Medical Ethics

Health care is ubiquitous in the lives of industrialized people. Yet, every medical development, technique, and procedure impact the environment. Green Bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, Green Bioethics addresses, not the structure of environmental sustainability in health care institutions, but the sustainability of individual health care offerings.

Green Bioethics parallels traditional biomedical ethics by providing four principles for ethical guidance. Through these four principles, Green Bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The principles of Green Bioethics are:
- Distributive Justice (Allocate Basic Medical Resources before Special Interest Access)
- Resource Conservation (Provide Health Care Needs before Health Care Wants)
- Simplicity (Reduce Dependence on Medical Interventions)
- Ethical Economics (Humanistic Health Care Instead of Financial Profit)

The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources. The principles of Green Bioethics, in tandem with the concrete examples given in this book, will support sustainability in health care.

V tomto článku představuji dle svého názoru nejsilnější argument ve prospěch morální přípustnosti eutanazie. Úvodem stručně zmiňuji dva důležité argumenty pro eutanazii – z respektu k autonomii a z milosrdenství, odmítám je však jako nedostatečné. Předkládám definici obou forem asistované smrti, eutanazie a asistovaného sebeusmrcení. Představuji základní ideje teorie dobrého života a podrobněji popisuji hédonizmus. Definuji deprivační pojetí špat- nosti smrti a prostřednictvím hédonizmu konkrétně popisuji, kdy je smrt špatná, a kdy je naopak dobrá. Posléze před- stavuji konsekvencializmus a utilitarizmus a ukazuji, jak je možné z úvah o dobrém životě a špatnosti smrti dojít ke konkrétním normativním závěrům o eutanazii. Na závěr své úvahy zobecňuji i pro jiné teorie dobrého života, jakou je preferencializmus nebo teorie objektivní touhy a objektivní pluralistické teorie. Vyústěním tohoto článku je obhajoba teze, že v lékařské praxi existují situace, za nichž eutanazie představuji morálně přijatelnou volbu.

The concept of antinatalism is now becoming popular on the Internet. Many online newspaper articles deal with this topic, and numerous academic papers on antinatalism have been published over the past ten years in the fields of philosophy and ethics.  The word “antinatalism” was first used in the current meaning in 2006, when the two books that justify the universal negation of procreation were published: one by David Benatar and the other by Théophile de Giraud. However, we can find various prototypes of antinatalistic thoughts in ancient Greece, ancient India, and modern Europe. You might recall the name Schopenhauer.
In this paper, I briefly summarize the history of antinatalistic thoughts and propose a set of categories on antinatalism and related thoughts.

Different definitions of bioethics in American and Italian literature are reported. It is argued that they refer to three different conceptions of the epistemological status of bioethics: the first conceives of it as an application of moral principles to biomedical problems, the second as a methodology for the working out of clinical judgement, the third as a broader and interdisciplinary public inquiry. It is suggested that each approach grasps a part of the truth, for each singles out one level of the bioethical work. Bioethics is in fact a complex, three-level form of knowledge. The misunderstanding of this complexity has led to some confusion and to conflicts of attribution among those who are concerned with it.

Claude Eatherly, pilota e metereologo,
era un ragazzo texano di
27 anni quando ordinò lo sgancio
della prima bomba atomica della
storia, Little Boy, che colpì Hiroshima
il 6 agosto 1945.
Nonostante la giovane età, non
era certo un dilettante: per quella
missione vennero scelti i migliori
piloti della US Army, e Eatherly
aveva già dato prova del suo valore
militare, abbattendo, nel corso
della sua fulminante carriera,
più di trenta aerei nemici. Dopo
lo sgancio della bomba, tuttavia,
lasciò l’esercito e rifi utò qualsiasi
riconoscimento al valore da parte
degli Stati Uniti. Compì anche
maldestre rapine e altri piccoli
crimini, con la speranza di trovare
sollievo nel biasimo collettivo. Ma
ciò non bastò a placare i suoi dilanianti
sensi di colpa e Eatherly
venne internato in un ospedale
psichiatrico. Fu in questo momento,
quattordici anni dopo Hiroshima,
che iniziò un carteggio con
Günther Anders, il fi losofo tedesco
autore del capolavoro L’uomo
è antiquato. Il risultato è questo
libro: un commovente scambio
epistolare tra Anders e un’anima
persa, in cerca di un’espiazione
tanto impossibile quanto necessaria.
Dopo anni di assenza dalle
librerie, torna disponibile una delle
testimonianze più toccanti sul
disastro che cambiò per sempre
la coscienza collettiva.

ABSTRACT
This research, situated at the junction of feminist, trans and disability studies, examines the limits of intersectional feminist analyses and the difficulties faced in their consideration of gender identity and ability through an analysis of two types of body modification: transsexuality and transability (voluntary disability acquisition). In response to the question “what are the limits of intersectional analyses and how can they be addressed?”, three objectives are proposed: 1) participate in the critical examination of specific limits of intersectional feminist analyses in order to diversify their axes through the consideration of gender identity and ability; 2) question the conceptual assumptions and cisgenderist and (cis)ableist privileges informing negative discourses around these body modifications and highlight points of convergence among feminist, transactivist and anti-ableist movements in order to encourage dialogue and solidarities among them; 3) provide feminist, trans and disability studies with an enriched model of intersectionality capable of addressing new claims for justice from oppressed groups, such as those of transsexual and transabled individuals. The negative discourses of certain feminists and other scientists regarding these body modifications are mapped and critiqued through a methodology combining archeological, genealogical and critical discourse analysis. The reflections presented here, inspired by poststructuralist and queer approaches, explore neither the “origins” of transsexuality and transability nor their motivations; this is a study of the negative discourses about these phenomena and the normative systems from which they originate. The result is an important contribution to theoretical, normative and political fields of knowledge: the examination of two “extreme” cases of body modification reveals the bodily normativities of dominant regimes, specifically cisgenderism and (cis)ableism, that remain as unrecognized in our societies as in our social movements. 


KEYWORDS
Intersectionality; feminist theories; trans theories; queer theories; disability theories; social movements; body modifications; bodies; transsexuality; transability; voluntary amputation; BIID; disability; mutilation; pathologization; normality/abnormality; stigmatization; discourse; critical discourse analysis; norms; oppression; autonomy; bioethics.


RÉSUMÉ
Cette recherche se situe à la jonction des études féministes, trans et sur la production du handicap. Elle s’intéresse aux limites des analyses féministes intersectionnelles et leurs difficultés à considérer certains axes identitaires, telles l’identité de genre et les capacités, à travers l’analyse de deux cas de figure de modifications corporelles, soit la transsexualité et la transcapacité (transformation visant à acquérir un handicap). Cette thèse s’articule autour de la question suivante : quels sont les angles morts des analyses intersectionnelles et comment pouvons-nous y remédier? Pour répondre à cette question, cette thèse propose trois objectifs : 1) Participer aux questionnements critiques entourant certaines limites des analyses féministes intersectionnelles pour en diversifier les axes à partir de l’identité de genre et des capacités; 2) Remettre en question les présupposés conceptuels et les privilèges cisgenristes et (cis)capacitistes qui sous-tendent les discours négatifs entourant ces modifications corporelles et mettre en valeur les points de convergence entre les mouvements féministes, transactivistes et anticapacitistes pour instaurer des dialogues et des solidarités entre eux; 3) Fournir un modèle enrichi de l’intersectionnalité pouvant être déployé en études féministes, trans et sur la production du (trans)handicap, apte à répondre aux nouvelles revendications de justice de groupes opprimés, comme celles des personnes transsexuelles et transcapacitaires. À l’aide d’une méthodologie alliant l’analyse critique de discours, l’analyse archéologique et généalogique, les discours négatifs de certaines féministes et d’autres scientifiques sur ces transformations corporelles sont cartographiés et critiqués. Les réflexions présentées ici, s’inscrivant dans une approche poststructuraliste et queer, ne proposent pas une recherche des « origines » et des motivations de la transsexualité et de la transcapacité, mais plutôt une étude des discours négatifs vis-à-vis ces phénomènes et des systèmes normatifs qui sous-tendent ces discours. C’est sous cet angle que cette recherche constitue un apport important aux champs des savoirs, tant sur le plan théorique, normatif que politique : en se penchant sur deux cas de figure « extrêmes », elle met en lumière les normativités corporelles des régimes dominants, notamment cisgenriste et (cis)capacitiste, occultées tant dans nos sociétés que dans nos mouvements sociaux.


MOTS CLÉS
Intersectionnalité; théories féministes; théories trans; théories queers; théories sur le handicap; mouvements sociaux; modifications corporelles; corps; transsexualité; transcapacité; amputations volontaires; BIID; handicap; mutilations; pathologisation; normalité/anormalité; stigmatisation; discours; analyses critiques de discours; normes; oppressions; autonomie; bioéthique.

Whether children should be vaccinated against coronavirus disease-2019 (COVID-19) (or other infectious diseases such as influenza) and whether some degree of coercion should be exercised by the state to ensure high uptake depends, among other things, on the safety and efficacy of the vaccine. For COVID-19, these factors are currently unknown for children, with unanswered questions also on children’s role in the transmission of the virus, the extent to which the vaccine will decrease transmission, and the expected benefit (if any) to the child. Ultimately, deciding whether to recommend that children receive a novel vaccine for a disease that is not a major threat to them, or to mandate the vaccine, requires precise information on the risks, including disease severity and vaccine safety and effectiveness, a comparative evaluation of the alternatives, and the levels of coercion associated with each. However, the decision also requires balancing self-interest with duty to others, and liberty with usefulness. Separate to ensuring vaccine supply and access, we outline 3 requirements for mandatory vaccination from an ethical perspective: (1) whether the disease is a grave threat to the health of children and to public health, (2) positive comparative expected usefulness of mandatory vaccination, and (3) proportionate coercion. We also suggest that the case for mandatory vaccine in children may be strong in the case of influenza vaccination during the COVID-19 pandemic. (J Pediatr 2021;231:10-6).

It is sometimes argued that the non-therapeutic, non-consensual alteration of children’s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed ‘female genital mutilation’ or FGM), and one for boys (in which such alterations should be termed ‘male circumcision’). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children—whether female, male, or intersex—should be free from having parts of their genitals removed unless there is a pressing medical indication.

The expectation, from the ethos of medicine and society, is that a practitioner should make the correct ethical decision
in the clinical setting. Yet there is little help for them as to a process for making ethical decisions. A structured six-step
framework may assist. It is not an algorithm to arrive at a determinate answer in all situations and ethical issues but
instead offers a process that indicates the most relevant information and biomedical considerations a practitioner needs
to be aware of and helps to make ethics issues more manageable. The issues practitioners face are complex and resistant to reduction; it is hubris to pretend otherwise. Yet, the difficulty of these issues warrants practitioners relying on a
framework to guide them in the process of making ethical decisions.

Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed

Part of a series from Visual Aid Publishing, designed for Kindle, iPad etc. Aimed at a general readership but also useful for teaching purposes, as an accessible, thought provoking and inexpensive introduction.  Topics include Abortion, Euthanasia, Acts and Omissions, Kant, Mill, Hume, Law and Morality, Emotivism, Moral Luck, Altruism, Torture, Suicide, Ethics and Religion, Relativism, Justice and many more (another eighty-five, to be precise).

Some people with dementia are transformed by the disease, to the point that family members may describe them as a “different person.” These transformations may be negative or positive. What factors affect the judgements of ordinary people about whether an advance directive (AD) should be followed in such cases? We conducted three studies to test the influence of (1) positive versus negative transformation and (2) “treat” versus “withhold treatment” AD on the judgements of US participants (n = 1676) as to whether the AD should be followed and the extent to which the late-stage dementia patient had become a different person. We found that participants generally endorsed following the AD, irrespective of condition, but much less so when the patient had a positive transformation. Participants also favored “treat” over “withhold treatment” ADs. Unexpectedly, we found that AD type affected “different person” judgments: participants registered significantly weaker agreement with the propos...

In 1995 the American Medical Association's ethics council issued an opinion calling for the direct procurement of organs from anencephalic newborns, making them an exception to the "dead donor" rule. Such a firestorm erupted that the Council for Ethical and Judicial Affairs withdrew its opinion. Although the AMA has called for further research into possible "consciousness" in anencephalic newborns, present studies convincingly demonstrate that the brain stems of these infants are almost completely devoid of any evidence of even primitive functional organization. New studies indicate that cerebral absence causes unusual behaviors such as stiffening and hyperirritability that can be detected prenatally. Although widespread testing and screening in recent years has drastically reduced the number of anencephalic newborns, the discussion of use continues, raising ethical issues that pertain to other marginal patients such as those in persistent vegetative states. There are two schools of thought on the permissibility of using anencephalic newborns as organ sources: physicalism and personalism. Physicalism holds that all humans are so precious that no exceptions can be made regarding organ procurement, even in the case of anencephaly. Personalism sees moral worth related to one's potential or actual mental capacities, and because of anencephalic newborns' uniqueness, believes considerable liberties can be taken here. Most bioethicists are themselves in the personalist camp, but many have questions about changing the law to allow for a proposal such as the AMA Council's, because of the social impact of that change.

Many researchers believe that the proper identification of psychology variables depends on using accurate tools that function beyond cultural, political and social attachments for measuring the psychological features in human societies. In this regard, the present study has been conducted to examine the psychometric properties and factor structure of Black’s Moral Agency Scale (2016) in Iranian population. This scale has 15 items with three subscales of responsibility, external attribution and group pressure that has been validated with a desirable validity and reliability in American-European society. In the present study, to use this scale first the Persian version was prepared using back translation and then it was distributed among a sample of 381 male and female students of the University of Mazandaran, who were selected through multi-stage cluster sampling to participate in this study. In the next step, the construct validity of the scale was examined by exploratory factor analysis method. The results showed that after removing 2 items due to loading onto a factor other than the main factor, the scale has a three-factorial structure such as the original version. Then, to examine the confirmatory factor analysis, the model's fit was evaluated using Amos software, which confirmed the results of the structure obtained from the exploratory factor analysis. Moreover, for further evaluation of the validity of the scale, the correlations between the factors and the total score was examined through Pearson's correlation, and results indicated a good correlation between the subscales with the total score of the scale. To assess the reliability of the scale, the Cronbach's alpha coefficient was adopted. The Cronbach's alpha for responsibility, group pressure, external attribution and total scale scores were 0.53, 0.57, 0.55, and 0.60, respectively. Finally, with due regard to the data obtained from this research, it can be said that the present scale has an acceptable reliability and validity and is suitable for use by Iranian researchers in future studies.

Attention Press and Media: As a known legal and bioethics expert in women's health I have witnessed the reality that many women's health issues are lost in getting national coverage. It is clear that language concepts are essential in the education of the public on complex medical issues. At a recent meeting held at the Jungian Institute in Los Angeles a group of female therapists (all well-educated and not isolated persons), I found that only one woman had heard of morcellation. The rest of the group were horrified and found it difficult to believe me as I discussed the event of morcellation. This incident showed me the failure of our nation to learn about man made medical disasters that have cause pain, suffering, dysfunction and yes, even death of women. In order for one to discuss these issues basic terms are needed to begin with. I recalled my years of philosophy and that language is essential in the transference of information. One cannot report on these topics without having a language that the public can understand. Thus I will be providing new terms so that the press and reporters can use the terms and focus on these stories, for the loss of life is ongoing. Sometimes a term is needed to understand an event in our history. When the term " holocaust " came into use, the world was then capable of grasping the horror. There has been little effort to recognize that these stories all need to be told so that action can take place to change " mayhem and killing practices " .

I am asking you to publish this across the nation. ~ Dr. Vikki Hufnagel, MD

Background: The use of embryos in embryonic stem cell research (ESCR) has elicited ethical controversies as it entails the destruction of 5-day old human embryos to harvest stem cells. Objective: To explore the ethical positions of Islam, Buddhism, Hinduism, and Catholicism concerning the use of (1) left-over embryos from in vitro fertilization (IVF) also known as ‘surplus’ embryos and (2) ‘research embryos’ which are created by scientists to conduct research using embryonic stem cells. Methods: The opinions of religious leaders of Buddhist, Hindu, and Catholic faiths in Malaysia pertaining to ESCR were examined via in-depth, semi-structured interviews while Islamic responses are collected from local writings related to the derivation of fatwa on this issue. Participants’ responses on the ethics of human stem cell research are presented as a reflection of various scriptural texts of these four religions. These are presented and supported with the help of international bioethics lite...

Professional autonomy interferes at a structural level with the various aspects of the health care system. The health care systems that can be distinguished all feature a specific design of professional autonomy, but experience their own governance problems. Empirical health care systems in the West are a nationally coloured blend of ideal type health care systems. From a normative perspective, the optimal health care system should consist of elements of all the ideal types. A workable optimum taking national values into account could be attained by governance structures that also introduce elements from other ideal type systems. Thus a normative approach to medical practice guaranteeing an essential degree of professional autonomy for a relationship of trust between the patient and the physician, could be combined with an efficient and equitable allocation of health care resources.