Relativist ethics, scientific objectivity, and concern for human rights

This paper comments on the conflict between ethical relativism and anthropologists’ concerns with rights, and tries to show that neither scientific objectivity nor respect for cultural diversity require denying an extracultural stance for ethical judgments. An earlier version of this paper was presented at a symposium entitled “Ethics in Science: Special Problems in Anthropology and Archaeology” held at the 1998 Annual Meeting of the American Association for the Advancement of Science (AAAS), Philadelphia, PA, 15 February, 1998.     

Disconnection, Depression, and Spirituality: A Study of the Role of Spirituality and Meaning in the Lives of Individuals with Severe Depression

This qualitative study explores the role of spirituality and meaning among 15 participants suffering from severe depression. During the time of this study, all the participants were in treatment at Loma Linda University Behavioral Medicine Center. The emerging themes are: (1) depression creates a sense of spiritual disconnection. Participants indicated feeling disconnected from God, the community, and oneself; (2) spirituality plays an important role in coping with the pain of depression; (3) there exists a deep yearning for a sense of meaning and a struggle to make sense of one’s pain; and (4) coming to terms with one’s circumstances and one’s depression at some level assists in the healing process.     

The ethical assessment of innovative therapies: Liver transplantation using living donors

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide. Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines for the procedure before it was introduced in the United States. We used a process of “research ethics consultation” that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery.     

Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

肾源交换计划

肾源交换计划的目的是尽可能减少活体肾移植中配型不成功造成的肾源损失,缓解肾脏供求矛盾,使更多的患者得到合适的肾脏。该计划已在许多国家实施且颇具成效。本文主要介绍肾源交换计划的概念、分类和他国的实施经验,分析可能涉及的伦理问题,总结他国取得的成效,并就肾源交换计划在我国实施的可行性进行探讨。     

Introducing ethics across the curriculum at South Dakota school of mines and technology

This paper describes how the Electrical and Computer Engineering Department at South Dakota School of Mines and Technology has chosen to integrate ethics into their curriculum. All university freshmen engineering students are introduced to ethics through the presentation of ethical dilemmas. During this exercise, students are forced to argue both sides (‘for’ and ‘against’) of a hypothetical ethical engineering dilemma. It provides a setting for great discussion with the desired outcome that they learn to carefully analyze a situation before they draw conclusions. In the sophomore year, students are introduced to methods to use the fundamental principles, the fundamental canons, and the suggested guidelines for use with the fundamental canons of ethics when analyzing appropriate action to be taken when confronted with ethical dilemmas. We currently use the ‘sophomore’ method for seniors because the sequencing is just beginning. Next year the seniors will do more indepth analysis of ethical case studies. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.     

Ethical and legal aspects in teaching students of medicine

Due to the rapid advances in medical technology, medical students are now being faced with increasingly complex and unparalleled ethical and practical dilemmas during their training. The new and future challenges of high-tech medicine demand improvements in current medical education, not only by meeting the needs of students through humanized training programs, but also by involving them in finding solutions to the ethical and legal quandaries they encounter. Today’s students of medical universities must acquire knowledge and understanding of the ethical and legal issues relevant to the practice of medicine, and we have to do everything possible to introduce these students to the current discussions on more or less controversial ethical and legal topics. Although final answers may not be found, the very discussion, argumentation, and awakening of students’ interest should become an essential part of the core curriculum of every doctor. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004. The author is a student and member of the Senate Committee on Teaching.     

Ethical Considerations for the Treatment of Youth in Foster Care

Mental health clinicians treating youth in foster care face several ethical challenges, such as competence for treating youth in foster care, understanding who can provide informed consent, and confidentiality. However, few articles have addressed these ethical concerns or provided recommendations for clinicians on how to navigate these issues. This article presents a brief summary of the foster care system, an overview of the major ethical challenges clinicians may encounter when treating youth in foster care, areas of the American Psychological Association’s Ethics Code, Code of Ethics of the National Association of Social Workers, and American Counseling Association Code of Ethics most germane to the treatment of youth in foster care, and general recommendations for clinicians treating this population.     

Croatia founded a national body for ethics in science

The Committee for Ethics in Science and Higher Education (CESHE) was created in Croatia as a national body appointed by the Parliament. Thus Croatia became one of a handful of countries with national means of responding to allegations of scientific misconduct. The Committee’s duties, with the help of the Ethics Code, include promotion of ethical norms and values in science and higher education. The CESHE will work on cases of possible research misconduct and alleged disregard for the ethical norms associated with research.     

Common morality, coherence, and the principles of biomedical ethics

The fifth edition of Beauchamp and Childress's Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth edition's discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for improving this leading text.     

亲属肾移植的伦理学探讨

活体亲属肾移植是当前解决器官匮乏最重要的途径,近年来我国亲属肾移植例数也不断增多。但是亲属肾移植因其具有一定的特殊性,相比尸体供肾移植更为敏感,也更易于引发伦理问题。简要介绍国内外亲属肾移植的研究进展,重点对亲属肾移植的生命伦理学问题加以探讨。     

History of organ donation by patients with cardiac death

When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice has been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source.     

关于阴茎移植的伦理问题

随着医学科学的发展,器官移植日趋成熟,不仅使患者延长了生命,更大大提高了生活质量。阴茎移植是器官移植和免疫学发展的结晶,是异体器官移植领域内新的突破,为阴茎缺失的患者带来了新生,对患者心理、家庭和社会有着重大影响。但目前异体阴茎移植刚刚起步,技术尚不成熟,且阴茎是一特殊器官,涉及到的伦理道德问题很多,我们试图从受者、供者、医生和法律等方面讨论阴茎移植所面临的伦理道德问题,希望阴茎移植能真正造福于人类。     

2004–2009 : révision de la loi de bioéthique en France,quels enjeux,quels débats ? Assistance médicale à la procréation,gestation pour autrui,transplantation

The bioethics law, adopted for the first time in 1994 and revised in 2004, is under revision again. This process has raised numerous debates at various institutional, professional and social levels. The government also organised a unique type of citizens’ consultation: the General Estates in Bioethics (GEB). Several panels of citizens had the opportunity to express their informed opinion on a selected set of topics concerning the law revision, after having received a special training by an expert committee. We have analysed the contributions of six public bodies – the Parliament Office for Scientific and Technological Choices Evaluation (OPECST), the National Consultative Ethics Committee, (CCNE), the State Council, (CE), the Biomedical Agency, (ABM), the Senate and the Parliamentary Information Mission for this bioethics law revision – as well as the final GEB's report. In this article, we present and compare their proposals on three themes: Medically assisted procreation (MAP), surrogacy and transplantation. Whereas a consensus emerged from the debates on certain issues – apart from the Senate, all institutions seem to be in favour of maintaining the current banning of surrogacy – other points are still under debate – how to open the access to MAP technologies, under what conditions should we grant access to selected data concerning gamete donors, how is death defined in the difficult conditions of a potential non heart beating donor, should the presumed consent regime for post mortem donation be revised, and if so how, – The parliament should discuss the law during 2010's first semester, and will have the difficult responsibility to take measures on issues raising medical, scientific, social, philosophical and moral questions.     

Ethical challenges with the left ventricular assist device as a destination therapy

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers.     

Institutional culture and individual behavior: Creating an ethical environment

Much of the work in professional ethics sees ethical problems as resulting from ethical ignorance, ethical failure or evil intent. While this approach gets at real and valid concerns, it does not capture the whole story because it does not take into account the underlying professional or institutional culture in which moral decision making is imbedded. My argument in this paper is that this culture plays a powerful and sometimes determinant role in establishing the nature of the ethical debate; i.e., it helps to define what are viable action options, what is the organization’s genuine mission, and what behaviors will be rewarded or criticized. Given these conclusions, I also argue that consulting ethicists need more than an understanding of ethics theory, concepts and principles; they also need a sufficiently rich understanding of organizational culture and a willingness and an ability to critique that culture. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

活体肝移植伦理相关问题的质性研究

活体肝移植术虽部分解决了供肝短缺问题,但需从活的供体身上切取部分肝脏,使其承担手术创伤甚至死亡的风险,故存在诸多伦理问题。本文应用质性研究,对7名与活体肝移植相关的不同领域专家及6名手术相关者进行访谈,采用 Nvivo9．0软件辅助对访谈资料进行了分析。探讨活体肝移植的伦理审查、供体选择及心理评估的相关伦理问题。结果显示,尽管活体肝移植手术仍在全国多家医院进行,目前政府对活体肝移植伦理审查和监管更加严格,伦理审查缺少对供体、受体的心理综合评估。因此,建议建立健全并推广死亡器官捐赠注册系统以增加肝源,减少活体肝移植对供体带来的健康风险,并开发适用的心理综合评估工具,评估结果应列入伦理审查范围。     

The ethics activities of the World Medical Association

Since its formation in 1947, the World Medical Association (WMA) has been a leading voice in international medical ethics. The WMA’s principal ethics activity over the years has been policy development on a wide variety of issues in medical research, medical practice and health care delivery. With the establishment of a dedicated Ethics Unit in 2003, the WMA’s ethics activities have intensified in the areas of liaison, outreach and product development. Initial priorities for the Ethics Unit have been the review of paragraph 30 of the Declaration of Helsinki, the expansion of the Ethics Unit section of the WMA website and the development of an ethics manual for medical students everywhere. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004.     

老龄活体供肾移植的临床应用

为缓解供体器官的严重短缺,老龄活体供肾移植逐渐成为一种可以接受的对策。老龄活体供肾移植有其特殊性并且更易于引发伦理争论。本文简要介绍此问题的研究现状,并就若干社会伦理学问题展开讨论。     

Some aspects of medical ethics from the perspective of bioengineering

The problem of ethics in medical care as seen from the bioengineering results from the almost incredible technological achievements based on scientific research: On the one hand there is inadequate handling of technology and fear on the part of the patient; on the other hand there is admiration on the part of the physicians and the nursing staff. This article will survey the points of criticism concerning ethical behavior and will present and evaluate general problems of mechanization in medical care. General phenomena of human interaction, and especially problems related to medical care, will be discussed. It will be necessary to develop clinical medical technology, aiming primarily at ‘realizing the patient's concern’. After analyzing these concerns, it is necessary for the clinical medical engineer to develop an ‘invisible’ technology. Criteria for such an ‘invisible’ technology (function, design, automatic control, methods of implantation, whether chronic application is necessary) are being demonstrated by particular devices (artifical heart, functional electro-stimulation, diaphragmatic pace-maker).