Man, Mind, and Morality: The Ethics of Behavior Control

Politics & Social Sciences

MacKlin, Ruth

Philosophy

Pearson College Div

A young man, terminally ill and in extreme suffering, asks to be removed from life support, requesting morphine first so he'll be asleep when the machine stops. His physician agrees, but the hospital's chief administrator intervenes, arguing that the morphine might itself cause death, leaving the physician open to criminal indictment for murder. To placate the administrator, the doctor and patient reach a grim compromise: life support will be disconnected first, and only after manifest signs of suffering appear will the physician administer the morphine, to alleviate pain. The patient's request is ultimately respected, but many staff members feel he has been made to suffer needlessly. This is just one of many cases Ruth Macklin discusses in Enemies of Patients, an eye-opening look at the growing number of forces that are hostile to the interests of patients, including hospital administrators, lawyers who represent hospitals, insurance companies, government regulations, and even some well intentioned physicians. Macklin, a highly regarded medical ethicist, the author of Mortal Choices and the subject of a New York Times Magazine cover story, provides a behind-the-scenes look at how the patient's ethical rights are often violated. She describes, for instance, how a new breed of hospital administrator, the risk manager, acts consistently as an enemy of the patient, often urging physicians to continue aggressive, expensive treatments for critically ill patients--even when the patient and doctor agree the treatment should cease--for fear of lawsuits, bad publicity, or criminal indictment. (Macklin points out, for instance, that even though no physician has ever been convicted of a crime for withdrawing treatment from a patient in a permanent vegetative state, hospital lawyers and risk managers regularly assert that there is a danger of criminal liability in such cases.) The government also can become an enemy of patients. The most egregious case, according to Macklin, is the Federal government's "gag rule" which has prohibited health care facilities that receive Title X funds from discussing abortion with pregnant women, violating the patient's right to full information. And physicians themselves can become enemies of patients. Some, seeing themselves as fiscal gatekeepers, ration expensive health care procedures on financial rather than medical grounds. Some physicians refuse to treat patients who don't follow their advice (a cardiologist, for instance, who will not take care of patients who smoke) and others won't treat patients who pose a threat of lawsuit (such as a California woman in need of life-sustaining dialysis, who had previously sued another physician). Packed with numerous case histories drawn from the author's experience in a major urban medical center, Enemies of Patients will give readers a better understanding of their rights as patients and show them how to forge an alliance with their doctors against common enemies.

Enemies of Patients

Oxford University Press

This book analyzes the debate surrounding cultural diversity and its implications for ethics. If ethics are relative to particular cultures or societies, then it is not possible to hold that there are any fundamental human rights. The author examines the role of cultural tradition, often used as a defense against critical ethical judgments, and explores key issues in health and medicine in the context of cultural diversity: the physician-patient relationship, disclosing a diagnosis of a fatal illness, informed consent, brain death and organ transplantation, rituals surrounding birth and death, female genital mutilation, sex selection of offspring, fertility regulation, and biomedical research involving human subjects. Among the conclusions the author reaches are that ethical universals exist but must not be confused with ethical absolutes. The existence of ethical universals is compatible with a variety of culturally relative interpretations, and some rights related to medicine and health care should be considered human rights. Illustrative examples are drawn from the author's experiences serving on international ethical review committees and her travels to countries in Africa, Asia, and Latin America, where she conducted educational workshops and carried out her own research.

Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine

Health, Fitness & Dieting

Mental Health

This is a collection of Ruth Macklin's previously published articles that appeared in scholarly journals or as chapters in books. Dr. Macklin's pioneering work in ethics and global health spans more than two decades. The articles in this volume range from a chapter in a book published in 1989 to a journal article currently in press. The essays fall into two broad categories: policy and practice, and multinational research. Topics in the first category include cultural beliefs and attitudes regarding family planning, long-acting contraception, abortion, and more broadly, policies and practices affecting women's health. Two essays dealing with justice focus on HIV/AIDS: how developing country governments might distribute medications fairly to all who are in need; and what obligations do industrialized countries and world leaders have to provide affordable medications to developing countries. A theme that runs throughout the essays is a defense of the universality of ethical principles, despite cultural differences that exist around the globe. The section on multinational research includes articles on international ethics guidance documents, such as the Declaration of Helsinki; discussion of the obligations of researchers and sponsors when they conduct research in developing countries; what constitutes exploitation when research is conducted in resource-poor countries; and, as in the first section of the book, the application of universal ethical principles to the global research enterprise. The author criticizes the view that double standards in research are acceptable: one standard for rich countries, and a lower standard for developing countries. Several essays deal with sensitive and controversial ethical aspects of research on reproductive health and HIV/AIDS.

Ethics in Global Health: Research, Policy and Practice

Medical Books

Medicine

Mortal Choices: Bioethics in Today's World

Pantheon Books

Discusses ethical issues in medicine, including informed consent, the right to die, incompetency, parental decisions, resource allocation, and experiments with human subjects

Mortal Choices: Ethical Dilemmas in Modern Medicine

Houghton/Mifflin

This book examines the ethical controversies that have surrounded the design and conduct of international medical research sponsored by industrialized countries or industry, and carried out in developing countries. Is it acceptable to lower the ethical standards adopted in the industrialized world when carrying out research in developing, or resource-poor, countries? Ruth Macklin concludes that double standards in medical research are ethically unacceptable.

Double Standards in Medical Research in Developing Countries (Cambridge Law, Medicine and Ethics, Series Number 2)

Cambridge University Press

Feeling Good and Doing Better: Ethics and Nontherapeutic Drug Use (Contemporary Issues in Biomedicine, Ethics, and Society)

The place of drugs in American society is a problem more apt to evoke diatribe than dialog. With the support of the Na tional Science Foundation's program on Ethics and Values in Science and Technology, and the National Endowment for the Humanities' program on Science, Technology, and Human Values, * The Hastings Center was able to sponsor such dialog as part of a major research into the ethics of drug use that spanned two years. We assembled a Research Group from leaders in the scientific, medical, legal, and policy com munities, leavened with experts in applied ethics, and brought them together several times a year to discuss the moral, legal and social issues posed by nontherapeutic drug use. At times we also called on other experts when we needed certain issues clarified. We did not try to reach a consensus, yet several broad areas of agreement emerged: That our society's response to nontherapeutic drug use has been irrational and inconsistent; that our attempts at control have been clumsy and ill-informed; that many complex moral values are entwined in the debate and cannot be reduced to a simple conflict between individual liberty and state paternalism. Of course each paper should be read as the statement of that particular author or authors. The views expressed in this book do not necessarily represent the views of The Hastings Center, the National Science Foundation, or the National En dowment for the Humanities.

Gaylin, Willard

Murray, Thomas H. H.

Science & Math

Humana

This volume is one outcome of a two-year study conducted by the Behavioral Studies Research Group of The Hastings 1 Center. It is divided into three parts to reflect the several facets of the interdisciplinary project from which it stems. In the opening chapter Willard Gaylin and Ruth Macklin, who di­ rected the study, describe its basic conception and structure, which centered around three programs to conduct research into aspects of violence and aggressive behavior, programs aborted in the early 1970s because they were politically and IThis project was supported by the EVIST Program of the National Science Foundation under Grant No. 05577-17072, and by a joint award by the National Endowment for the Humanities. Any opinions, findings, conclu­ sions, or recommendations expressed herein are those of the authors and do not necessarily reflect the views of the National Science Foundation or the National Endowment for the Humanities. Other published outcomes are the edited transcripts of two of the case-study workshops conducted under this project: "Researching Violence: Science, Politics, and Public Contro­ versy," Special Supplement, The Hastings Center Report 9 (April 1979); and "The XYY Controversy: Researching Violence and Genetics," Special Sup­ plement, The Hastings Center Report 10 (August 1980). Copies of these tran­ scripts are available for purchase from The Hastings Center, 360 Broadway, Hastings-on-Hudson, NY 10706. ix PREFACE x socially controversial.

Violence and the Politics of Research (The Hastings Center Series in Ethics)

Business & Money

Powledge, Tabitha M.

Management & Leadership

Springer

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