Contemporary Issues in Biomedical Ethics

Not long ago, a colleague chided me for using the term "the biological revolution. " Like many others, I have employed it as an umbrella term to refer to the seemingly vast, rapidly-moving, and fre­ quently bewildering developments of contemporary biomedicine: psy­ chosurgery, genetic counseling and engineering, artificial heart-lung machines, organ transplants-and on and on. The real "biological revo­ lution," he pointed out, began back in the nineteenth century in Europe. For it was then that death rates and infant mortality began to decline, the germ theory of disease was firmly established, Darwin took his famous trip on the Beagle, and Gregor Mendel stumbled on to some fundamental principles of heredity. My friend, I think, was both right and wrong. The biological revolution did have its roots in the nineteenth century; that is when it first began to unfold. Yet, like many intellectual and scientific upheav­ als, its force was not felt for decades. Indeed, it seems fair to say that it was not until after the Second World War that the full force of the earlier discoveries in biology and medicine began to have a major impact, an impact that was all the more heightened by the rapid bi­ omedical developments after the war.

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I. Rights and Moral Decisions.- 1 Legalism and Medical Ethics.- I. General Remarks on Legalism.- II. The Spell of Legalism.- III. The Utility of Legalism.- IV. The Language of Rights.- V. Morality and the Ethics of Rights.- VI. Another Model: Moral Relationships and Duties.- VII. Responsibilities.- VIII. A Comparison of the Two Models.- IX. The Vindication of Rights.- X. Integrity, Autonomy, and Rights.- 2 Comments on "Legalism and Medical Ethics".- 3 The Moral Rights of the Terminally I11.- I. Killing and Letting Die.- II. Patients' Rights Regarding Medical Treatment.- III. Patients' Rights to Information About Their Condition.- IV. Some Legal Implications.- 4 Comments on "The Moral Rights of the Terminally I11".- II. Issues in Genetics.- 5 On Getting "Genetic" Out of "Genetic Disease".- I. Introduction.- II. Etymology of "Genetic Disease": Some Shifts in Meaning.- III. Criteria for Applying "Genetic Disease": Some Valua- tional Dimensions.- IV. Uses of "Genetic Disease": Some Policy Implications.- 6 Protecting the Unconceived.- 7 Comments on "Protecting the Unconceived": Butchers, Bakers, & Candlestick Makers.- 8 Sterilization, Privacy, and the Value of Reproduction.- I. Introduction.- II. The Importance of Procreation.- III. Procreation and the Right to Privacy.- IV. Sterilization and Possible People.- Acknowledgements.- 9 Comments on "Sterilization, Privacy, and the Value of Reproduction".- 10 Reply to Buckner.- III. The Role of the Physician.- 11 Hippocrates Lost, A Professional Ethic Regained: Reflections on the Death of the Hippocratic Tradition.- I. The Hippocratic Tradition and the Obligation of Secrecy.- II. Science and Authority.- III. Responsibility in Medicine.- IV. Conclusion.- 12 Comments on "Hippocrates Lost, A Professional Ethic Regained: Reflections on the Death of the Hippocratic Tradition".- 13 Physicians as Body Mechanics.- I. Why See a Mechanic?.- II. Why Trust a Mechanic?.- 14 Physician as Body Mechanic-Patient as Scrap Metal: What's Wrong with the Analogy.- I..- II..- 15 Internal or External Physician-Patient Relationships, A Response to Clements.- IV. Informed Consent and Paternalism.- 16 The Ethical Content of Legally Informed Consent.- I. Introduction.- II. The Legal Dynamics of Informed Consent.- III. The Elements of Informed Consent.- IV. The Standard of Informed Consent.- V. The Functions of Informed Consent.- VI. The Effect of Informed Consent.- VII. Dilemmas of Informed Consent.- 17 Comments on "The Ethical Content of Legally Informed Consent".- I. Perennial Paradox: "The Ethical Nature of the Legal".- II. Information for Consent: Judging the Doctor's Judgement.- III. Surrogate Consent: Process and Substance.- 18 Involuntary Commitment of the Mentally 111: Some Moral Issues.- 19 Comments on Brock's "Involuntary Commitment of the Mentally 111: Some Moral Issues".- 20 On Paternalism and Health Care.- I. What is Paternalism?.- II. Paternalism in Health Care.- III. The Case Against Paternalism.- IV. The Limits of Autonomy.- 21 Comments on "Paternalism and Health Care".- I. Defining Paternalism.- II. Justifying Paternalism.- V. Professional Responsibility.- 22 Teaching Compassion: Professional Education for Humane Care.- I. The Nature and Scope of Compassion.- II. Conclusion.- 23 Accountability in Health Care Practice: Ethical Implications for Nurses.- 24 Biomedical Developments and The Public Responsibility of Philosophy.- I. The Argument: An Overview.- II. Biomedicine, Values, and the Reconstruction of Human Nature.- III. Particular Issues as Challenges to Philosophical Reflection.- IV. The Foundation of Ethics as the Public Responsibility of Philosophy.- V. An Ethics Grounded in the Nature of Things.- VI. A Critical Question.- VII. Transcendental Analysis, the a Priori of Communication and the Foundations of a Global Ethics.- VIII. The Paradox.- IX. The Opening Question.- X. The Transformation of Philosophy.- XI. Transcendental Analysis and the Moral Norms Presupposed by Scientific Discourse.- XII. Two Principles as a Foundation for a Global Ethics.- XIII. Conclusion.