Protecting reasonable conscientious refusals in health care
AbstractRecently, debate over whether health care providers should have a protected right to conscientiously refuse to offer legal health care services —such as abortion, elective sterilization, aid in dying, or treatments for transgender patients—has grown exponentially. I advance a modified compromise view that bases respect for claims of conscientious refusal to provide specific health care services on a publicly defensible rationale. This v iew requires health care providers who refuse such services to disclose their availability by other providers, as well as to arrange for referrals or facilitate transfers of car...
Source: Theoretical Medicine and Bioethics - November 25, 2019 Category: Medical Ethics Source Type: research
Conscientious objection in health care
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - November 25, 2019 Category: Medical Ethics Source Type: research
Conscience-based refusal of patient care in medicine: a consequentialist analysis
This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aim...
Source: Theoretical Medicine and Bioethics - November 20, 2019 Category: Medical Ethics Source Type: research
Conscience, tolerance, and pluralism in health care
AbstractIncreasingly, physicians are being asked to provide technical services that many (in some cases, most) believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, I endeavor, firstly, to clarify the meaning o...
Source: Theoretical Medicine and Bioethics - November 18, 2019 Category: Medical Ethics Source Type: research
Why psychological accounts of personal identity can accept a brain death criterion and biological definition of death
AbstractPsychological accounts of personal identity claim that the human person is not identical to the human animal. Advocates of such accounts maintain that the definition and criterion of death for a human person should differ from the definition and criterion of death for a human animal. My contention is instead that psychological accounts of personal identity should have human persons dying deaths that are defined biologically, just like the deaths of human animals. Moreover, if brain death is the correct criterion for the death of a human animal, then it is also the correct criterion for the death of a human person. ...
Source: Theoretical Medicine and Bioethics - November 18, 2019 Category: Medical Ethics Source Type: research
When is somebody just some body? Ethics as first philosophy and the brain death debate
AbstractI, along with others, have been critical of the social construction of brain death and the various social factors that led to redefining death from cardiopulmonary failure to irreversible loss of brain functioning, or brain death. Yet this does not mean that brain death is not the best threshold to permit organ harvesting —or, as people today prefer to call it, organ procurement. Here I defend whole-brain death as a morally legitimate line that, once crossed, is grounds for families to give permission for organ donation. I do so in five moves. First, I make the case that whole-brain death is a social constructi...
Source: Theoretical Medicine and Bioethics - November 15, 2019 Category: Medical Ethics Source Type: research
Controversies in defining death: a case for choice
AbstractWhen a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the brain, whether standard criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated....
Source: Theoretical Medicine and Bioethics - November 14, 2019 Category: Medical Ethics Source Type: research
Brain death: new questions and fresh perspectives
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - November 14, 2019 Category: Medical Ethics Source Type: research
Whole-brain death and integration: realigning the ontological concept with clinical diagnostic tests
AbstractFor decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of affairs, epistemological standards, and clinical criteria for...
Source: Theoretical Medicine and Bioethics - November 5, 2019 Category: Medical Ethics Source Type: research
Instrumentalist analyses of the functions of ethics concept-principles: a proposal for synergetic empirical and conceptual enrichment
AbstractBioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics —and the specific role(s) it can or should play—remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three methodological steps according to which the meani ng of ethics concepts can be refi...
Source: Theoretical Medicine and Bioethics - October 4, 2019 Category: Medical Ethics Source Type: research
Correction to: Stephen Scher and Kasia Kozlowska: Rethinking health care ethics
The originally published review of this book did not include the information that an electronic version is available. (Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - October 2, 2019 Category: Medical Ethics Source Type: research
The human organism is not a conductorless orchestra: a defense of brain death as true biological death
AbstractIn this paper, I argue that brain death is death because, despite the appearance of genuine integration, the brain-dead body does not in fact possess the unity that is proper to a human organism. A brain-dead body is not a single entity, but a multitude of organs and tissues functioning in a coordinated manner with the help of artificial life support. In order to support this claim, I first lay out Hoffmann and Rosenkrantz ’s ontological account of the requirements for organismal unity and summarize an earlier paper in which I apply this account to the brain death debate. I then further support this ontological a...
Source: Theoretical Medicine and Bioethics - September 27, 2019 Category: Medical Ethics Source Type: research
When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule?
AbstractThe basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term “death” nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation. I propose to focus on the irreversible loss of the capacity fo...
Source: Theoretical Medicine and Bioethics - September 27, 2019 Category: Medical Ethics Source Type: research
Harm should not be a necessary criterion for mental disorder: some reflections on the DSM-5 definition of mental disorder
AbstractThe general definition of mental disorder stated in the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at all. In this paper, we focus on the harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In t...
Source: Theoretical Medicine and Bioethics - September 17, 2019 Category: Medical Ethics Source Type: research
Jeffrey P. Kahn, Anna C. Mastroianni, and Jeremy Sugarman (eds): Beyond consent: seeking justice in research , 2nd edition
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - August 25, 2019 Category: Medical Ethics Source Type: research
