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Biomedical subjects

Lynn A Jansen

Publications and source records attributed to Lynn A Jansen.

13 recordsLinked to original sources
PubMed2006

Hastening death and the boundaries of the self.

When applying moral principles to concrete cases, we assume a background shared understanding of the boundaries of the persons to whom the principles apply. In most contexts, this assumption is unproblematic. However, in end-of-life contexts, when patients are receiving 'artificial' life-support, judgments about where a person's self begins and ends can become controversial. To illustrate this possibility, this paper presents a case in which a decision must be made whether to deactivate a patient's pacemaker as a means to hasten his death. After discussing some common moral principles that are often applied to resolve ethical problems at the end of life and after explaining why they are of no help here, the paper argues that the correct analysis of this case, and of cases of this sort, turns on considerations that relate to the constitution of the self. These considerations, the paper further argues, sometimes resist resolution. The constitution of the self is fixed in large measure by our concepts and social conventions, and these do not always provide determinate grounds for delimiting the boundaries of the self.

Decision Making↗
PubMed2004

No safe harbor: the principle of complicity and the practice of voluntary stopping of eating and drinking.

In recent years, a number of writers have proposed voluntary stopping of eating and drinking as an alternative to physician-assisted suicide. This paper calls attention to and discusses some of the ethical complications that surround the practice of voluntary stopping of eating and drinking. The paper argues that voluntary stopping of eating and drinking raises very difficult ethical questions. These questions center on the moral responsibility of clinicians who care for the terminally ill as well as the nature and limits of the authority they exercise over them.

Complicity↗
PubMed2002

Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life.

In the recent medical ethics literature, several authors have recommended terminal sedation and refusal of hydration and nutrition as important, morally acceptable, and relatively uncontroversial treatment options for end-of-life suffering. However, not all authors use these terms to refer to the same practices. This paper examines the various ways that the terms terminal sedation and refusal of hydration and nutrition have been used in the medical literature. Although some of these practices are ethically appropriate responses to end-of-life suffering, others (at least as they are currently described in the medical ethics literature) are not. This paper identifies and discusses the principles that morally distinguish these practices from one another and specifically describes different features of medical practices and moral principles that affect the moral acceptability of various medical treatments. These distinctions reveal the complexity of the issues surrounding terminal sedation and refusal of hydration and nutrition, a complexity that has not been adequately addressed in recent discussions.

Adult↗
PubMed2002

Ethical concerns relating to the detection and treatment of ovarian cancer.

In recent years, research scientists, physicians, and legislators have begun to examine more closely the barriers that women at risk for ovarian cancer run up against in their attempts to get adequate screening and early intervention. In this paper, I discuss two (related) ethical problems that must be confronted by those who respond to these barriers. Both problems stem from an important underlying fact about ovarian cancer. There is no single identifiable cause or marker for this disease. This means that different strategies for combating ovarian cancer will, in all likelihood, have a differential impact on the members of the population who are at risk for this disease. As I show in the paper, this raises important ethical questions about fairness.

Biomarkers, Tumor↗
PubMed2002

Proportionality, terminal suffering and the restorative goals of medicine.

Recent years have witnessed a growing concern that terminally ill patients are needlessly suffering in the dying process. This has led to demands that physicians become more attentive in the assessment of suffering and that they treat their patients as 'whole persons.' For the most part, these demands have not fallen on deaf ears. It is now widely accepted that the relief of suffering is one of the fundamental goals of medicine. Without question this is a positive development. However, while the importance of treating suffering has generally been acknowledged, insufficient attention has been paid to the question of whether different types of terminal suffering require different responses from health care professionals. In this paper we introduce a distinction between two types of suffering likely to be present at the end of life, and we argue that physicians must distinguish between these types if they are to respond appropriately to the suffering of their terminally ill patients. After introducing this distinction and explaining its basis, we further argue that the distinction informs a (novel) principle of proportionality, one that should guide physicians in balancing their competing obligations in responding to terminal suffering. As we explain, this principle is justified by reference to the interests terminally ill patients have in restoration, as well as in the relief of suffering, at the end of life.

Attitude to Death↗
PubMed1998

Assessing clinical pragmatism.

"Clinical pragmatism" is an important new method of moral problem-solving in clinical practice. This method draws on the pragmatic philosophy of John Dewey and recommends an experimental approach to solving moral problems in clinical practice. Although the method may shed some light on how clinicians and their patients ought to interact when moral problems are at hand, it nonetheless is deficient in a number of respects. Clinical pragmatism fails to explain adequately how moral poblems can be solved experimentally, it underestimates the relevance and importance of judgment in clinical ethics, and it presents a questionable account of the role that moral principles should play in moral problem solving.

Bioethics↗
PubMedDate not supplied

A closer look at the bad deal trial: beyond clinical equipoise.

Some commentators have recently proposed that "clinical equipoise," although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects--"bad deal trials"--could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.

Ethics, Clinical↗