The Many Faces of Physician-Assisted Suicide

Physician-assisted suicide is a complex and controversial issue that touches on standards of medical practice, the balance between individual rights and the rights of the state, and our fears of death and pain. Supporters of assisted suicide propose it as an alternative to a lingering, highly technological death, and define it as the act of a physician who prescribes a lethal dose of a medication for a terminally ill patient, with the knowledge that the patient intends to commit suicide. The recent U.S. Supreme Court ruling upheld prohibitions against assisting in a suicide, but left open the possibility that in certain specific cases assisted suicide might be constitutionally protected. The Supreme Court's refusal to extend constitutional protection to assisted suicide was done in part to insure that public debate and legislative fact-finding would continue. As stated in Justice Rehnquist's majority opinion, ...Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide (Washington v. Glucksberg, 96-110—Opinion, 1997, p. 26). As researchers, policy makers, and health care providers, we have an obligation to insure that political debate and empirical research are continuing and productive, and that this issue becomes more than just an occasion to play out ideological or personal differences.     

Engineering responsibilities in lesser-developed nations: The welfare requirement

Increasing numbers of engineers from developed countries are employed during some part of their careers in lesser-developed nations (LDN’s), or they may design products for use in LDN’s. Yet determining the implications of professional engineering codes for engineers’ conduct in such settings can be difficult. Conditions are often substantially different from those in developed countries, where the codes were formulated. In this paper I explore the implications of what I call the “welfare requirement” in engineering codes for professional engineering conduct in LDN’s. An earlier version of this paper was presented at the Engineering Foundation Conference on “Ethics for Science and Engineering Based International Industries”, Durham, NC, USA, 14–17 September 1997.     

Software informed consent: Docete emptorem, not caveat emptor

Should software be sold “as is”, totally guaranteed, or something else? This paper suggests that “informed consent”, used extensively in medical ethics, is an appropriate way to envision the buyer/developer relationship when software is sold. We review why the technical difficulties preclude delivering perfect software, but allow statistical predictions about reliability. Then we borrow principles refined by medical ethics and apply them to computer professionals.     

Hermeneutics and Experiences of the Body. The Case of Low Back Pain

The purpose of this paper is to elaborate on the notion of clinical medicine as a hermeneutical enterprise and to bridge the gap between the general perspectives of hermeneutics and the particularities of medical practice. The case of a patient with low back pain is analyzed. The discussion centers around the metaphor of the patient as a text and a model of five social discourses about low back pain. The problems addressed are: (1) the nature of a moral experience, (2) the variety of available texts, (3) the difference between the doctor's and patient's narratives, and (4) the patient's and doctor's responsibility regarding the existential, biographical meaning of an illness. Although many problems are left unsolved, it is argued that from a philosophical point of view the notion of medicine as a hermeneutical enterprise opens up the possibility of gaining insight in the foundations of the clinical encounter.     

Casuistry and Principlism: The Convergence of Method in Biomedical Ethics

Casuistry and principlism are two of the leading contenders to be considered the methodology of bioethics. These methods may be incommensurable since the former emphasizes the examination of cases while the latter focuses on moral principles. Conversely, since both analyze cases in terms of mid-level principles, there is hope that these methods may be reconcilable or complementary. I analyze the role of principles in each and thereby show that these theories are virtually identical when interpreted in a certain light. That is, if the gaps in each method are filled by a concept of judgment or Aristotelian practical wisdom, these methods converge.     

The significance of prognosis for a theory of medical practice

A typical problem of modern medicine results from the gap between scientific knowledge and its application in individual cases. Whereas scientific knowledge is generalized and impersonal information, medical practice takes place under conditions which are singular, individual and irreversible. The paper examines whether prognosis is able to bridge this gap or hiatus theoreticus. It is shown that diagnosis of a single case always relies on prognostic considerations. The individual prognosis (as distinguished from the nosologic prognosis of a certain disease) enables doctors to apply scientific knowledge and practice according to the actual situation, the history and personal preferences of the patient. Prognosis – not diagnosis – therefore legitimizes medical interference. A methodology of individual prognosis as the basis for a theory of practice is discussed.     

The Evolutionary Roots of Morality in Theological Perspective

Theological ethics can interpret the relation between evolution and morality in at least three ways. The reductionist approach holds that morality emerges because it is adaptive. The independent approach maintains that morality develops without registering the influence of evolution. Finally, the interdependence position holds that morality reflects the influence of evolution to the extent that the latter shapes human emotional capacities and predispositions, for example, those regarding reciprocity and kin preference. The third approach is more suitable for theological ethics, which attends to ways in which natural desires can be ordered to serve morality, for example, to be habituated to virtue, and to ways in which we must strive to curb or minimize their disruptive effects on human communities.     

Neural fetal tissue transplants: old and new issues

Abstract. Neural fetal tissue transplantation offers promise as a treatment for devasting neurologic conditions such as Parkinson's disease. Two types of issues arise from this procedure: those associated with the use of fetuses, and those associated with the use of neural tissue. The former issues have been examined in many forums; the latter have not. This paper reviews issues and arguments raised by the use of fetal tissue in general, but focuses on the implications of the use of neural tissue for basic concepts of personnood and personal identity.     

Reflections on peer review practices in committees selecting laureates for prestigious awards and prizes: Some relevant and irrelevant criteria

An important function in all scholarly and academic activities is the participation in the peer review system. One aspect of this peer review evaluation is service on committees judging candidates for important awards, prizes and fellowships. Some reflective observations on this process are made in which a number of factors determining the final choice are identified. It is pointed out that the decisions of such committees are based not only on relevant and objective criteria but are also influenced by a number of irrelevant criteria; caution must be exercised to minimize the effect of the latter factors in order to maintain the highest ethical standards in the selection process. The ranking practices of awards committees, national academies and learned societies are briefly reviewed by pointing out some ethical pitfalls, anecdotal incidents, and the ways to avoid the tarnishing of the selection process. Dr. Vijh is a physical chemist whose research interests include interfacial electrochemistry and the chemical physics of solid surface s.