The Cambridge textbook of bioethics

communication skills (cont.) medicine use 505, 507, 510–11

preoperative conferences 448–9, 450–1, 458 prenatal/neonatal testing 107, 108 religious/cultural sensitivities

Aboriginal patients 383, 385, 387, 389–90 Chinese patients 400, 401

Hindu/Sikh patients 405–6 reportable diseases 278

in research 218–19 communitarianism 211, 344, 345, 492 community healthcare 299–305 competence see capacity complementary medicine 513–19

Aboriginal peoples 385 Ayurveda 404, 406 Chinese 398–9

USA 514, 516, 517 compulsory treatment

mental illness 491, 492

of pregnant women 98–9, 99–100 reportable diseases 32, 277

conception 232

religious views 393, 404, 412, 434, 437 confidentiality 43–7

for adolescents seeking sexual health advice 46, 475, 478–9

breaching 44, 45–6, 46–7, 277 for donors 149, 155

in emergency medicine 470 in genetic testing 45, 161, 164

infectious diseases 43, 47, 274–5, 277, 278–9, 481–2 interpreters and 406

for Jehovah’s Witnesses considering blood transfusions 420

pharmacists and 508–9

in research 45, 47, 189, 211, 212, 498 in small communities 289, 292, 295

conflict between individuals mother and fetus 97–102 physician and family

over end of life care 52, 54, 69, 78–83, 89, 466, 467 over treatment of children 123, 128–9

conflict of interest

caused by commercial marketing practices 266–72 in child abuse reporting 136–7

institutional 223, 226, 227, 228 organ donation and 88, 149 pharmacists’ roles 507

physician–manager dual role 246 physician–researcher dual role 204, 214–19

financial 187–92, 222–8

in the pharmaceutical industry 267, 269 in surgery 449

physicians’ obligations to state and society 277–8, 351, 356–7, 456, 470

physicians in other community roles 289, 292, 295 Confucianism 398, 399, 400

conscientious objections by pharmacists 508 consent 9–10, 11–15, 25

in adolescents 34, 124, 421 in alternative medicine 516

in assisted reproduction 114–15, 117 autonomy and 12, 17, 24, 27, 32, 510 bio-banking 162, 166–72

for breaking confidentiality 45–6 broad consent 168, 169, 171, 211 capacity 17–22, 58

in children 18, 121–5, 124–5, 130 emergency medicine 469, 470, 471, 472–3 in the ICU 466

in mental illness 19, 20, 21, 491 in regenerative medicine 154, 157 in surgery 450

in children 18, 33, 114, 121–5, 123–5, 128, 130 communication and 19, 20–1, 27–8, 157 cultural differences 14, 20, 28

Aboriginal peoples 386 Chinese culture 397–8, 400 Hinduism/Sikhism 404, 405 Islam 411

Judaism 428 disclosure 24–9, 37

in alternative medicine 516 in assisted reproduction 114 to children 122

by pharmacists 510

in regenerative medicine 154, 157 in research 188–9, 190, 226

in surgery 448, 450–1

therapeutic privilege 12, 13, 24, 26, 29, 37, 258 documentation of 12, 21–2, 28, 171

in emergency medicine 14–15, 26, 33 capacity 469, 470, 471, 472–3 exceptions 13, 471

surgery and 11, 14–15, 449, 451 exceptions to requirement for 12, 13, 32–3

emergency medicine 13, 471

in mental illness 491–2

research on biological samples 168–9, 170 treatment of infectious diseases 32, 277, 482

explicit 11

genetic testing 162, 163, 164 implied 11, 46, 471

law on 12–13, 18 capacity 18, 21–2 for children 123–4

disclosure 24–6, 37–8, 188 emergency medicine 471 innovative surgery 196

in pregnancy 99–100

refusal of treatment 18, 434, 457 voluntariness 32–3

in mental illness 488–9, 491–2 capacity 19, 20, 21, 491 voluntariness 33–4, 488

organ donation 146, 147, 149

for postmortem procedures 146, 168, 170–1, 440 in pregnancy 97, 98–9, 99–101, 102

in regenerative medicine 154, 157 in research 188, 218

bio-banking 162, 166–72 clinical trials 154, 157 disclosure 188–9, 190, 226

epidemiological studies 189, 207, 208, 210–12 on fetuses 234

innovative surgical procedures 196

in surgery 11, 14–15, 196, 447, 448–9, 449–52 voluntariness 31–5, 149

in mental illness 33–4, 488

see also refusal of treatment; substitute decision making

contact tracing 276 contraception 419, 438

Convention against Torture (1984) 350, 355

Convention on Human Rights and Biomedicine (1997) 13, 162

coroners 89

corporal punishment 133 corporate ethics

in healthcare organizations 243–8

institutional conflict of interest 223, 226, 227, 228 resource allocation 243, 246, 247–8, 251, 255

in pharmaceutical companies 359–66 corruption

and financial conflict of interest 223–5 international aid and 373

cost-effectiveness analysis 252, 509 Costa Rica 371

Council of Europe on consent 13

use of bio-banked samples 168, 169, 170 on genetic testing 162

on maternal and fetal rights 99 on torture 351, 354

website 334

Council for International Organizations of Medical Sciences (CIOMS) 168, 169, 189–90, 209

CPR see resuscitation Cuba 371

cultural differences 245, 343–5, 379–81 abortion

Buddhism 391–5, 393–4 Catholicism 438 Chinese culture 399

Hinduism/Sikhism 403, 404, 406, 407 Islam 408, 412

Jehovah’s Witnesses 419 Judaism 427 Protestantism 434

autonomy 28

Aboriginal peoples 385, 386, 389 Chinese culture 67, 397–8, 401 Hinduism/Sikhism 404

Judaism 426 Protestantism 432

child abuse, definition of 133–4 consent 14, 20, 28

Aboriginal peoples 386 Chinese culture 397–8, 400 Hinduism/Sikhism 404, 405 Islam 411

Judaism 428 death 87, 90

Aboriginal peoples 386 Buddhism 392, 393, 394–5 Catholicism 438

Chinese culture 399–400 Hinduism/Sikhism 404 Islam 411

Judaism 426 diet 407, 411, 428

embryo and fetal research 234, 235 end of life care 38, 59, 62, 67, 466

Aboriginal peoples 383, 386, 389–90 Buddhism 393, 394–5

cultural differences (cont.) Catholicism 436, 437, 439–40 Chinese culture 397, 400–2 Judaism 424, 426, 427–8 Protestantism 430, 433, 434

funerary practices 386, 392, 411, 412 modesty

in Hindu patients 406 interpreters and 389, 405, 406 in Islamic patients 411

in Jewish patients 428 organ donation

Catholicism 438

Islam 408, 410–12 Japanese culture 147, 393 Jehovah’s Witnesses 419

rural communities 289–95

see also individual religions/ethnic groups cystic fibrosis 108, 160, 164

data management

community healthcare ethics cases 303 in research

anonymization/coding of samples 45, 167–8, 170, 189, 211

legal requirements 209 need to publish 202 registries 198, 202

see also documentation

Data Protection Act (1998) (UK) 45, 162 death

assisting see euthanasia

brain death 85–90, 146, 393, 412 legal definition 88, 89, 147 patients’ attitudes towards 56, 67

postmortem use of samples 168, 170–1 religious/cultural views 87, 90

Aboriginal peoples 386 Buddhism 392, 393, 394–5 Catholicism 438

Chinese culture 399–400 Hinduism/Sikhism 404 Islam 411

Japanese culture 147, 393 Judaism 426

see also organ donation, posthumous

Declaration of Helsinki (1964) 189, 209, 217 see also World Medical Association

declarations of interest 225–6, 271

dementia, incapacity and 19 denial (of facts) 80

denial (of treatment) 253 depression 174, 180

detainees, maltreatment of 350–7 developing countries

access to medicines in 359–66 clinical trials in 203, 341, 345, 346–7 international aid to 369–74

research on diseases prevalent in 225, 362 diet

Hindu 407

Islamic 411

Jewish 428

direct-to-consumer advertising 496–500, 501–2 directed clinical interviews 21

disability

anti-discrimination legislation 107, 163, 483 Catholic view on 440

prenatal testing and 106 disasters 281–6

disciplinary proceedings, use of alternative medicine 513, 516, 519

disclosure

consent and 24–9, 37

in alternative medicine 516 in assisted reproduction 114 by pharmacists 510

in regenerative medicine 154, 157 in research 188–9, 190, 226

in surgery 448, 450–1

therapeutic privilege (non-disclosure) 12, 13, 24, 26, 29, 37, 258

to children 122

of financial interests 225–6, 271

of incidental findings 208, 210, 498, 500–1 of medical errors 37, 40, 257–62

see also truth telling discrimination

in assisted reproduction 115, 116 disability 106, 107, 163, 483 ethnicity 177–8, 388

genetic 161, 163, 177–8

in reports of child abuse 134

as a result of epidemiological research 208 disease mongering 224

DNR see do-not-resuscitate orders do-not-resuscitate (DNR) orders

during surgery 454–5, 454–9, 457–8

in emergency medicine 472 in ICU 465

documentation

advance directives 63, 65, 68 community healthcare ethics cases 303 confidentiality of 43, 45

of consent 12, 21–2, 28, 164, 171 of research data 171, 188, 198, 202

when discussing alternative medicine 518–19 see also data management

donation

by children 127, 129, 130–1 of embryos 113

of fetal tissue 234 of gametes 112, 114

of solid organs see organ donation Down syndrome screening 106 driving 43, 47

drug abuse

diversion of prescription drugs 509 in pregnancy 97–102, 99–100

see also alcohol abuse

drug companies see pharmaceutical companies durable powers of attorney for healthcare (proxy

directives) 59, 62, 68 see also living wills

economic considerations see financial considerations education

of healthcare workers see training of women 370

effectiveness in bioethics 309–10, 313–20, 322–7 egalitarianism 345

electroencephalography 88, 89 embryos

in vitro fertilization 113

preimplantation genetic diagnosis 105, 113, 115–16 stem cell research 231–2, 233, 234–6

law 116, 155–6, 235 public opinion 156–7 emergency medicine 469–73

consent 14–15, 26, 33

capacity 469, 470, 471, 472–3 exceptions 13, 471

surgery and 11, 14–15, 449, 451 Jehovah’s Witnesses 421

major incidents 281–6 resuscitation 469, 472, 473 triage 469

end of life care 51, 53–6

access to experimental interventions 214, 217, 219 advance care planning 51, 54, 55–6, 65–70

conflicts over withdrawing/withholding treatment 54, 69, 78–83, 89, 466, 467

disclosure 14, 27

euthanasia 51, 53–6, 72–5, 465 religious views 394–5, 409, 427

ICU care 83, 462, 464 law 54

advance directives 59, 66 euthanasia 73–4

substitute decision making 59, 61 withdrawing/withholding treatment 79, 83, 433, 465

pain control 54, 55, 393 hastening death 72–5

preparing for death 56, 67, 393 religious/cultural views 38, 59, 67, 466

Aboriginal peoples 383, 386, 389–90 Buddhism 393, 394–5

Catholicism 436, 437, 439–40 Chinese culture 397, 400–2 Islam 409

Judaism 424, 426, 427–8 Protestantism 430, 433, 434

substitute decision making 13, 58–63, 69, 466 truth telling 14, 27, 39, 40

enhancement of function 155, 488, 496 enrollment into clinical trials 204

financial inducements to physicians 187–92, 223, 226, 228

patient factors 205, 214, 216, 219 epidemics 241, 276–7, 286, 342

quarantine 277, 284–5, 483 epidemiology

bio-banking 161, 166–72, 209 research 189, 207–12

surveillance systems 275, 276–7, 483 epilepsy 43, 47

equipoise theory 203, 215–16 errors see medical errors ethical principles

advertising 496–8 alternative medicine 513–14

assisted reproduction 114–16 capital punishment 455–7 children 121–3, 128–9, 134–7 confidentiality 44, 161, 481–2

conflict of interest 215–16, 223–5, 267–8

ethical principles (cont.) consent 12, 454

capacity 17

for children 121–3 disclosure 24, 258 genetic testing 162

regenerative medicine 154 voluntariness 31–2

cultural differences 343–5

see also individual religions/ethnic groups death, definition of 86–7, 393

DNR orders 454 emergency medicine 470

end of life care 54, 59, 65, 79 euthanasia 72–3

genetics 161–2, 177–8 infectious diseases 274–5, 481–2 organ donation 145

deceased donors 86, 87, 88, 146 live donors 146, 155

organizational ethics 244

pregnant women, treatment of 98–9, 232 public health 274–5, 285, 481–2 regenerative medicine 154–5

research 167, 188

clinical trials 203–4, 215–16, 223–5 on embryos 234–5 epidemiological studies 167, 207–8 on fetuses 233–4

innovation 195–6 neuroimaging 498 resource allocation 252 rural healthcare 291–2

screening

genetic 105, 161–2 prenatal/neonatal 105–6

truth telling 24, 36–7, 258

ethics review boards (committees) 190, 191, 198, 201, 211 applied systems thinking in 315–20

financial conflict of interest and 226 rural 290, 292, 293

ethnicity

discrimination and 177–8 see also cultural differences

eugenics 115–16, 178 Europe

clinical trials 204 consent 13

bio-banking 168, 169, 170

end of life decision making 466 genetic testing 162

maternal and fetal rights 99 tissue engineering 156 torture 351, 354

transplant coordination 147 see also individual countries

European Society of Human Genetics 168, 170 European Union (EU) 156, 204

euthanasia 51, 53–6, 72–5, 465 religious views on 394–5, 409, 427

evidence-based medicine 201, 203 executions see capital punishment explicit consent 11

extrajudicial rendition 350, 355–6, 357

fairness (justice) 146, 188, 252, 258

see also international distributive justice families

bereaved 56 childcare issues

child abuse 133, 134, 137

substitute decision making 114, 121, 123, 125, 129 end of life care

advance directives 69

conflicts over treatment 54, 69, 78–83, 89, 466, 467 substitute decision making 58, 59, 60, 61, 62, 63, 466

genetics

behavioral studies 175–6 confidentiality of test results 45, 161

home healthcare and 300, 304, 305 of physicians 284 religious/cultural factors

Aboriginal peoples 385, 388 Chinese culture 397–8, 400–2 Hinduism/Sikhism 404, 405, 406

truth telling 36, 39, 40 fathers 101, 234

see also parents fertilization 232

religious views 393, 404, 412, 434, 437 fetuses

abortion of see termination of pregnancy research on 231–2, 232–3, 233–4, 235 rights of 98, 99, 101, 234

testing 104–5, 105–6, 106–7, 107–8 religious views on 412, 434, 438

fiduciary duty

of organizations 245

of physicians 189, 191, 196, 217, 258, 268 of psychotherapists 489

of surgeons 448

filial piety in Chinese culture 399, 400 financial considerations

assisted reproduction 114, 115 clinical trials 203–4

financial gain by physicians 187–92, 195, 222–8 drug companies’ marketing practices 266–72

innovation 195, 198 macroeconomics 342

access to medicines in developing countries 359–66 international aid 369–74

organ donation

expenses to living donors 147 sale of organs 145, 147, 148 organizational ethics 243, 247–8

pharmacists 507, 509–10

resource allocation 115, 243, 246, 247–8, 251–5 withdrawing/withholding treatment 83, 440

finder’s fees 187–92, 223, 226, 228 First Nations (North America) 384, 387 five elements (Chinese medicine) 398 Fletcher, Joseph 432

Food and Drug Administration (FDA) (USA) 156, 189 food donations 365

forcible restraint 31, 34 France

assisted reproduction 114, 116 consent for bio-banking 168, 170

fraud 225, 516 free will 179

freedom to consent see voluntariness friends, as substitute decision makers 61, 62 funerary practices 386, 392, 411, 412

Gelsinger, Jesse 223, 225

General Medical Council (UK) 268 on consent 26, 33

on driving against medical advice 47 on research 204

general practice 475 genetics

behavioral 144, 174–81

gene therapy 153, 154, 157–8 genetic testing 143, 160–5, 166, 497

confidentiality 45, 161 consent 162, 163, 164

preimplantation genetic diagnosis 105, 113, 115–16

prenatal 104, 105, 108 religious views on 434, 438

see also bio-banking

Geneva Convention (1949) 352, 456 genocide 343, 427

Germany

assisted reproduction 114 consent for bio-banking 169, 170 stem cell research 235, 236

gestational agreements 113, 114 Ghana 360

ghost-authored papers 224, 226 GlaxoSmithKline 224

global health ethics 339–40, 341–7 access to medicines 359–66 international aid 369–74

Good Samaritan principle 369–70, 371 grief 17, 22, 56, 81

guidelines see policy guidelines guilt, in family members 81 Gustafson, James 433

Guthrie, Robert 105

healthcare agents 59, 60, 61, 62 Helsinki Declaration 1964 189, 209, 217

see also World Medical Association Hinduism 403–7

Hippocratic oath 37, 45, 408 HIV/AIDS

confidentiality 43, 47

research in developing countries 341, 346–7 testing for 481–6, 485–6

in the USA 483 Holocaust survivors 427 home care 299–305

hub and spokes service delivery model 323–5 human experimentation see research

Human Genome Organization (HUGO) 163, 168, 169, 189 human immunodeficiency virus see HIV/AIDS

human rights

access to medicines 359–60, 364–6 assisted reproduction 116 consent 13

fetal lack of 99

freedom from torture 351–2 genetic information 162

Human Tissue Act (2004) (UK) 162, 168, 170 Hurlbut, Richard 232

hygiene, religious 404, 411

530 Index

ICU (intensive care units) 462–3

bed allocation 251, 253–4, 255, 462–4, 466–7 end of life care 83, 462, 464

ideological totalism 355

imaging (self-referred scans) 496, 498, 499–500, 500–1, 501–2

immunization 419, 482, 483 implied consent 11, 46, 471 in-training evaluation reports 332

in vitro fertilization see assisted reproduction incapacity

consent and 13, 58 identification of 18, 19, 491 non-disclosure and 26 short-term 471

see also capacity; substitute decision making incidental findings, disclosure of 208, 210, 498, 500–1 India

life expectancy 371 sale of organs 147

stem cell research 155, 235 see also Hinduism

individualism 344, 345

industry see pharmaceutical companies infant mortality rates 370

infectious diseases 481–6 emerging 342, 362

epidemics 274, 276–7, 286, 342 quarantine 277, 284–5, 483

reportable 32, 274–5, 274–9, 481–2, 484 infertility, treatment for see assisted reproduction influenza pandemics 274, 483

informed consent see consent informed refusal 28

see also refusal of treatment innovation

in drugs 362–3, 364 in surgery 194–9, 449

institutional review boards see ethics review boards institutionalization 33, 34

instruction directives (living wills) 13, 63, 65, 66, 68–70

see also proxy directives insurance

medical (patients) 283, 290, 516 professional (doctors) 259

intellectual property 362, 363 intensive care units see ICU

International Association of Bioethics 335

international distributive justice 369–74 International Epidemiological Association 209

International Ethical Guidelines for Biomedical Research Involving Human Subjects (2002) 168, 169, 189–90

International Federation of Gynecology and Obstetrics (FIGO) 100

international humanitarian law 352 internet resources see websites interpreters 28

for Aboriginal patients 383, 385, 387, 389–90 for Chinese patients 401

for Hindu/Sikh patients 405–6 intubation 53, 56, 58, 63

Inuit peoples 384, 387 Iran 147

Iraq 354 Ireland 235 Islam 408–15

Islamic Organization for Medical Sciences 410 Israel

assisted reproduction 115 end of life care 465

stem cell research 235 torture 351

see also Judaism Italy

stem cell research 156, 235, 236 truth telling 38

Japan

abortion in 393

concept of death 147, 393 disclosure 27, 39

life expectancy 369 organ donation 147, 393

jargon, avoidance of 28, 80–1, 450 Jehovah’s Witnesses 33, 124, 416, 434 Jewish ethics 424–9

Joint Centre for Bioethics (Canada)

examples of systems thinking 315, 316, 317, 318, 319

strategies for improving effectiveness 323–7 Joint Commission for Accreditation of Healthcare

Organizations (JCAHO) (USA) 245, 313, 323 journals

disclosure of financial conflict of interest 225 ghost-authored papers 224, 226 pharmaceutical industry and 269 specializing in ethics 191

Judaism 424–9

justice 146, 188, 252, 258

see also international distributive justice

karma 404 Kelly, Gerald 439 Koran see Quran Korea 38, 394

law

advertising 268, 498

alternative medicine 513, 514–17, 519 assisted reproduction 114, 116, 235 capital punishment 457

children

child protection 123, 134, 135, 136 consent 123–4

newborn screening 106 confidentiality 44–5, 277 conflicts of interest 225, 268 consent 12–13, 18

capacity 18, 21–2 for children 123–4

disclosure 24–6, 37–8, 188 emergency medicine 471 innovative surgery 196

in pregnancy 99–100

refusal of treatment 18, 434, 457 voluntariness 32–3

death

definition of 88, 89, 147 euthanasia 73–4

emergency medicine 470–1 end of life care 54

advance directives 59, 66 euthanasia 73–4

substitute decision making 59, 61 withdrawing/withholding treatment 79, 83, 433, 465

free will 179

genetic testing 162–3 healthcare organizations 244–5 imprisonment 355

infectious diseases 275–6, 277, 278, 483 Islamic 409

Jewish 425

medical error 257, 259, 260 mental illness 490–1

organ donation 88, 147 patents 362, 363

pharmacists 507, 508 pregnant women 99–100, 234 prenatal testing 106

public health 275–6, 277, 278, 286, 483 research 188–9, 217, 498

clinical trials 204, 227

on embryonic stem cells 116, 155–6, 235 epidemiological studies 208–9

on fetuses 233–4, 235 innovation 196–7

resource allocation 252 screening programmes 106 torture 351–3, 355

truth telling 24–6, 37–8, 188 leadership training 325

less-developed countries see developing countries licensing of providers of alternative medicine 515, 517 lie detector tests 496

life expectancy 369, 370–1, 374

living wills (instruction directives) 13, 63, 65, 66, 68–70 see also proxy directives

logistical difficulties in accessing care 289, 291–2, 294–5 London bombing (7 July 2005) 281, 286

long-term care 33, 34

Maastricht classification of non-heart-beating donations 150

MacArthur Competence Assessment Tool-Treatment (MacCAT-T) 21

malpractice see negligence

management of bioethics services 309–10, 313–20, 322–7

community healthcare example 301–4 managers, ethics for 243–8

mandatory treatment mental illness 491, 492

of pregnant women 98–9, 99–100 reportable diseases 32, 277

manipulation 31, 34 marginal analysis 252 marketing

direct-to-consumer advertising 496–500, 501–2 to healthcare professionals 266–72, 359, 366 via pharmacists 508–9

maternal rights during pregnancy 97–102, 234 media reporting

behavioral genetics 176–7 end of life decisions 79 neuroscience 499, 500

532 Index

media reporting (cont.) regenerative medicine 157

medical errors

disclosure 37, 40, 257–62 negligence 257

in alternative medicine 513, 515–16, 518–19 corporate responsibility 245

inadequate consent 13, 25, 26, 188 inadequate disclosure of errors 37, 259

rates 260, 506

medical insurance 283, 290, 516 medical pluralism 514

see also complementary medicine medical records, access to 45, 172, 189 medicalization of conditions 155, 178 medicolegal issues see law

mental illness 487–93 autonomy 13, 489 Catholic view of 438 confidentiality and 46 consent 488–9, 491–2

capacity 19, 20, 21, 491 voluntariness 33–4, 488

hospitalization 33–4, 490, 491–2

in Jehovah’s Witnesses 416, 418–19, 421–2 methodological approaches 3–5

Me´tis 384, 387

Mill, John Stuart 44, 491 minors see children mission statements 243 mistakes see medical errors modesty

in Hindu patients 406 interpreters and 389–90, 405, 406 in Islamic patients 411

in Jewish patients 428

money see financial considerations monks, Buddhist 391, 392, 395 monoamine oxidase A 179

moral absolutism 346

moral disengagement 355, 457 moral distress 59, 246, 285, 300, 314 moral objections by pharmacists 508 moral relativism 346

mothers, rights during pregnancy 97–102, 234 see also parents

multiculturalism 345

multidisciplinary teams, confidentiality and 43, 46 Muslim ethics 408–15

National Center for Ethics in Healthcare of the Veterans Health Administration (USA) 315, 316, 317, 320

negligence 257

in alternative medicine 513, 515–16, 518–19 corporate responsibility 245

inadequate consent 13, 25, 26, 188, 516 inadequate disclosure of errors 37, 259

neonates see newborns Netherlands 46, 73, 74 neural tube defects

replacement bladders 153, 158 screening for 106

surgery in utero 232

neuroregenerative therapies 154, 155, 157 neuroscience 495–502

New Zealand 114, 498 newborns

research on 233

screening 104, 105, 106, 107, 108–9 non-compliance with therapy 475, 479 non-disclosure

of medical errors 37, 258, 259

therapeutic privilege 12, 13, 24, 26, 29, 37, 258 non-ideal justice 371–4

non-interference 385, 386, 389 non-maleficence

capital punishment and 456 causing disability and 440 end of life care 79

non-therapeutic interventions 128 in research 188, 216

non-therapeutic pediatric interventions 127–31 North America see Canada; USA

notifiable diseases 32, 274–5, 274–9, 481–2, 483, 484 nuclear transfer cloning 155, 156, 232

Nuffield Council on Bioethics (UK) 162, 163, 179 nuns, Buddhist 392, 395

Nuremberg Code (1947) 167, 189, 217, 456 nurses 59, 246, 271

Oath of the Muslim Doctor 408, 409 objective structured clinical examinations 332 off-label prescribing 505, 510–11

oocytes

donation 112, 114

in vitro fertilization 113 Oregon (USA) 75

organ donation 143, 145 live 145, 146, 147, 148, 149

posthumous 145, 146–7, 147–8, 149, 150 death of the donor 86, 87, 88, 146, 147

religious/cultural views Catholicism 438 Islam 408, 410–12

Japanese culture 147, 393 Jehovah’s Witnesses 419

xenotransplantation 148

see also bone marrow donation organ regeneration/replacement 153–8

organization of bioethics services 309–10, 313–20, 322–7 community healthcare example 301–4

organizational ethics 243–8

institutional conflict of interest 223, 226, 227, 228 resource allocation 243, 246, 247–8, 251, 255

ovulation induction 112

pediatrics see children; newborns pain control

in end of life care 54, 55, 393 hastening death 72–5

palliative care see end of life care pandemics see epidemics parents

attitudes towards genetic testing 179–80 child abuse and 133, 137

consent for fetal research 234

as substitute decision makers 114, 121, 123, 125, 129 refusing treatment 33, 124, 421, 434

patents 362, 363 paternalism 32, 59, 128 Paterson, Ron 32 patient advocates 34

patient autonomy see autonomy

Patient Self-Determination Act (1990) (USA) 59, 66 peer review of innovations 195, 197, 198 persistent vegetative state 73, 87, 89, 394 pharmaceutical companies

advertising

to consumers 498, 500

to healthcare professionals 267, 268, 270 via pharmacists 508–9

causing conflicts of interest

in education and patient care 266–72 in research 187–92, 222–8

obligation to provide access to medicines 359–66 pharmacists 505–11

pharmacogenomics 163, 164, 172 pharmacovigilance 202, 224

phenylketonuria 105

physical abuse of children 132–7 physical restraint 31, 34

physician-assisted suicide 72, 73, 75, 427, 508 placebo trials 187, 191–2, 203, 215

in developing countries 341, 346–7 policy guidelines

alternative medicine 517 assisted reproduction 116 bio-banking 168–71 children, treatment of 124–5 conflict of interest

financial 225–7, 268, 270

in the physician–researcher role 217 confidentiality 45–6, 498

consent 13, 18, 26, 33 bio-banking 168–71 DNR orders 457–8 in pregnancy 99–100

death, definition of 88 disclosure 26, 38, 226, 259–60 emergency medicine 471, 472 end of life care 54, 60, 79, 83 genetics

behavioral 179 testing 163

ICU admission 464 infectious diseases 483–4 medical error 259–60 neuroscience 498–9 organ donation 147–8

organizational matters 245–6 pregnancy 100

regenerative medicine 156 research 189–90

clinical trials 204

conflicts of interest 217, 225–7 on embryos and fetuses 235–6

epidemiological studies 168–71, 209 innovation 197

neuroimaging 498 rural healthcare 292–3 torture 350–1, 353–4

truth telling 26, 38, 226, 259–60 postnatal psychosis 487, 493 poverty

access to healthcare and 283, 342, 359–66 aid to poorer countries 369–74

rural 290