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At least 19 recordsLinked to original sources
PubMed1979

Choosing priorities.

Dr Gray leaves us with a question at the conclusion of his article--how should we choose priorities? He says that the debate so far has been mainly on what we should choose, but perhaps we should consider how to choose even more. Under the various subheadings of Criteria, Principles and Persons Dr Gray sets out the pros and cons of the arguments in the priority debates and tries to offer some more specific guidelines to offset the criticism that the government's priority discussions have been too generalised. Yet this is a difficult task when everyone's priorities are so different.

Cost-Benefit Analysis↗
PubMed1975

Ethics of selective treatment of spina bifida. Report by a working party.

Ethical problems in medicine usually arise when normal guiding principles appear to be in conflict. In the case of babies with severe spina bifida, or similar abnormalities, two such fundamental principles may be applied with opposing conclusions. The first is that any decision requires an estimate of the balance of suffering and happiness for those concerned in an action, and the other is the assertion that human life is sacred. Resolution of the conflict between these is possible by looking at the problem in a different and less fundamental way, and one such approach is through the concept of ordinary and extraordinary means. While man does not possess power of absolute ownership over life, his duties of stewardship require him to use ordinary means of safeguarding life; he may use, but is not obliged to use, extraordinary means. The distinction between ordinary and extraordinary means may vary with circumstance, and so the application of this principle involves decisions at a third or more practical level. These include an assessment of the child's abnormality, of the effects of this upon the quality of life possible for the child, and of the burdens that will be placed on the family and society. At each level the ethical decisions involve complex choices, and clearly any present policies must be regarded as temporary unavoidable compromises rather than as final solutions.

Attitude of Health Personnel↗
PubMed1978

The regulation of hazards and hazardous behaviors.

Risks to individuals engaged in "high risk" behaviors may be present because of the individual's own actions, as in the case of smoking. Alternatively, the risks may be present either because of factors in the environment such as carcinogens, or because of the causal actions of others, such as pollution by industries. Traditionally, justifications for policies that would control hazards and restrict hazardous behaviors have been based on paternalistic principles or on a theory of social justice. Arguments for both are criticized and rejected in favor of a third alternative rooted in utilitarian moral theory. It is argued that: (1) paternalism leads to unacceptable consequences because it would allow too much limitation of individual liberty by policy makers; (2) justice-based arguments are too abstract for public policy problems and often rest on questionable empirical assumptions; and (3) utilitarian suggestions about the use of cost-benefit analysis for the resolution of these health policy problems are more promising than available alternatives, because they provide a solid moral basis for allocating scarce resources and for controlling hazardous behaviors.

Attitude to Health↗
PubMed1979

[Prospective controlled clinical trials in surgery. controversial issues in motivation and performance (author's transl)].

Controversial aspects in prospective controlled trials in surgery can be detected at various stages in the course of this research work, such as in motivation, planning and performance as well as in assessment and evaluation of the results. Especially the introduction of control groups, randomization and "blindness" of patients, operators and doctors running the follow-up are subjects of a controversial discussion. Subthreshold arguments for defenders and eniers of the trial are taken from different theories of science, such as empirism and rationalism which are more effective in the daily routine work than expected. Provided that convincingly only therapeutic and diagnostic procedures are compared which were considered as equi-effective and reliable to the same extent according to the best and most complete knowledge available it is ethically justified to perform controlled randomized trials. It should, however, not be expected that they (always) produce differences between treatment of high degree of difference. The aim of the controlled trials is not the introduction of sensational novelties into medicine, but the abolition and prevention of unnecessary and unworthy modes.

Ethics, Medical↗
PubMed1977

Revolutions and the rights of man.

The author describes the dialectical struggle in psychiatric treatment between those who advocate maximum liberty in the management of the mentally disordered and those who believe such patients will benefit more from firm guidance and discipline. He uses illustrations from British psychiatric history to illustrate this struggle. He also points out and discusses two current challenges to psychiatry worldwide: the unconstructive hostility of the various schools of antipsychiatry and the political abuse of psychiatric diagnosis and treatment, particularly in the USSR.

Attitude of Health Personnel↗