Ethics and Medicine最新文献

Recent studies have revealed much higher risks of cerebral palsy and malformations in babies conceived by in vitro fertilization (IVF) than in babies conceived naturally. Here we question whether parents can legitimately accept this risk on behalf of offspring. We argue that parents can expose their baby to a risk only to preserve it from a worse possibility, and this is not the case of IVF, which is not a therapeutic tool for children because when the IVF decision is taken, the child has not yet been conceived. It is concluded that procreative techniques require considerably more research before being made available to couples.

Self-demand amputees are persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves. They want to rid themselves of a limb that they believe does not belong to their body-identity. The obsessive desire to have appendages surgically removed to fit an alternative body-image is medically and ethically controversial. My purpose in this paper is to provide a number of normative and professional ethical perspectives on whether or not it is possible to justify surgery for self-demand amputees. In doing so I proceed dialogically, moving between empirical context and normative theory, revealing the taken for granted normative assumptions (what I call the natural attitude--a technical term borrowed from phenomenology) that provide ethical limits to justifying the treatment of self-demand amputees. While I critically examine both Kantian responses against as well as Utilitarian responses for amputation on demand, I conclude that neither normative tradition can fully incorporate an understanding of what it is like to be a self-demand amputee. Since neither theory can justify the apparent non-rational desire of amputation on demand, ethical justification, I argue, falls short of the recognition that there may be a problem. To end, I introduce a meta-ethical idea, "the struggle for recognition," opening up the theoretical possibility of a hermeneutics of recognition before ethical justification that may be more sensitive to the problem of radical embodied difference exemplified by self-demand amputees.

It is common knowledge that the supply of cadaveric organs does not meet demand. This shortage is often used as ethical argument against transplantation in Non-Resident Aliens; however, this fact in isolation does not present a comprehensive picture of organ allocation in USA. Even though approximately 153 cadaveric livers, kidneys, and hearts are transplanted into Non-Resident Aliens each year, roughly another 85 livers, kidneys and hearts are recovered as usable for transplantation but are not transplanted due to inability to find a recipient. These organs are also unable to be exported due to logistics or lack of patient matching. Because usable, recovered allografts are discarded on a yearly basis, there is no justification to use "allograft scarcity" as argument against transplantation in Non-Resident Aliens. Further, consistent with other countries, a system of two waiting lists which allocates organs to US Residents with the first right of refusal (with Non-Resident Aliens having to access organs refused by or not matched to US Residents) is ethically appropriate. Justification for this two-list system lies in deconstructing "who" is the transplant community, and who are "guests" of the transplant community.

The development of genetic tests marketed and sold direct-to-consumers (DTC) via the internet raises moral concerns and debate about their appropriateness and ethical and clinical significance. These tests are offered for a wide range of diseases and conditions, and the mutations have variable penetrance and associated risk. A number of these tests lack data on their accuracy and reliability, making interpretation of results difficult. DTC genetic testing is undertaken outside the context of the physician-patient relationship and may lack appropriate individual and family genetic counseling, leaving the consumer vulnerable to potential harms, such as misinterpretation of results, including false positive or false reassurance, with limited or no benefits. Beauchamp and Childress's four principles of biomedical ethics provide a framework for analyzing the ethical issues raised by DTC genetic testing. We argue that the potential harms outweigh the potential benefits of such tests, that respect for autonomy should be limited in light of potential harm from DTC testing, and that the availability of genetic testing over the internet may be considered unfair and unjust and affect resource allocation by placing an unfair burden on primary care physicians. In light of the moral issues posed by these tests, practical responses are suggested in the areas of consumer education, medical education, and interaction with commercial companies.

Amidst controversy surrounding research on human embryos, biotechnology has conceived a substitute in the artificial human embryo. We examine the claim that novel embryos constructed artificially should be exempt from ethical restraints appropriate for research on embryos that come into being through natural processes. Morally relevant differences in intrinsic value depend on the sense in which the entity may be artificial, whether in regard to constituent matter, genetic or cellular form, generative means, or intended purpose. Considering each of these Aristotelian categories from a physicalist viewpoint, technology can achieve only limited degrees of artificiality because redesigned embryos still retain most of their natural features and relationships. From an essentialist viewpoint, the very limits of technology preclude the capability of manipulating the fundamental nature or essence of the individual who, even at the embryonic stage of life, cannot be made to be artificial through and through. A human may possess artificially contributed attributes but cannot be an artificial being. Classification of novel human organisms as artificial, therefore, is insufficient grounds by which to relinquish the principle that human moral status should be recognized for all living beings of human origin. In uncertain cases, at least the possibility of special human moral status should be considered present in organisms that are derived asexually, are developmentally defective, or are otherwise technologically altered.

The death of Terri Schiavo by starvation and its sanction by some United States Courts indicates the alarming revival of the eugenics and euthanasia movement. From the legal sanction of physician-assisted suicide, the euthanasia movement now tries to advance the legal protection for "mercy killing." Terri was diagnosed with persistent vegetative state, a term that is outdated, vague and imprecise and that likens a human being to a vegetable. Medical literature indicates that patient with so-called "persistent vegetative state" can recover, and that they do experience pain. The euthanasia movement, linked to eugenics in its origin and present day influence in bioethics espouses the Nazi notion of "lives not worth living," unlimited patient autonomy, and philosophical utilitarianism. John Paul II countered the eugenic philosophy with the classical Western concept of man as the image and likeness of God, responsible for the care of himself and society as a whole. He taught in writing and by example that food and water are basic human care that every person should receive. In the last days of his life he showed a judicious use of proportionate or ordinary means to maintain life. He chose to forego disproportionate medical treatment when there was no reasonable hope of recovery. At that point he continued to receive ordinary medical care, together with basic human and spiritual care.