Issue 2(3)
Journal of Bioethical Inquiry, Volume 2, Number 3 (December 2005)
Editorials
Bioethics in New Zealand: Continuity, Changes, and Challenges
Lynley Anderson
Letter to the Editor
David Isaacs
Recent Developments
Recent Developments in Law
John McPhee and Cameron Stewart
Original Research
Generating a Taxonomy of Regulatory Responses to Emerging Issues in Biomedicine
Wendy Lipworth
In the biomedical field, calls for the generation of new regulations or for the amendment of existing regulations often follow the emergence of apparently new research practices (such as embryonic stem cell research), clinical practices (such as facial transplantation) and entities (such as Avian Influenza/“Bird Flu”). Calls for regulatory responses also arise as a result of controversies which bring to light longstanding practices, such as the call for increased regulation of human tissue collections that followed the discovery of unauthorised post-mortem organ retention. Whilst it seems obvious that new regulations should only be generated if existing regulations are inadequate (a practice referred to in this paper as “regulatory syncretism”), this does not always occur in practice. This paper examines the conceptual steps involved in generating regulatory responses to emerging phenomena. Two decision points are identified. First, a stance is taken as to whether the emerging phenomenon raises unique ethical or legal issues (exceptionalism versus non-exceptionalism). Second, the decision is made as to whether new regulation should be generated only for truly unique phenomena (syncretism versus asyncretism). It is argued here that it is important to make a careful assessment of novelty, followed by a reflective and deliberate choice of regulatory syncretism or asyncretism, since each type of regulatory response has advantages which need to be harnessed and disadvantages which need to be managed—something that can only occur if regulators are attentive to the choices they are making.
Compromised Ethical Principles in Randomised Clinical Trials of Distant, Intercessory Prayer
Peter Graeme Hobbins
The effects of distant, intercessory prayer on health outcomes have been studied in a range of randomised, blinded clinical trials. However, while seeking the evidentiary status accorded this “gold standard” methodology, many prayer studies fall short of the requirements of the World Medical Association’s Declaration of Helsinki for the ethical conduct of trials involving human subjects. Within a sample of 15 such studies published in the medical literature, many were found to have ignored or waived key ethical precepts, including adequate standards of care, patient confidentiality and informed consent. Prayer was considered in most studies to pose negligible or no risk to subjects, despite the fact that no clear mechanism of action nor any safety monitoring procedures were described. As a result, many studies did not meet basic ethical standards required of clinical trials of biophysical interventions, making application of their results ethically problematic. If investigators wish their data to adequately inform the use or rejection of intercessory prayer to improve health, these shortcomings should be addressed in future studies.
An Economic Theory of Patient Decision-Making
Douglas O. Stewart and Joseph P. DeMarco
Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist’s analysis of autonomy centers on decisional capacity—finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient’s perspective. We show that a rational patient’s desired treatment level typically departs from the level yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient’s decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals’ beliefs about the “unreasonable” attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making.
Exploring the Concept of Genetic Discrimination
Margaret Otlowski
The issue of genetic discrimination has attracted growing attention and has been the focus of a recent major Australian inquiry. It is, however, a complex and loaded notion, open to interpretation. This paper explores the concept of genetic discrimination in both its theoretical and practical dimensions. It examines its conceptual underpinnings, how it is understood, and how this understanding fits within the legal framework of disability discrimination. The paper also examines the phenomenon in practice, including the “fear factor” and the resulting implications for the development of regulatory policy. The paper argues that we need to be discerning in our interpretation of this term, and differentiate between discriminatory conduct which is legal and illegal. Further, it is argued that a concerted societal response to the “problem” of genetic discrimination is needed involving targeted legal reforms as well as broader non-legal strategies.
Reviews
Ethics and Law for the Health Professions
Annette Braunack-Mayer
Case Studies
Responses to Sandy Elkin
Pauline Norris, Hamish J. Wilson, and Medicines Australia
In That Case: Call for Responses
Neil Pickering
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