The incidentalome.
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Biomedical subjects
Publications and source records attributed to Susan M Wolf.
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Tremendous debate surrounds the acceptability of physician-assisted suicide in the United States. Progress requires carefully mapping the relationship of this practice to termination of life-sustaining treatment, appropriate pain relief and palliative care, and euthanasia. Arguments that have been offered in favor of permitting physicians to aid suicide include the importance of patient autonomy, the claim that patients need this option to cope with symptoms at the end of life, and the assertion that practices already accepted involve intentionally ending life. Arguments that have been offered against include the potential for abuse, the claim that forbidding intentional killing is essential to the ethics of medicine, and the assertion that patients can be provided good and humane care at the end of life without assisting suicide. Addressing the demand for physician-assisted suicide requires improvement in end-of-life care and continued discussion attentive to emerging empirical data.
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The relationship of law of bioethics always complex, has shifted post 9/11. Instead of looking to law as protector of rights and liberties, the new bioethics approach, exemplified by the President's Council on Bioethics, deploys law as aggressor. Thus we see a call to get tough, to prohibit a range of biomedical practices, with the prospect of not only civil but criminal enforcement. Bioethicists face a grave choice, whether to embrace the use of state force to resolve bioethics debates.
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This article starts by finding a lack of procedural ethics in the usual debates over the functioning of ethics committees and the proper relationship of ethics committees and the courts, and traces this lack to the absence of a theory of process and process values. I then show why ethics commmittees are an excellent place to start in working on process. I therefore turn to the task of developing process values, and specifically a notion of patient-centered process. Here I recommend both process values commanded by our underlying substantive values, and further independent process values. I specifically suggest that surfacing problems of gender, racial, and economic bias make certain processes ethically mandatory. Having thus indicated what the needed process values might look like, I sketch their considerable theoretical potential. I return to the particular problem of ethics committees and the courts, and use my notion of patient-centered process to derive an answer to the question of how the two entities should interrelate. Finally, I step back to suggest where we might go from here in developing a theory of process.
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