The Cambridge textbook of bioethics

practical (applied) ethics 3, 316 precautionary principle 285 pregnancy

brain death during 90, 436, 439–40 caring for pregnant women 97–102 prenatal testing 104, 106, 107–8, 106 research studies 232, 234

see also termination of pregnancy preimplantation genetic diagnosis 105, 113, 115–16 prenatal testing 104–5, 105–6, 106–7, 107–8

religious views on 412, 434, 438 prescriptions

causes of bias in prescribing patterns 266–72, 359, 366 ethics for pharmacists 505–11

preventive ethics 294, 476–7 primary healthcare 475

Prince of Wales’ Foundation for Integrated Health (UK) 518

principlism 3–4, 492

priority setting see resource allocation prisoners, maltreatment of 350–7

see also capital punishment prisoners of war 352, 354 program-budgeting analysis 252 prophylaxis 127, 482, 483 Protestantism 234, 235, 430–5

proxy directives (durable powers of attorney for healthcare) 59, 62, 68

see also living wills

‘‘prudent patient’’ standard of disclosure 25–6, 37 psychiatric illness see mental illness psychotherapy 488–90

public accountability 514 public health 274

in developing countries 370

disasters and epidemics 241, 281–6, 342 epidemiological research 189, 207–12 genetic screening and 160, 162

infectious diseases 32, 274–5, 275–9, 481–2, 483, 484 newborn screening 105

public opinion

abortion see termination of pregnancy genetic testing 163

stem cell research 156–7 publication bias 202, 224, 227 purity, religious views 404, 406, 411

qi (ch’i) 398

quality end of life care 51, 53–6, 81–3

quarantine 277, 284–5, 483 Quebec 170, 189

Quinlan, Karen 87 Qur’an 408, 409

Ramsey, Paul 432

randomized clinical trials 201–2, 203, 215–16

Re T (Adult Refusal of Treatment) [1992] (UK) 18, 32 ‘‘reasonable doctor’’ standard of disclosure 25, 37 ‘‘reasonable suspicion’’ in child abuse 135 reasoned contextual universalism 346

reasoned global universalism 346

recruitment into clinical trials see enrollment into clinical trials

refusal of treatment

on behalf of/by children 33, 124, 421, 434

of blood products by Jehovah’s Witnesses 33, 124, 416, 419–22, 434

consent issues 15, 18, 457 capacity 18, 19, 471 voluntariness 32, 33

DNR orders

during surgery 454–9, 457–8 in emergency medicine 472 in ICU 465

euthanasia and 72–3

for infectious diseases 482, 484 in mental illness 491

in pregnancy 97, 102

rural residents refusing transfers 289, 291, 294–5 regenerative medicine 143, 153–8

see also stem cell research registries (databases) 198, 202 religion 245, 379–81

see also cultural differences; individual religions reportable diseases 32, 274–5, 274–9, 481–2, 483, 484 reproductive freedom 98, 115

research 185–6, 187–92, 195 bio-banking 161, 166–72 Catholic view of 438

on children 129, 201, 205, 233 clinical trials 201–5

conflict of interest 187–92, 204, 214–19, 222–8 consent 154, 157

placebo trials 187, 191–2, 203, 215, 341, 346–7 conflict of interest

financial 187–92, 222–8

in the pharmaceutical industry 267, 269 physician–researcher dual role 204, 214–19, 449

confidentiality and 45, 47, 189, 211, 212, 498 consent and 188, 218

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

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

innovative surgical procedures 196

in developing countries 203, 341, 345, 346–7 on embryos see stem cells below epidemiological 189, 207–12

on fetuses 231–2, 232–3, 233–4, 235 funding patterns 224–5, 362–3, 364 law 188–9, 217, 498

clinical trials 204, 227 epidemiological studies 208–9 fetuses 233–4, 235

innovation 196–7

stem cells 116, 155–6, 235 neuroimaging 495–6, 498–9, 500–1, 502 on pregnant women 234

regenerative medicine 143, 153–8 stem cells 231–2, 233, 234–6

law 116, 155–6, 235 public opinion 156–7

surgical innovation 194–9, 449

research ethics boards see ethics review boards residential care 33, 34

resource allocation

in assisted reproduction 115 during disasters 282, 283–4

in ICU 251, 253–4, 255, 462–4, 466–7 organizational ethics and 243, 246, 247–8, 251, 255 organs for transplantation 146, 147–8

pharmacists and 506–7, 509–10 prioritizing 251–5, 283

refusal of treatment and 421 rural communities 290–1

resuscitation

conflict between families and physicians 78, 80, 83 in emergency medicine 469, 472, 473

substitute decision making 58, 62, 63 success of CPR 80, 455, 473

see also do-not-resuscitate orders Roman Catholicism 234, 235, 436–41 rural healthcare 289–95

safety

of community care providers 300, 304

of healthcare

pharmacists’ responsibilities 505, 506, 507–8, 510–11 reporting adverse events 202, 224, 258, 259, 262

of physicians 284, 286 reporting torture 354

treating patients with infectious diseases 484, 485 Saudi Arabia 412

screening tests genetic 160–5

neonatal 104, 105, 106, 107, 108–9 prenatal 104–5, 105–6, 106–7, 107–8 religious views on 412, 434, 438

secondary gain 81

severe acute respiratory syndrome 277, 284 sexual abuse see children, abuse of

sexual health

confidentiality of advice to adolescents 46, 475, 478–9 sexually transmitted diseases 274–5, 278–9

sexually transmitted diseases 274–5, 278–9 Shariah 409

side effects see adverse events Sikhism 403–7

Singapore 147, 235 social factors

in assisted reproduction 115, 116 in epidemiological research 208 in palliative care 56, 67

in reporting of child abuse 134 see also poverty

somatic cell nuclear transfer 155, 156, 232 South Africa 254

Spain 46

sperm donation 112, 114 spina bifida

replacement bladders 153, 158 screening for 106

surgery in utero 232 Sri Lanka 371, 393

stakeholder impact analysis 244 stem cell research 231–2, 233, 234–6

law 116, 155–6, 235 public opinion 156–7 stigmatization of disease

in small communities 289, 292, 295 social consequences 281, 284

substance abuse

capacity and 469, 470, 471, 472–3 diversion of prescription drugs 509 in pregnancy 97–102, 99–100

536 Index

substitute decision making 13, 58–63, 69 for children 114, 121, 123, 125, 129 for ICU patients 466

organ donation 146 suicide 409, 426, 439

assisted 72–5, 427, 508

suicidal behavior as mental illness 492 surgery 447–52

consent 11, 14–15, 196, 447, 448–9, 449–52 DNR orders 454–5, 454–9, 457–8

in emergencies 11, 14–15, 449, 451 fetal 232

innovative procedures 194–9, 449 resource allocation 254

surrogacy 113, 114, 412

surveillance systems 275, 276–7, 483 Sweden 169

Switzerland 73

systems thinking 309, 313–20

Taoism 400

Tay Sachs disease 104 teaching see training teenagers see adolescents

terminal illness see end of life care termination of pregnancy 98, 106, 233

Buddhism 391–5, 393–4 Catholicism 234, 436, 438, 439–40 Chinese culture 399

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

Jehovah’s Witnesses 419 Judaism 427 Protestantism 234, 434

terrorism

dealing with major incidents 281–6 extra-judicial rendition 350, 355–6, 357

Thailand 391–5 therapeutic alliance 489

therapeutic cloning 155, 156, 232

therapeutic misconception 190, 203, 216, 217–18, 219

therapeutic privilege 12, 13, 24, 26, 29, 37, 258 Third World see developing countries

tissue engineering 153, 154, 156, 158 Tokyo Declaration (1975) 350, 353 Toronto Community Ethics Network 301–4

Toronto University Joint Centre for Bioethics 315, 316, 317, 318, 319, 323–7

torture 350–7

Trade Related Aspects of Intellectual Property (TRIPS) Agreement 363

training

in bioethics 310, 329

drug company sponsorship and 266, 267, 269–70, 270–1, 272

in leadership 325 in surgery 197, 448

transplantation

bone marrow 127, 129, 130–1 fetal tissue 233, 234

organs see organ donation regenerative medicine and 153, 155 xenotransplantation 148

trauma medicine see emergency medicine triage

in emergency medicine 469 for intensive care 463–4, 467 in major incidents 283–4

Trillium Gift of Life Network (Canada) 147 TRIPS see Trade Related Aspects of Intellectual

Property tropical diseases 362 trust

confidentiality and 43, 44 disclosure and 24, 37

in end of life care 78, 87 in pregnant women 98, 101

truth telling 10, 36–40

to Aboriginal peoples 383, 385, 386, 389–90 to children 39, 122, 124–5

in Chinese culture 397, 400–2

disclosure of medical errors 37, 40, 257–62 in end of life care 14, 27, 39, 40

offering truth 40, 332, 386, 389 teaching example 329, 331, 332, 333

therapeutic privilege 12, 13, 24, 26, 29, 37, 258 see also disclosure

tuberculosis 33, 483 Turkey 354 Turkheimer, Eric 177

Tuskegee Syphilis Study 208 twin studies 175–6

Uganda 254

UK see United Kingdom ultrasound 104

UN see United Nations

undue influence 31, 32

UNESCO (United Nations Educational, Scientific and Cultural Organization) 162, 168, 334

United Kingdom (UK)

alternative medicine 514, 517, 518 assisted reproduction 114, 116 bio-banking 168, 170

brain death 89 confidentiality 44, 45 consent 13, 19, 26, 32, 33 disclosure 25, 26, 37, 38

driving against medical advice 47 General Medical Council 268 genetics

behavioral 179 testing 162–3

London bombing (7 July 2005) 281, 286 maltreatment of prisoners 351

management of bioethics services 315, 316, 318, 319

pharmaceutical companies’ influence 268, 269, 272 pregnant women’s rights 99

research

clinical trial guidelines 204 on embryos 116, 155, 235

rural healthcare 290 teaching resources 334 withdrawal of treatment 73

United Nations (UN)

on access to medicines 360 on bio-banking 168

on genetics 162

on maternal rights 99

on torture 350, 351, 352–3, 354, 355 see also World Health Organization

United States of America see USA

Universal Declaration of Human Rights (1948) (UN) 99, 351

USA

accreditation 245, 313, 323 advertising 498, 499 alternative medicine 515–17 anthrax scare 281, 284 assisted reproduction 117, 235 bio-banking 168, 170

brain death 89

capital punishment 457, 458, 459 children

child abuse 132, 133, 134, 135, 136

Index 537

decision making for 124 newborn screening 105, 106

confidentiality 45, 508 consent 26, 37, 188, 234

disability legislation 107, 163, 483 disclosure 26, 37, 38, 188

DNR orders 457, 458 emergency medicine 470–1 end of life care 54

assisted suicide 74–5

substitute decision making 59–60, 66, 466 withdrawal of treatment 79, 83

Food and Drug Administration 156, 189 infectious diseases 276, 482, 483

management of bioethics services 313, 315, 316, 317, 320

medical error 257, 259 mental illness 490, 491 organ donation 147, 148 organizational ethics 245

pharmaceutical companies’ influence 269–70 poverty and healthcare 283, 290, 360 prenatal testing 106

public health 276, 286, 483 newborn screening 105, 106

research 189

Belmont Report 185, 188, 195, 214 clinical trials 204, 227

on embryos 155, 156, 235, 236 on fetuses 233–4

financial conflict of interest 195, 226 patient access to 217

Tuskegee Syphilis Study 208 rural healthcare 290, 292, 293 surgery 448, 450, 458 teaching resources 334

tissue engineering 156

Uniform Anatomical Gift Act (1968, 1987) 147 United Network for Organ Sharing 147

utilitarianism confidentiality 44

in international aid 364, 369 organ donation 146

in treatment of mental illness 491

vaccination 419, 482, 483

Veterans Health Administration (VHA) (USA) 60 victim-blame 355

Vietnam 371