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  • Daniel Sulmasy unpacks the concept of informed consent
    them to make good choices and that includes permitting physicians to make recommendations based on their experience and practical wisdom Patients can freely decline the physician s recommendation but they deserve guidance to help them to make the best choices that they can make XS Can t limits on informed consent be seen as a subtle paternalism This depends on what those limits are Some limits on patient choice are justified and the ethical question ought to be whether patients are free to demand from the health care system whatever they choose For example I defend a narrow standard of biomedical futility based on the judgment that a treatment will not work or that the patient will die soon even if the treatment is given Under such conditions one does not in my view need informed consent from the patient or family not to provide requested interventions This is based on the principle that there can be no moral obligation to do what cannot work and can only result in harm to the patient This is just common sense ethics not paternalism Judgments based on broader understandings of futility by contrast can be paternalistic For example if the doctor determines that a treatment might work but the quality of life expected for the patient would be too low to justify it even if the family is requesting it that judgment would be paternalistic and in my view unjustified XS Recently BioEdge reported the case of a pregnant Australian woman who refused a blood transfusion on religious grounds and died along with her baby How would you have navigated this tragic situation This is truly tragic The sort of case you describe might for instance involve a Jehovah s Witness who holds a religious belief that blood transfusion is gravely sinful As a general rule under US law patients can refuse any treatment for themselves Nonetheless also as a general rule parents are precluded from martyring their children That is they cannot refuse life saving medical care for their children on the basis of their own religious beliefs Such legal protections however only kick in at birth Until that time the mother s right to refuse treatment trumps the effect of that refusal on her developing fetus For instance the US Supreme Court banned one city s policy of incarcerating pregnant cocaine addicts to protect the fetus from the adverse effects of cocaine So in the case you describe one could plead on moral grounds with such a patient on behalf of the not yet born child but could not transfuse her legally against her wishes XS The Grey Matters report from the President s bioethics commission suggested that patients with impaired consent capacity be included in neuroscience research How is this consistent with protecting the disadvantaged Some medical conditions that are poorly understood and urgently need more research impair the capacity of those who suffer from them to consent to research making research difficult or impossible to carry out These

    Original URL path: http://www.bioedge.org/bioethics/daniel-sulmasy-on-informed-consent/11445 (2016-02-18)
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  • BioEdge: the latest news and articles about bioethics
    Witness who refused transfusion allowed to die in UK Michael Cook 16 June 2012 Comments tags informed consent Jehovah s Witness Two cases involving Jehovah Witnesses who refused blood transfusions are in the news a 22 year old with sickle cell anaemia who died in the UK and a 4 year old girl in Australia who lived after a court ordered transfusion Search BioEdge Subscribe to BioEdge newsletter Subscribe to

    Original URL path: http://www.bioedge.org/bioethics/tag/Jehovah%27s+Witness (2016-02-18)
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  • BioEdge: the latest news and articles about bioethics
    conduct virtue ethics Patients often complain that new doctors lack empathy What s the solution Kristján Kristjánsson on virtuous medical practice Xavier Symons 03 April 2015 Comments tags interviews medical students principalism professional ethics virtue ethics Philosopher Kristján Kristjánsson recently spoke to BioEdge about the importance of virtue in medicine Search BioEdge Subscribe to BioEdge newsletter Subscribe to BioEdge RSS feed Recent Posts Dutch psychiatric patients may get euthanasia too

    Original URL path: http://www.bioedge.org/bioethics/tag/virtue+ethics (2016-02-18)
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  • BioEdge: ‘Foreigners do not understand us’
    is probably worse in other countries In Belgium and in The Netherlands so the claim goes we are conducting our affairs in the open in a candid and transparent way while no data is available for other countries I have heard these arguments again and again In fact the Belgian like the Dutch actually do not welcome criticism and are quite conservative in their liberal attitude to euthanasia Both countries are protective of their systems and believe that their euthanasia policy is correct and just Curiously some of the leading Belgian scholars on euthanasia publish only the facts without any interpretation or reflection I am yet to hear a convincing argument for this so called neutral approach I say so called neutral because silence is also a stand Belgian and also Dutch people pride themselves on their openness on their ability to discuss and debate life and death decisions openly In this same spirit they should openly debate the more intricate and problematic aspects of the euthanasia policy while having adequate knowledge about the various end of life practices The full picture of the data should be disclosed to the public Transparency is indeed of vital importance in promoting and safeguarding patient s autonomy at the end of life Does Belgium offer lessons for other countries which are considering euthanasia or assisted suicide There are many lessons to be learned from Belgium both positive and negative Let me mention only some of them and I start of the positive The practice of medicine should be deontological rather than utilitarian Patient s autonomy and preferences should be respected as much as possible The Belgian medical system on the whole manifests that Belgian palliative care has been developing and continues to develop This is a great positive in the Belgian medical system The World Health Organization WHO defines palliative care as the active total care of patients whose disease is not responsive to curative treatment maintaining that control of pain of other symptoms and of psychological social and spiritual problems is paramount The medical staff must examine whether it is possible to prevent or to ease the pain by means of medication and palliative care Belgian scholars continue to conduct surveys about the euthanasia practice and produce consecutive reports also in English This is certainly a good practice Other countries should also strive to compile extensive reports of their own end of life practices The practice of a truly independent second opinion to verify the patient s diagnosis and his her voluntary wishes is a good example to follow The Belgian themselves are still challenged to implement this practice in full for all patients but they are constantly trying to improve The insistence that the final act should performed by physicians is correct The Belgian medical establishment is struggling with this directive as well sometimes the practice is conducted by nurses but professionals are aware of the problem and trying to remedy this Much of the euthanasia practice of ending life in

    Original URL path: http://www.bioedge.org/bioethics/foreigners-do-not-understand-us/11505 (2016-02-18)
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  • BioEdge: Interview: Julian Savulescu, editor of JME
    not radically new but it was sufficient to get into the mainstream media with demands for sacking of at least one of the academics concerned Blogs and social media connected these articles with Christian right groups that then moved them around the internet What I have learnt is that it is not Big Brother who is watching but everyone In the current era everything that is published can be instantly accessed by nearly everyone Ethicists have to be prepared for titles and one liners to be pumped around the internet You have to be prepared to defend what you have written or published against the harshest criticism Do I welcome media coverage I used to and it was part of my previous job to engage with the media These days I think it can sometimes do more harm than good It is mostly the people who violently disagree who get involved not those who agree or even who are open to an engaged debate The terms of internet discourse are not pleasant there are few rules that people abide by and it tends to be nasty and brutish but not necessarily short XS How should journal editors and academics manage the media It must be hard to navigate between being too boring and being too controversial You can t manage the media It is hard to perfectly predict what will be picked up and how But on any potentially provocative piece you need to make sure that you can defend it that the title is not going to be offensive or damagingly inflammatory and that lines can t easily be pulled to misrepresent what the argument actually is My previous boss said to me about the media it doesn t matter so much what you say as what people hear I think the goal should be to get people to hear the argument in its entirety without being sidestepped into a knee jerk response without engaging in it They might well still disagree but then it is a debate not a meaningless controversy for a few days XS Editing a journal impartially can t be easy What do you think it means to be balanced And how do you go about achieving balance in what you publish On provocative pieces we try to run commentaries that give the opposing side now We give priority to pieces that present a different perspective than those that we have previously published on a topic Editing a journal is a job you have a duty to the readers as well as to authors XS Blind peer review is one way to achieve objectivity but it has been attacked in recent years Are you happy with it Peer review is less than perfect Blind peer review is an attempt to reduce the subjectivity but you can still send the same article to two experts in the field and receive completely divergent views We are moving towards a system of triple blinding blinding not just to

    Original URL path: http://www.bioedge.org/bioethics/interview-julian-savulescu-editor-of-jme/11530 (2016-02-18)
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  • BioEdge: the latest news and articles about bioethics
    selection and presentation of its material The latest feature is Author Meets Critics a series in which authors present the principal arguments of a recent book and then respond to a handful of critics The latest goss on infanticide Michael Cook 23 June 2012 Comments tags after birth abortion infanticide Journal of Medical Ethics Julian Savulescu A Washington Post blog has announced that the editor of the Journal of Medical

    Original URL path: http://www.bioedge.org/bioethics/tag/Journal+of+Medical+Ethics (2016-02-18)
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  • Interview with Daniel Robinson -- the foundations of bioethics
    of what will thereupon be brought about there and then Truman s advisors were right in telling him that more death and destruction would attend a ground war in japan than in using two atomic bombs They got the right calculation but one that excluded what turned out to be a nuclear arms race that has yet to reach critical mass So even if your moral compass does no more than give sums regarding future and dubiously quantified happiness or utility we are simply awful as oracles XS You have edited a book discussing the Roman Catholic perspective on human nature What do you think utilitarian approaches to bioethics miss in terms of human nature DR I think one can accommodate a utilitarian ethics within the framework of catholic teaching The fit will be less than ideal but as i say the two surely can co exist Indeed one might regard eternal life in heaven as the most desirable and greatest happiness thereupon acceding to church teaching for that very utilitarian outcome The problem of course is that a quid pro quo moral life is not authentically moral in the first instance for such a life would adopt any course of action promising the same payoff XS Respect for autonomy is seen by many as the most important principle in bioethics Do you agree DR Autonomy is not a principle it is a power murders are committed autonomously and banks are robbed as well The question therefore is just what principle do we adopt and apply autonomously Bioethicists have this ipse dixit habit of regarding as ethically settled whatever 80 of them subscribe to The problem begins as is often the case with the hyphen If we have a defensible ethics we do not need a bio ethics less a

    Original URL path: http://www.bioedge.org/bioethics/interview-daniel-robinson-on-bioethics-and-utilitarianism/11560 (2016-02-18)
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  • BioEdge: the latest news and articles about bioethics
    Comments tags autonomy bioethics communitarianism Daniel Callahan One of the grand old men of American bioethics he is a reminder of a broader and more communitarian view Search BioEdge Subscribe to BioEdge newsletter Subscribe to BioEdge RSS feed Recent Posts Dutch psychiatric patients may get euthanasia too easily says US study 14 Feb 2016 A Dutch report applies the brakes on completed life euthanasia 13 Feb 2016 Celebrating 15 years

    Original URL path: http://www.bioedge.org/bioethics/tag/communitarianism (2016-02-18)
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