Contents

The Authors

Preface

PART I: Foundations

1 Theories of Medical Ethics

- Introduction

- Some historical backgroud

- Codes of conduct

- Utilitarian theories

- Virtue ethics

- A professional ethic

- Respect for persons

- A worthwhile life

- Some principles

- - Non-maleficence/beneficence

- - Autonomy

- - Professional integrity

- - Justice

- Filling out the picture

- An illustration

- Summary and conclusions

2 The Healing Ethos

- Introduction

- The doctor-patient relationship

- Information and consent

- Confidentiality

- Truthfulness

- Collegial relationships

- Conclusion

3 Health Care Ethics in Diverse Cultures

- Cultural tensions in healthcare

- New Zealand biculturalism

- Is there hope for transcultural rapprochement?

- A possible basis for ethics

- History and transcultural ethics

4 The Human Body

- Introduction

- Obtaining bodies for dissection

- - Historical developments in the United Kingdom and New Zealand

- - Current legislation in the United Kingdom and New Zealand

- - Persons and bodies

- - Use of unclaimed bodies

- Cadavers in the dissecting room

- - Perceptions of the cadaver

- - Students'experience of dissection

- Post-mortem examinations

- - Post-mortems and consent

- - Ethical perspectives

- Archival human material

- Use of biopsies from surgical operations

- Can the dead body be abused?

- - The public display of dead bodies

- - Teaching on the newly dead

- - Research on the clinically dead

PART II: Clinical Ethics

5 Genetic Dilemmas

- Introduction

- Clinical illustrations

- Somatic cell gene therapy

- - Responses to somatic cell gene therapy

- Germ line gene therapy

- - Negative and positive eugenics

- Cloning

- - Why clone a humam being?

- - Reasons against reproductive cloning

- - Human therapeutic cloning

- Genetic screening

- - Principles of genetic screening programs

- - Genetic screening for susceptibility to disease

- Patenting of human genes

- Human Genome Project

- Biobanking

- Human genes in other organisms

- General ethical questions

6 Issues before Birth

- Introduction

- Biological definitions

- - Embryo and foetus

- - Fertilisation and pre-embryonic stage

- Personhood of the embryo and foetus

- - Embryos/foetuses are persons

- - Embryos/foetuses are non-persons

- - Embryos/foetuses are potential persons

- Research on embryos

- - Sources of embryos for research

- - General issues and principles

- - Embryo research as related to infertility

- - Embryo research as related to the prevention of hereditary diseases

- - Embryo research directed towards curing human disease

- Foetal research

- Abortion

7 Birth and Beyond

- Birth rights

- Dilemmas after birth

- Parental decisions regarding treatment options

- Child abuse and child protection

- The 'best interests of the child' criterion

- Resouce allocation and at-risk children

- Children as research participants

8 Organ and Tissue Transplantation

- Introduction

- Consent in cadaveric organ donation

- Organs from living donors

- Use of anencephalics in transplantation

- Foetal neural transplantation

- Xenotransplantation

- - Arguments against xenotransplantation

- - Animal welfare

- Tissue transplantion

- - Foetal motherhood

9 The Challenge of AIDS

- Ethical responses to AIDS

- - Informed consent and HIV testing

- - Public health issues

- - HIV, AIDS, and societal injustice

- - AIDS in the Third World

- - HIV tests and conflicts between patients

- - The doctor-patient relationship

- Confidentiality

- A terminal illness

10 Ethical Issues in Psychiatry

- Introduction

- Diagnosis, classification, and stigmatisation

- - When is a syndrome not a syndrome?

- Clinicians, patients , and therapeutic relationships

- Compulsory treatment

- Alcohol and drug addiction

- Psychosurgery and electroconvulsive therapy

- Confidentiality

- Suicide and psychiatric illness

- Conclusion

11 Disability and Ethics

- Introduction

- Infantilisation

- The social amplification of disability

- Eugenics and selective abortion

- Cultural genocide and euthanasia

- Sexuality and sexual choices

- Narratives and silences of disabilities

- The silences imposed by medicine

12 Aging, Dementia, and Mortality

- Introduction

- Neurobiology of aging

- Approaches to aging

- - The blessing of mortality

- - Resources, the elderly, and quality adjusted life years (QALYs)

- - Problems of aging

- - Independence and the impairments of age

- Neurobiology of Alzheimer's disease

- Approaches to Alzheimer's disease

- - The personal experience of dementia

- - Personhood and dementia

- - Appropriate care in Alzheimer's disease

- - Would the demented be better off dead?

- - Genetic testing and counselling

- Brain death

- - Significance of the brain

- - Definitions of death and brain death

- - Whole brain definition of death

- - Higher brain definition of death

13 Ending Human Lives

- Introduction

- The death of a person

- Facing death

- Suicide

- Euthanasia

PART III: Medicine and Society

14 Research Ethics

- Introduction

- Scientific validity

- Risks and benefits

- Information and consent

- Procedures

- - Independence and impartiality

- - Due process

- - Accountability

- International research ethics

- The use of animals in medical research

15 Trying New and Unusual Things

- Introduction

- Medicine and rationality of science

- Limitations of medical scientific discourse

- Values intrinsic to medicine

- Surgical innovation

- Other systems of healing

- A clinical modus operandi

- Contemporary orthodox medical science

- Conclusion

16 Justice and Health Care

- Introduction

- The paradox of health care

- Equity and theories of justice

- Arbitrating between needs

- Maximising the minimum

- A basic minimum?

- State-funded care versus private practice

- Conclusion

17 Law, Ethics, and Medicine

- Introduction

- Ethics and the law

- Professional requirements on doctors and others

- Health care workers and criminal law

- Civil disputes

- Conclusion

Appendix 1 The Hippocratic Oath

Appendix 2 The Geneva Convention Code of Medical Ethics

Appendix 3 Council for International Organizations of Medical Sciences (CIOMS) International Guiding Principles for Biomedical Research Involving Animals, June 1984

Appendix 4 World Medical Association Declaration of Helsinki

References

Index