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Biomedical subjects

B M Dickens

Publications and source records attributed to B M Dickens.

At least 19 recordsLinked to original sources
PubMed1999

Human rights and abortion laws.

Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women's wishes and women's reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women's reproductive self-determination and due to prenatal life. Human rights protect healthcare providers' claims to conscientious objection, but not at the cost of women's lives and enduring health.

Abortion, Induced↗
PubMed1999

International developments in abortion law from 1988 to 1998.

OBJECTIVES: In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women's human rights has influenced legal reform. METHODS: A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences. RESULTS: Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third-party authorizations, and blockades of abortion clinics. CONCLUSIONS: Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women's health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information.

Abortion, Legal↗
PubMed1998

Bioethics for clinicians: 16. Dealing with demands for inappropriate treatment.

Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements.

Adult↗
PubMed1997

Bioethics for clinicians: 13. Resource allocation.

Questions of resource allocation can pose practical and ethical dilemmas for clinicians. In the Aristotelian conception of distributive justice, the unequal allocation of a scarce resource may be justified by morally relevant factors such as need or likelihood of benefit. Even using these criteria, it can be difficult to reconcile completing claims to determine which patients should be given priority. To what extent the physician's fiduciary duty toward a patient should supersede the interests of other patients and society as a whole is also a matter of controversy. Although the courts have been reluctant to become involved in allocation decisions in health care, they expect physicians to show allegiance to their patients regardless of budgetary concerns. The allocation of resources on the basis of clinically irrelevant factors such as religion or sexual orientation is prohibited. Clear, fair and publicly acceptable institutional and professional policies can help to ensure that resource allocation decisions are transparent and defensible.

Canada↗
PubMed1997

Bioethics for clinicians: 11. Euthanasia and assisted suicide.

Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means.

Attitude to Health↗
PubMed1997

Human research beyond the medical model: legal and ethical issues.

Advances in medical health depend on non-medical, as well as medical research. When research involves human participants, it raises legal and ethical concerns that have come to be approached by reference to codes of research ethics. Many of these are centered on physician-patient relationships and the pursuit of medical science. This article considers a number of issues that arise from research that follows non-medical models of research, and applications of rules of ethical medical research outside physician-patient settings. In particular, it addresses health research in the social sciences, the exclusion of women as participants in medical research, studies that depend on incomplete disclosure of information to prospective participants and their deception, and public health research based on groups and communities rather than participants as individuals.

Adolescent↗
PubMed1996

Legal and ethical issues in genetic testing and counseling for susceptibility to breast, ovarian and colon cancer.

The prediction of susceptibility to heritable breast, ovarian and colon cancer raises important legal and ethical concerns. Health care professionals have a duty to disclose sufficient information to enable patients to make informed decisions. They must also safeguard the confidentiality of patient data. These duties may come into conflict if a positive finding in one patient implies that family members are also at risk. A legal distinction is made between a breach of confidentiality and the legitimate sharing of information in a patient's interest or to prevent harm to a third party. Physicians also have a fiduciary duty to warn. Other issues concern the legal liability assumed by genetic counsellors, whose disclosures may influence decisions about childbearing, for example, and the risk of socioeconomic discrimination faced by people with a known genetic susceptibility. Traditional ethical orientations and principals may be applied to these and other questions, but feminist ethics will likely have particular importance in the development of an ethical stance toward testing and counseling for heritable breast and ovarian cancer.

Beneficence↗
PubMed1996

Legal and ethical challenges in gene therapy.

This paper addresses implications of applying the ethical principle of justice to gene therapy. Regarding somatic cell gene therapy as a treatment of last resort for life-threatening or seriously disabling disorders may be inconsistent with subjecting therapy to the preliminary scientific and ethical scrutiny given to research proposals. Emergency care may justify disregarding legal conditions of care, and be governed by different ethical priorities than research. Excluding gene therapy for reasons of enhancement rather than cure is widely agreed, but cosmetic procedures are considered legitimate in private markets. Intergenerational justice is a principle that may justify concentrating therapy on conditions afflicting children rather than older patients.

Advisory Committees↗
PubMed1994

Legal issues in predictive genetic testing programs.

This article reviews aspects of predictive genetic testing to which the general law of doctor-patient relations applies and identifies peculiarities of such testing that raise more specialized legal issues. Where testing programs are experimental in character, investigators bear legal responsibilities to inform their subjects adequately and separate duties to submit their proposals to ethical review. Access to routine care and counseling and to specialized testing programs are addressed in the contexts of antidiscrimination laws and patient protection. The law on patients' adequately informed and free decision-making regarding testing is reviewed, with particular attention to reproductive counseling and planning for future inability to make or express decisions about care. Modern perceptions of the legal nature of medical confidentiality are applied to results of predictive genetic testing, and distinctions are illustrated between justified and excusable breaches of confidentiality, particularly with regard to familial disorders. Attention is given to patients' directions that their medical information be made available to third parties and to themselves. Finally, legal issues are considered regarding legal control of tissue samples that patients give for genetic diagnosis.

Aged↗