Ethical dilemmas in testing for late onset conditions: reactions to testing and perceived impact on other family members

This paper examines some of the ethical dilemmas that arise when testing for the late onset, untreatable condition of Huntington disease (HD) specifically now that technology allows us to test younger generations of the family for the mutant gene. Drawing on interview data from families with Huntington disease, the reactions to testing and perceived impact on other family members are considered. These are discussed in the light of the possible lowering of the age of test applicants. This potentially raises problems for a younger generation as they are confronted with reproductive decisions that the older generation did not have to face. It also means that individuals have the prospect of living with knowledge of a future illness for much longer.     

The myth of technology in health care

Technology is believed to have liberated health care from dogmas, myths and speculations of earlier times. However, we are accused of using technology in an excessive, futile and even detrimental way, as if technology is compelling our actions. It appears to be like the monster threatening Dr. Frankenstein or like the socerer’s broom in the hand of the apprentice. That is, the same technology that should liberate us from myths, appears to be mythical. The objective of this article is to investigate the background for the re-entrance of the myth: How we encounter it and how we can explain it. The main point is that a myth of technology is normative: it relates ‘is’ and ‘ought’ and directs our actions. This becomes particularly clear in health care. Hence, if there is a myth of technology, it is an ethical issue, and should be taken seriously.     

Conflict of interest in medicine in Lithuania: legal and ethical aspects

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

Pessimism

The problem of pessimism is the secular analogue to the evidential problem of evil facing traditional theism. The traditional theist must argue two things: that the evidence shows that this is on balance a good world and that it is the best possible world. Though the secular optimist who advocates any form of secular moral theory need not argue that the current and future world will likely be the best possible world, she nonetheless must argue that were there a clean solution to the problem of current and future suffering in which all sentient life could be instantly and painlessly eliminated, we would have reasons not to employ the clean solution because the future promises to bring on balance a good world in which the evil of human and animal suffering is outweighed by whatever is good in the world. Pessimism is the view that the evidence argues against secular optimism. It is argued here that it is anything but clear that secular optimism is warranted when viewed from an impersonal point of view. The problem is then evaluated from the personal point of view in which a form of personal optimism is defended even in the face of impersonal pessimism.     

Caring,Social Policy,and Homelessness

Care theory offers a way to overcome a weaknessof liberalism – its reluctance to intervene inthe private lives of adults. In caring for thehomeless, we must sometimes use a limited formof coercion, but our intervention is alwaysinteractive, and the process of finding asolution is one of negotiation between theneeds expressed by the homeless and the needswe infer for them.     

When religion may be an ethical issue

Though Americans are a religious people, there are times when religion or religious views may confound the ethical process. This article claims that religious values may be expressed as either principles or narratives, then seeks to establish a case for dealing with religious claims as principled narratives. Methods of evaluation are explored and then seven guidelines are offered for dealing with religion in ethics consultations.     

One Frog, Two Frog, Red Frog, Blue Frog: Factors Affecting Children's Syntactic Choices in Production and Comprehension

Two experiments are reported which examine children's ability to use referential context when making syntactic choices in language production and comprehension. In a recent on-line study of auditory comprehension, Trueswell, Sekerina, Hill, and Logrip (1999) examined children's and adults' abilities to resolve temporary syntactic ambiguities involving prepositional phrases (e.g., “Put the frog on the napkin into ¨”). Although adults and older children used the referential context to guide their initial analysis (pursuing a destination interpretation in a one-frog context and a modifier interpretation in a two-frog context), 4 to 5-year olds' initial and ultimate analysis was one of destination, regardless of context. The present studies examined whether these differences were attributable to the comprehension process itself or to other sources, such as possible differences in how children perceive the scene and referential situation. In both experiments, children were given a language generation task designed to elicit and test children's ability to refer to a member of a set through restrictive modification. This task was immediately followed by the “put” comprehension task. The findings showed that, in response to a question about a member of a set (e.g., “Which frog went to Mrs. Squid's house?”), 4- to 5-year-olds frequently produced a definite NP with a restrictive prepositional modifier (e.g., “The one on the napkin”). These same children, however, continued to misanalyze put instructions, showing a strong avoidance of restrictive modification during comprehension. Experiment 2 showed that an increase in the salience of the platforms that distinguished the two referents increased overall performance, but still showed the strong asymmetry between production and comprehension. Eye movements were also recorded in Experiment 2, revealing on-line parsing patterns similar to Trueswell et al.: an initial preference for a destination analysis and a failure to revise early referential commitments. These experiments indicate that child–adult differences in parsing preferences arise, in part, from developmental changes in the comprehension process itself and not from a general insensitivity to referential properties of the scene. The findings are consistent with a probabilistic model for uncovering the structure of the input during comprehension, in which more reliable linguistic and discourse-related cues are learned first, followed by a gradually developing ability to take into account other more uncertain (or more difficult to learn) cues to structure.