Journal of medical ethics
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Journal of medical ethics · Nov 2005
Review Historical ArticleThe tension between self governance and absolute inner worth in Kant's moral philosophy.
The concepts of autonomy as the self governance of individuals and dignity as the inner worth of human beings play an important role in contemporary bioethics. Since both notions are crucial to Immanuel Kant's moral theory, it would be tempting to think that Kantian ethics could ease the friction between the two concepts. It is argued in this paper, however, that this line of thought cannot be supported by Kant's original ideas. While he did make a conscious effort to bring autonomy and dignity together, his emphasis on the absolute inner worth of our collective humanity made it impossible for him to embrace fully the personal self determination of individuals, as it is usually understood in today's liberal thinking.
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Journal of medical ethics · Oct 2005
ReviewJust allocation and team loyalty: a new virtue ethic for emergency medicine.
When traditional virtue ethics is applied to clinical medicine, it often claims as its goal the good of the individual patient, and focuses on the dyadic relationship between one physician and one patient. An alternative model of virtue ethics, more appropriate to the practice of emergency medicine, will be outlined by this paper. This alternative model is based on the assumption that the appropriate goal of the practice of emergency medicine is a team approach to the medical wellbeing of individual patients, constrained by the wellbeing of the patient population served by a particular emergency department. By defining boundaries and using the key virtues of justice and team loyalty, this model fits emergency practice well and gives care givers the conceptual clarity to apply this model to various conflicts both within the department and with those outside the department.
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Journal of medical ethics · Jul 2005
ReviewDoes it matter that organ donors are not dead? Ethical and policy implications.
The "standard position" on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that (1) brain death is not death, and (2) even though "brain dead" patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US "whole brain" criterion and the UK "brain stem" criterion. ⋯ We dispute their claim that the removal of vital organs is morally equivalent to "letting nature take its course", arguing that, unlike "allowing to die", it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation.
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Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. "Evidence based medicine" (EBM) emerged in the 1980s and a new gospel of "Rules of Evidence" was introduced. ⋯ There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community.
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Journal of medical ethics · Apr 2004
ReviewEvidence based medicine guidelines: a solution to rationing or politics disguised as science?
"Evidence based medicine" (EBM) is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. ⋯ This challenges traditional professionalism in much the same way as managed care has done in the US. Here we chart some of these major philosophical issues and show why simple solutions cannot be found. The profession needs to pay more attention to different uses of EBM in order to preserve the good aspects of professionalism.