trade-offs of specific options. Like economics, utilitarian decision analysis makes predictions of expected good in complex situations, using data when possible, and focusing human judgment on the issues relevant to consequences. With such a guiding theory, bioethics would never yield decisions that clearly go against the expected good of those involved, as some do now.

Baron discusses issues in bioethics that can be illuminated by such analysis, including "enhancements" to nature in the form of genetics, drugs, and mind control; reproduction; death and end-of-life issues, including advance directives, euthanasia, and organ donation; coercion and consent; conflict of interest and the reform of internal review boards; and drug research. Although Baron opposes current practice in bioethics, he argues that by combining utilitarianism and decision analysis, bioethics can achieve its aims of providing authoritative guidance in resolving thorny medical and ethical issues.

This textbook for instruction in biomedical research ethics can also serve as a valuable reference for professionals in the field of bioethics. The 149 cases included in the book are grouped in nine chapters, each of which covers a key area of debate in the field. Some of the case studies are classics, including the famous cases of the Tuskegee Syphilis Study (in which subjects with syphilis were not given treatment) and the Willowbrook hepatitis studies (in which institutionalized subjects were intentionally exposed to hepatitis). Others focus on such current issues as human embryonic stem cell research, cloning by somatic nuclear transfer, and the design and function of institutional review boards. Each chapter begins with a brief introduction that places the issues raised in context; this is followed by a number of cases (each of which is no more than a few pages). Study questions meant to encourage further discussion follow each case.

After an introductory discussion of the history and tenets of ethics in medical research, the book's chapters cover the topics of oversight and study design; informed consent; the selection of subjects; conflicts of interest; the social effects of research; embryos, fetuses, and children; genetic research; the use of animals; and authorship and publication. Following these chapters are appendixes with the texts of the Nuremburg Code and the World Declaration of Geneva, two key documents in the establishment of bioethical standards for research. Also included are a glossary, a table of cases by general category, and an alphabetical listing of cases.

Edited by Glenn McGee

Modern scientific and medical advances bring new complexity and urgency to ethical issues in health care and biomedical research. This book applies the American philosophical theory of pragmatism to such bioethics. Critics of pragmatism argue that it lacks a universal moral foundation. Yet it is this very lack of a metaphysical dividing line between facts and values that makes pragmatism such a rigorous and appropriate method for solving problems in bioethics. For pragmatism, ethics is a way of satisfying the complex demands of multiple individuals and groups in a contingent and changing world. Pragmatism also demands careful attention to the ways in which scientific advances change our values and ethics.The essays in this book present different approaches to pragmatism and different ways of applying pragmatism to scientific and medical matters. They use pragmatism to guide thinking about such timely topics as stem cell research, human cloning, genetic testing, human enhancement, and care for the poor and aging. This new edition contains three new chapters, on difficulties with applying pragmatism to law and bioethics, on helping people to die, and on embryonic stem cell research.

Medicine and Morality in a Time of Crisis

The war on terrorism and the threat of chemical and biological weapons have brought a new urgency to already complex moral and bioethical questions. In the Wake of Terror presents thought-provoking essays on many of the troubling issues facing American society, written by experts from the fields of medicine, health care policy, law, political science, history, philosophy, and theology.

One of the first potential casualties of catastrophic circumstances is civil liberties. In the past, medical experiments conducted for national security purposes have violated ethical standards, and this book questions whether current policy provides sufficient safeguards against further abuses. It also focuses on public health issues, offering contrasting views on the extent to which civil authorities should be allowed to restrict freedom of movement in the name of national security and debating whether aggressive public health interventions improve public confidence and cooperation or detract from them.

A major area of concern is preparedness for future terrorist attacks. Chapters are devoted to ethical issues involved in the development, distribution, and rationing of vaccines and antidotes; resource allocation and medical triage; the moral duties of emergency health workers and other first responders; and the obligations of private entities such as managed care organizations and pharmaceutical companies. Contributors also address the implications of terrorism for our health insurance system and the role of genetic advances in bioterrorism. Underlying all of these issues, the authors argue, is the need to maintain a spirit of social solidarity, which can in turn only be achieved if preparations are publicly acknowledged and generally regarded as both prudent and fair.

Contributors: George Annas, Ronald Bayer, James Childress, James Colgrove, Evan DeRenzo, Lisa Eckenwiler, Alan R. Fleischman, Lawrence O. Gostin, James G. Hodge, Jr., Kenneth Kipnis, Paul Lombardo, Eric Meslin, Ann Mills, Jonathan D. Moreno, Griffin Trotter, Patricia Werhane, Emily Wood.

The Challenge of Equity

Engendering International Health presents the work of leading researchers on gender equity in international health. Growing economic inequalities reinforce social injustices, stall health gains, and deny good health to many. In particular, deep-seated gender biases in health research and policy institutions combine with a lack of well-articulated and accessible evidence to downgrade the importance of gender perspectives in health. The book?s central premise is that unless public health changes direction, it cannot effectively address the needs of those who are most marginalized, many of whom are women.

The book offers evidence and analysis for both low- and high-income countries, providing a gender and health analysis cross-cut by a concern for other markers of social inequity, such as class and race. It details approaches and agendas that incorporate, but go beyond, commonly acknowledged issues relating to women's health; and it brings gender and equity analysis into the heart of the debates that dominate international health policy.

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