Journal of Medicine and Philosophy - current issue

Editorial Board

Tue, 12 Jan 2010 23:32:00 PST

Subscription

Tue, 12 Jan 2010 23:32:00 PST

Cover

Tue, 12 Jan 2010 23:32:00 PST

La Frontera: Responsibly Managing Borders and Boundaries in Clinical Ethics

Mccullough, L. B. — Tue, 12 Jan 2010 23:32:00 PST

The papers in the 2010 "Clinical Ethics" number of the Journal of Medicine and Philosophy explore issues along La Frontera, the borders and boundaries of clinical ethics. The first three papers in this "Clinical Ethics" number of the Journal explore borders and boundaries drawn within clinical ethics, concerning the moral standing of complementary and alternative medicine, palliative sedation, and induced abortion and feticide. The fourth and fifth papers explore the borders and boundaries between research ethics and clinical ethics.

The Proper Role of Evidence in Complementary/Alternative Medicine

Hansen, K., Kappel, K. — Tue, 12 Jan 2010 23:32:00 PST

In this article we explore the role evidence ought to play in complementary and alternative medicine (CAM). First, we consider the claim that evidence in the form of randomized controlled trials (RCTs) cannot be obtained for CAMs. Second, we consider various claims to the effect that there are ways of obtaining evidence that do not make use of RCTs. We argue that there is no good reason why CAM should be exempted from the general requirement that treatments undergo evaluation by RCT. Third, we consider two implications for health care policy. First, many activities in conventional medicine have never been rigorously evaluated and are widely in use nonetheless. We argue that this fails to provide a reason for exempting CAM from a demand for evidence. Second, CAM use may be compared to a choice of lifestyle, and this has a significant impact on which requirements of evidence can reasonably be imposed.

Disambiguating Clinical Intentions: The Ethics of Palliative Sedation

Jansen, L. A. — Tue, 12 Jan 2010 23:32:00 PST

It is often claimed that the intentions of physicians are multiple, ambiguous, and uncertain—at least with respect to end-of-life care. This claim provides support for the conclusion that the principle of double effect is of little or no value as a guide to end-of-life pain management. This paper critically discusses this claim. It argues that proponents of the claim fail to distinguish two different senses of "intention," and that, as a result, they are led to exaggerate the extent to which clinical intentions in end-of-life contexts are ambiguous and uncertain. It argues further that physicians, like others who make life and death decisions, have a duty to get clear on what their intentions are. Finally, it argues that even if the principle of double effect should be rejected, clinical intentions remain ethically significant because they condition the meaning of extraordinary clinical interventions, such as that of palliative sedation.

Selective Terminations and Respect for the Disabled

Stangl, R. — Tue, 12 Jan 2010 23:32:00 PST

It is widely thought that abortion on the grounds of fetal abnormality is morally justified. More controversially, Peter Singer has argued that some infants with severe disabilities ought to be killed. Many disability rights activists object that such claims and practices express disrespect toward disabled persons, even if fetuses and infants are only potentially persons. This can seem puzzling. If disabled fetuses are not members of the community of disabled persons, how can our treatment of the former express disrespect toward the latter? In what follows, I shall argue for two claims: first, the he puzzle is only apparent because whether we respect someone depends not only on how we do treat him but also on how we would treat him were circumstances different, and secondly, "substitutionary arguments" for selective terminations of disabled fetuses or infants do express disrespect toward disabled persons, even if fetuses and infants are only potentially persons.

Clinical Research in Context: Reexamining the Distinction between Research and Practice

Anderson, J. A. — Tue, 12 Jan 2010 23:32:00 PST

At least since the seminal work of the (US) National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in the 1970s, a fundamental distinction between research and practice has underwritten both conceptual work in research ethics and regulations governing research involving human subjects. Notwithstanding its undoubted historical importance, I believe the distinction is problematic because it misrepresents clinical inquiry. In this essay, I aim to clarify the character of clinical inquiry by identifying crucial contextual constraints on justification constitutive of clinical science. This analysis shows that, from an epistemological point of view, clinical research and clinical practice are not sharply distinct but intimately intertwined. This result is important in its own right—an enriched understanding of the epistemology of clinical research is valuable in and of itself. But this result is also important because it has profound implications for the ethics of human subjects research.

The Exceptional Ethics of the Investigator-Subject Relationship

Sachs, B. — Tue, 12 Jan 2010 23:32:01 PST

This article concerns the validity of six canonical rules that institutional review boards use to constrain the behavior of investigators. These rules require investigators to design their studies in a scientifically valid way, not pay their subjects to take risks, minimize risks to their subjects, secure for their subjects access to effective interventions post-trial, not pay their subjects too much and allow their subjects to withdraw from the study unconditionally. Enforcement of these rules is problematic because there are other relationships that seem to be like the investigator-subject relationship in all ethically relevant respects, such as the employer-employee and volunteer organizer-volunteer relationships, to which we would not dream of applying these same rules. Applying these rules in one context but not the others is a violation of ethical consistency I label "exceptionalism." We should conclude that it is time to reexamine the validity of the six rules.