Physician Robert M. Arnold and professor of psychiatry and sociology Charles W. Lidz assert that informed consent in clinical care is anessential process that promotes good communication and patient autonomy despite the obstacles of implementation. Professor of medical ethics Robert M. Veatch argues that informed consent is a transitional concept that is useful only for moving toward amore radical framework in which physicians and patients are paired on the basis of shared deep social, moral, and institutional values.
John Hardwig, an associate professor of medical ethics, argues that the prevalent ethic of patient autonomy ignores family interests inmedical treatment decisions. He maintains that physicians should recognize these interests as legitimate. Bioethicist Jeffrey Blustein contends that although families can be an important resource in helping patients make better decisions abouttheir care, the ultimate decision-making authority should remain with the patient.
Alan F. Holmer, an attorney and head of the Pharmaceutical Research and Manufacturers of America, argues that advertising of medication empowers consumers by educating them about health conditions and possible treatments. Matthew F. Hollon, a physician, believes that advertising of medication is designed to increase consumer demand, rather than for educational purposes, and has little public health value.
Psychiatrist Christopher James Ryan argues that advance directives that refuse active treatment in situations when a patient’s incompetenceis potentially reversible should be abolished because healthy people are likely to underestimate their desire for treatment should they becomeill. Geriatricians Steven Luttrell and Ann Sommerville assert that respect for the principle of autonomy requires that individuals be permittedto make risky choices about their own lives and that ignoring autonomous choices made by competent adults reinstates the outmoded notion of medicalpaternalism.
Physician Marcia Angell asserts that a physician’s main duties are to respect patient autonomy and to relieve suffering, even if thatsometimes means assisting in a patient’s death. Physician Kathleen M. Foley counters that if physician-assisted suicide becomes legal, it will begin to substitute for interventions thatotherwise might enhance the quality of life for dying patients.
Leslie J. Blackhall, Gelya Frank, and Sheila Murphy, from the University of Southern California, and Vicki Michel from the Loyola Law School, advise clinical and bioethics professionals facing truth-telling dilemmas to make room for the diverse ethical views of the populations they serve. Philosopher Mark Kuczewski and bioethicist Patrick J. McCruden argue that by insisting on informed consent or an appropriate waiver process, the health care system respects cultural differences rather than stereotyping them.
Physician Steven H. Miles maintains that physicians’ duty to follow patients’ wishes ends when the requests are inconsistent with whatmedical care can reasonably be expected to achieve, when they violate community standards of care, and when they consume an unfair share of collectiveresources. Philosopher Felicia Ackerman contends that it is ethically inappropriate for physicians to decide what kind of life is worth prolonging andthat decisions involving personal values should be made by the patient or family.
Physician M. LeRoy Sprang and osteopathic physician Mark G. Neerhof assert that late-term abortion is needlessly risky, inhumane, andethically unacceptable. They state that all abortions of 23 weeks or later should be considered unethical unless the fetus has a lethal condition orthe mother’s life is endangered. While acknowledging that early abortion is safer, simpler, and less controversial, physician David A. Grimes contends that late-termabortion is fundamentally important to women’s health because some medical conditions of both women and fetuses cannot be diagnosed early in pregnancyand because of the prevalence of incest and rape.
In a case involving a pregnant woman’s use of crack cocaine, a majority of the Supreme Court of South Carolina ruled that a statelegislature may impose additional criminal penalties on pregnant drug-using women without violating their constitutional right of privacy. Attorney Lynn M. Paltrow argues that treating drug-using pregnant women as criminals targets poor, African American women while ignoring other drug usage and fails to provide the resources to assist them in recovery.
Ethicist Robert F. Weir and pediatrician Charles Peters assert that adolescents with normal cognitive and developmental skills have thecapacity to make decisions about their own health care. Advance directives, if used appropriately, can give older pediatric patients a voice in theircare. Pediatrician Lainie Friedman Ross counters that parents should be responsible for making their child’s health care decisions. Children needto develop virtues, such as self-control, that will enhance their long-term, not just immediate, autonomy.
The Committee on Bioethics of the American Academy of Pediatrics states that all children deserve medical treatment that is likely toprevent substantial harm, suffering, or death, regardless of the parents’ religious objections to treatment. Professor of philosophy Mark Sheldon assesses the case of Jehovah’s Witness parents who refuse to allow their children to undergo bloodtransfusions and concludes that they cannot be said to be truly harming or neglecting their children. Rather, they are placing their children’sspiritual interests above worldly ones.
Robert P. George, a professor of jurisprudence at Princeton University, argues that harvesting stem cells from discarded embryos is equivalent to killing a human being, and therefore the practice should be banned. David Baltimore, president of the California Institute of Technology and a Nobel Prize winner for his career research, contends that promising stem cell research should not be impeded by a view that considers a tiny mass of cells that has never been in a uterus to be a human being.
Columnist Andrew Sullivan sees no ethical difference between using genetic information to predict future workplace performance and usingother means to do so. Sullivan argues that genetic information is more reliable and less discriminatory than other types of information. Thomas H. Murray, a professor of biomedical ethics, contends that actuarial fairness—the insurance industry’s standard—fails toaccomplish the social goals of health insurance and that genetic tests should not be used to deny people access to health insurance.
Jerod M. Loeb and his colleagues, representing the American Medical Association’s Group on Science and Technology, assert that concern foranimals, admirable in itself, cannot impede the development of methods to improve the welfare of humans. Philosopher Tom Regan argues that conducting research on animals exacts the grave moral price of failing to show proper respect for animals’inherent value, whatever the benefits of the research.
Physician Thomas B. Freeman and his colleagues contend that their study of fetal-tissue transplantation, which used imitation, or sham,surgery in one group of patients, will establish whether this treatment is beneficial or not. Furthermore, this treatment will benefit thousands ofpatients with Parkinson’s disease if proven effective. Philosopher Ruth Macklin concludes that sham surgery is ethically unacceptable, particularly in the case of fetal-tissue transplantation,because it does not minimize harm to subjects, a fundamental principle underlying research ethics.
Insurance and policy analysts William S. Custer, Charles N. Kahn III, and Thomas F. Wildsmith IV assert that the employment-based healthcare system in the United States offers a solid, proven foundation on which to base any reform and that attempts to break the link between employmentand health insurance coverage may greatly increase the number of uninsured Americans. Economist Uwe E. Reinhardt argues that, on balance, the debits of the employer-based health insurance system outweigh the credits and thata parallel system detached from the workplace could eventually absorb the current system.
Philosopher Daniel Callahan maintains that since health care resources are scarce, people who have lived a full natural life span should beoffered care that relieves suffering but not expensive life-prolonging technologies. Sociologist Amitai Etzioni argues that rationing health care for the elderly would encourage conflict between generations and would inviterestrictions on health care for other groups.
Physician Norman G. Levinsky argues that withholding beneficial care from patients for the financial benefit of any party other than the patient is a violation of medical ethics. Philosopher Brendan Minogue asserts that physicians must balance the interests and wishes of the patient with the welfare of the health caresystem in which they practice and must stop viewing the case manager as the unavoidable but unwanted child within the family of medicine.
Philosopher Michael B. Gill and surgeon Robert M. Sade contend that the current ban on paying for kidneys ought to be overturned because there is no significant moral difference between the allowable policy of paying for blood and tissues and paying for kidneys and because the arguments that payment is intrinsically wrong or exploitive are flawed. Historian David J. Rothman asserts that trafficking in organs for transplantation is motivated by greed and subverts the ethical principlesof the medical profession.
Physician Andrew C. Yacht argues that doctors-in-training, like other workers, should have the right to organize and to bargain collectivelyfor better working conditions in hospitals so that they can provide enhanced care for their patients. Physician and medical educator Jordan J. Cohen asserts that doctors-in-training are primarily students, not employees, and that unionactivities would negatively affect the educational experience.
Law and public health professor Lawrence O. Gostin states that the threat of bioterrorism makes it imperative to reframe the balance between individual interests and society’s need to protect itself so that the common good prevails. Law professor George J. Annas contends that taking human rights seriously is our best defense against terrorism and fosters public health on both a federal and global scale.
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