Journal of medical ethics
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Journal of medical ethics · Nov 2012
Ethical considerations for performing decompressive craniectomy as a life-saving intervention for severe traumatic brain injury.
In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. ⋯ Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features.
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Journal of medical ethics · Nov 2012
Jehovah's Witnesses and autonomy: honouring the refusal of blood transfusions.
This paper explores the scriptural and theological reasons given by Jehovah's Witnesses (JWs) to refuse blood transfusions. Julian Savulescu and Richard W Momeyer argue that informed consent should be based on rational beliefs and that the refusal of blood transfusions by JWs is irrational, but after examining the reasons given by JWs, I challenge the claim that JW beliefs are irrational. I also question whether we should give up the traditional notion of informed consent.
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Journal of medical ethics · Nov 2012
Could it be permissible to prevent the existence of morally enhanced people?
This paper discusses Nicholas Agar's argument in Humanity's End, that it can be morally permissible for human beings to prevent the coming into existence of morally enhanced people because this can harm the interests of the unenhanced humans. It contends that Agar's argument fails because it overlooks the distinction between morally permissible and morally impermissible harm. It is only if the harm to them would be of the morally impermissible kind that humans are provided with a reason to prevent the coming into existence of enhanced people. But if their enhancement includes moral enhancement, it is unlikely that the enhanced people will cause morally impermissible harm.
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Journal of medical ethics · Nov 2012
Palliative sedation: not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation.
The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. ⋯ After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.