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CONTENTS Contents Acknowledgments iii Introduction xv Part I Sources of Bioethics for Members of Hospitals, Ethics Committees, and Regulators of Healthcare 1 Chapter 1 Drawing Lines in Bioethics: Medicine and the Law 3 1. What Are the Subjects of Bioethics and the Law? 3 2. Environmental Parts of Ethics 6 3. The European Union Convention on Human Rights (ECHR) and Bioethics Normal Medical Practice 9 4. The Partial Transition from Bioethics to the Law-Charles Snow 11 a) Differences between Bioethics (Referred to the Hospital's Ethics Committee) and Medical Malpractice (Referred to the Hospital's Peer Review Committee); Physician Expert Witnesses 14 b) The Better Way to Face These Problems 23 Chapter 2 The Creation and Evolution of the Universe and Humankind 27 1. Cosmic Evolution from the Beginning of Time 28 a. The Big Bang and the Meaning of the Creator of the Universe, Its Age, and Evolution 32 b. Potential of Progress in Astrobiology, Astrology 41 2. The Importance of the Continuance of Evolution into Bioethics, Medicine, and the Law 46 a) What Constitutes Life Itself? 46 b) The Importance of Considering the Meaning of Evolution 54 c) Evolutionary Advances by the Third Millennium 63 d) A Key to the Basis of Significant Contingencies (Not Design) in Evolution 66 e) Law and Biology 68 Chapter 3 Religious Sources, Their Restrictions, and Their Possible Bioethical Standards 73 1. Certain Differences between Religious and Bioethical Standards 74 a) Monotheism and Its Maintenance in Modern Times 76 b) Consideration of Religious and Ethical Standards under the U.S. Constitution 80 2. A Brief Look at Several of America's Diverse Religions Together with Their Restrictions on Possible Medical and Ethical Sources 86 3. The "Wall of Separation" and Legal Bans on Teaching Religion in Public Schools 127 Chapter 4 Some Differences and Difficulties with Science and Philosophy in the Search for Bioethical Standards 145 1. Better Reasoning and Performance of Science; Law and Ethics Partially Distinguished 146 2. Some Scientists Are Religious, Fewer Are Atheists, and More Are Agnostics 151 a) Prayer and Certain Conflicts; Reincarnation 152 b) Limitations of Science; Risk/Benefit Review by IRBs in Research Clinics; Complementary and Alternative Medicine (CAM) 165 3. A Problem With the Use of Either Reason or Philosophy Alone 176 4. The Allegation of Neutral Principles; Science and the Humanities 180 5. The Change in Modern Philosophy and Secular Humanism 185 Chapter 5 Autonomy, Responsibility, and Informed Consent 189 1. Autonomy and Responsibility 190 a) Animal Anatomy of Autonomy in Nature and the Need for Ecology 190 b) From Animal Autonomy to Human Autonomy 193 c) Paternalistic Opposition to Individual Autonomy 200 d) The Balance Between Autonomy and Responsibility, Majority vs. Minority 207 2. Eugenics Examples in Bioethical Issues 211 a) The Ethical Need for Increased Individual Responsibility 214 b) Bioethical Considerations of Religious Diversity and Educational Autonomy 218 3. The Informed Consent: Results from Advances in Autonomy 222 a) The Golden Rule for Use by Physicians 226 b) Alleged Reliance on Patients to Ask Questions 228 c) Informed Consent Concerned with Alternative Treatments in Law and Medicine and the Rise of Consumerism 230 d) Guidelines for Informed Consent in Medicine and the Law; Mandating Reporting of Violence 233 e) Informed Consent on Clinical Research under IRBs and Experimental Treatments during Life-Threatening Situations through Randomized Placebo-Controlled Investigations 237 f) Informed Consent by Emergency Department Physicians, EMTALA, the Triad Terrorist Attacks; Radiation Treatment 242 gi) Nuclear Terrorism 250 h) Informed Consent v. Ethnic Groups and Prisoners 258 i) Informed Consent v. Laws Authorizing Patient Access to Obtain Physician Profiles; Medical Students Characterized as "Doctors" 261 j) Mental Competence to Give Informed Consent 269 k) Informed Consent by Minors 275 Chapter 6 Ethics, Bioethics, and Ethics Committees 279 1. Lack of Fundamental Constitutional Rights to Healthcare and Education, Costs 280 2. Bioethicists: With and Without Religion 285 3. Ethics as Viewed by Some Physicians; Errors and Interests; Lack of Effective Discipline; and Use of Placebos 293 a) Ethics Viewed by a Survey of Physicians vs. Other Readers (of JAMA) 293 b) Evaluations of Physicians (or Bioethicists) Who Work for Manufacturers of Drugs or Medical Devices 294 c) Peer Review Distinguished from Most Bioethical Committee Matters 308 d) Medical Errors, Lack of Reporting, PSQIA and (Medicare Fraud) 312 e) Doctoring Business with Fraud and Waste; and Use of "Double Standards" for Admission to Medical Schools 322 4. The Vagueness of Bioethical Principles and the Need for an Alternative 325 5. The Teaching of Bioethical Ethics and the Law; Ethical Lapses 328 6. The Role of Biomedical Ethics Committees and the Meaning of Care 331 a) JCAHO's Requirement of a "Mechanism" for Ethical Issues 332 b) The Lack of Standards for Membership Credentials 336 c) The Goals of Medicine and of Bioethics Committees; "Clarification" and Other Goals 338 d) Physician Dominance in Hospital Ethics Committee Decision Making 341 e) Hospital and Ethics Committee Records 345 7. Organizational Ethics 348 a) Health Maintenance Organizations (HMOs); ERISA and Rationing 349 b) Fraud in Medicare and Medicaid; Contracting Practices of Healthcare Organizations and Needs of Guidelines of the FAR 356 Part II The Issues Bioethics Must Continue to Solve During the Twenty-first Century 363 Chapter 7 To Conceive or Not to Conceive-The Ethics of Family Planning and Birth Control 365 1. Births within Marriage, Divorce, Same Sex, and Births Outside of Marriage 366 2. The Great Ethical Problem of Overpopulation 378 a) The Current Increasing Population 378 b) The Ethical Need to Establish a National Goal for Family Planning; President Nixon's Goal 383 c) Immigration Ethics and Population Increase 387 d) Environmental (and Bioethical) Problems Growing Out of Overpopulation 392 3. Ethical Actions That Can and Should Be Taken 396 a) Involuntary Birth Controls 396 i) Involuntary Sterilization, Castration, and Mental Retardation 398 b) Voluntary Birth Controls 404 i) Voluntary Sterilization 405 ii) Contraception; Breast-feeding 408 iii) Unintended Pregnancies 415 iv) Emergency Contraception 418 Chapter 8 Infertility, Impotence, and Cloning 1. Fertility and Impotence 422 a) Some Causes of Impotence 422 b) Public Subsidizing of Reproductive Assistance and Mandatory Insurance Coverage 428 c) Fertility Clinics and Preimplantation Genetic Diagnosis; Lack of Regulation by Many States; Embryo Detraction 433 d) Sperm Banks and Sperm Problems 446 e) Egg Banks 450 f) Frozen Embryos and Agreements to Donate Them, Posthumous Reproduction 453 g) Multiple Births Resulting from Fertility Pills 460 h) Artificial Insemination of Single Mothers 465 i) Surrogacy 468 2. Cloning in the Third Millennium 472 a) Origins of Cloning 472 b) Some Religious Reactions 479 c) Some Political and Legal Statements on Human Cloning and Stem Cell Research 481 d) Some Views of Scientists and Physicians on Human Cloning 488 e) Proposed Limits on Cloning in Ethics and the Law 490 Chapter 9 The Choice of Abortion 497 1. Legality, Privacy, and Substantive Due Process 498 2. Restrictions on Public Funding of Abortions 508 3. Religion and Abortion 512 4. Abortion Pills and Other Devices 517 5. Unwanted Pregnancies, Unmarried Mothers, and Abortion Rates 521 6. Spousal and Parental Consent for Abortions 527 7. Harassing and Bombing Abortion Clinics 532 8. Formerly Mandated C-Sections to "Save" a Viable Fetus 537 9. Genetic Testing and Prenatal Counseling; Gender Selection 541 10. Partial Birth and Post-viability Abortions 549 11. Shortage of Physicians for Abortions 556 Chapter 10 Fetal Abuse and Severely Defective Newborns 561 1. Current Liberty Interests of Most Pregnant Drug Users 561 2. Withholding Medical Treatment from Severely Defective Premature Infants with Low Birth Weight 570 3. Newborn Screening Requirements: Intersex Conditions 577 4. Attempts to Prevent Premature Infants with Very Low Birth Weight and Futile Results in Certain Prenatal Births 581 5. Poor and Expensive Outcomes at Neonatal Intensive Care Units (NICUs) 585 6. Proposal that Parents Share Some Expenses and Time 593 7. Infanticide and Abortions after Viability of Certain Types of Severely Defective Infants 595 Chapter 11 Restrictions on the Sources and Allocation of Organ Transplants 605 1. Restrictions on Sources for Organ Transplant and Embryo Transfer in the Twenty-first Century 606 a) The Need for Consent to Organ Transplants 613 b) Religious and Cultural Restrictions on Transplants 618 i) Embryo Transfer for Stem Cell Research 621 c) Donations to or by Living Mature Minors and Other Legal Incompetents 633 d) Sales of Organs 638 e) Organs from Suicidal Donors and Executed Criminals (Murderers) 643 f) Organs from Anencephalics 648 g) Fetal Tissue and Mortality Rates in Hospitals; Age Limits 650 h) Whole Brain Death (by Neurologic Criteria) and Persistent or Permanent Vegetative State (PPVS) 657 i) Xenotransplants (from Animals to Humans) 668 2. Allocation of Donated Organs 674 a) Allocation Priority to the "Sickest" Nationwide; HIV Patients 675 b) Non-direct Donations by Living Individuals 680 c) Directed Donations by Living Persons 683 d) Transplants to Patients with End-Stage Renal Disease (ESRD) 684 Part III The Right to Die with Dignity 689 Chapter 12 The Right to Dignity in the Dying Process 691 1. The Need for End-of-Life-Care Professionals in the Dying Process 692 2. The Refusal to Acknowledge the Right to Die 704 3. Culture, Longevity, and Quality of Life Decisions; Monism and Dualism 707 a) Increasing Longevity 710 b) Decreasing Longevity and Quality of Life 719 c) Obesity and Deaths 735 4. Attempts to Change from the "Slow Course to Death" to "Varieties of Approaches to Death," Kubler-Ross 745 5. Pain and Its Partial Management 749 a) Pain 749 b) Pain Management and Its Limitations 751 6. Costs Incurred Nearing End-of-Life Healthcare 761 a) Entitlements and Their Limitations; Social Security 763 b) Inequitable Allocations and Deceiving Healthcare Payers v. HMOs 766 c) Long-term Home Care and Nursing Homes 773 Chapter 13 Improvements Needed in the Twenty-first Century Right to Die 779 1. Training for End-of-Life Care 780 a) Advance Directives, Living Wills 782 2. Surrogates, Durable Powers of Attorney, and Emergency Treatment (EMTLA) 791 3. Withholding and Withdrawal of Treatment; Limitations on Nonbeneficial (Futile) Treatment: DNR vs. CPR 798 a) Withholding Equals Withdrawal 802 b) Withholding Nutrition and Hydration 803 c) Patients in a Persistent or Permanent Vegetative State (PPVS) Without a Living Will or DPA; Subjective Personhood 808 4. The Rights of Mature Minors to Die and Jehovah's Witnesses 813 5. The Choices of Do Not Resuscitate (DNR) vs. Cardiopulmonary Resuscitation (CPR): Legal and Ethical 818 a) Presumed Consent to Cardiopulmonary Resuscitation (CPR) 820 b) Best Interests v. Substituted Judgment 826 6. Limitations on Nonbeneficial (Futile) Treatment 828 a) Treatment Beyond the "Goals of Medicine" 831 b) Treatment Regardless of a Lack of Consensus on "Futility" 833 c) The Unique Direction of Informed Consent 836 d) A Way to "Free" Physicians from Self-Interest or Self-Protection in Connection with Life Support; Anencephalics 838 e) The Authority and Responsibility of Physicians with ICUs and Authorized Executions 843 f) The Current Method of Stopping Futile Treatment of Dying Patients by the AMA and by Texas 851 7. Slow Code 855 Chapter 14 End-of-Life Choices of Terminal Patients 857 1. The Choice of Suicide 858 a) Some Religious Views of Jews and Jehovah's Witnesses 858 b) Various Reasons for Possible Suicides; Taking Risks (Motorcycles) 862 c) Limitations on the Duty to Deny Suicide 868 d) The Option of Knowing That You Can 871 2. The Goals of the Hospice Option 873 a) Assistance and Lack of Hospice Assistance in Dying 879 3. The Choice of Physician-Assisted Suicide; Double Effect; Costs of Capital Punishment Procedures 881 a) Some Religious Views on PAS 889 b) The Choice of Double Effect (or Euthanasia) by the Use (or Abuse) of Lethal Doses of Pain Medication 891 c) The Choice of PAS and/or Double Effect in Oregon 896 4. Limitation in Model Statutes; Mandatory Psychiatric Examination 907 5. Progressive Nullification of Anti-PAS Statutes 910 a) Civil Disobedience Actions by Physicians and Nurses 910 b) The Prohibition Analogy (Nullification) 911 c) The Example of Dr. Kevorkian 912 6. Other Choices of Euthanasia 914 Part IV Bioethics and Future Somatic and Germline Gene Therapy 921 Chapter 15 Bioethics on Genetics Superseding the Human Genome Project 923 1. The Human Genome Project 924 2. Genetically Modified Crops 934 3. Genetic Approaches to Disease; Confidentiality; Non-disease and Privacy 941 4. The Absence of Ethics and Morals in Patents on Genetically Engineered Living Things 952 5. The Possible Future of Inheritable Genetic Interventions and Changes in Homo Sapiens 960 a) Clinical Trials on Genetic Research 964 b) Distinctions Between Somatic and Germline Therapy 969 c) Somatic Gene Therapy and Some Needs for Mandatory Testing 972 d) The Publicity Needed for Recombinant DNA Research by Public and/or Private Entities 982 e) Germline Gene Therapy 985 i) Age Limits 991 ii) Intelligence Quotient; Millionaires; Brains of Males and Females; and Sizes in Animals 996 iii) The Importance of Germline Gene Therapy for Space Travel 1008 Chapter 16 Epilogue 1021 1. Twenty-first Century Bioethical Decisions within Traditional Cultural, Religious, or Nontraditional Categories by Federal and State Courts 1033 Appendix A: Environmental Crises at the Turn of the Third Millennium 1045 1. Life's Ecological Needs and Purposes According to Existential Philosophers; Environmental Crises 1046 2. Biomass and the "Lack in Accounting" for the Loss in its "Capital" 1049 3. A Sustainable Environment in Forests and for Animals 1053 4. Social Structures of Humans and Two Other Primates 1061 5. The Ocean and Their Fish and Whales 1062 6. The Human Need for Protection Against Release of Chemicals into the Atmosphere 1065 7. Ozone Depletion 1069 8. Global Warming and the Loss of Biological Diversity 1073 a) Solar, Moon, and Wind Power vs. Coal, Gas, and Oil 1076 b) The Hydrogen Engine vs. Electric Cars 1078 Appendix B: Some Views on Medicine in the Two Chinas and Tibet at the Turn of the Millennium 1081 1. Documentary Video "Beyond The Clouds" and Interview with an Experienced Doctor 1082 2. Birth Control for Han Chinese Majority vs. Minority 1084 a) The "Critical Appraisal" of Dr. Ruiping Fan 1085 b) Some Remarks on Articles Contained in the Volume "Chinese and International Philosophy of Medicine" (1998) 1086 3. Adoptions of Abandoned Girls by Foreigners in Beijing 1088 4. Reactions to a Presentation on American End-of-Life Laws in Beijing 1088 5. Reactions by Lawyers in the "Other China" (Taiwan) 1089 6. Tibet 1091 a) The Herbal Medicine Hospital in Lhasa, Tibet, a Teaching Hospital 1091 Appendix C: False Claims Act Settlements and Rulings in Healthcare Organizations 1093 Appendix D: Millennia 1103 Appendix E: Genetic Research and Economic Advantage of Abbreviated New Drug Applications 1103
Library of Congress Subject Headings for this publication:
Medical ethics -- United States.
Bioethics -- United States.
Bioethical Issues -- United States.
Bioethical Issues -- legislation & jurisprudence -- United States.
Bioethics -- United States.