Showing papers by "Arthur L. Caplan published in 1987"

Ethical and policy issues in rehabilitation medicine.

Abstract: The field of medical rehabilitation is relatively new.... Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, sometimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high-technology acute care medicine or genetic engineering.... Those in biomedical ethics could and did easily overlook the quiet, less obtrusive issues of rehabilitation.... The Hastings Center set out in 1985 to rectify that situation.... To explore the issues, the Center assembled a group of practitioners in the field, Hastings Center staff members, and individuals experienced in other areas of medical ethics.... The report that follows was written by Arthur Caplan and Daniel Callahan, assisted by Dr. Janet Haas of the Moss Rehabilitation Hospital in Philadelphia....

Ethical & Policy Issues in Rehabilitation Medicine

Abstract: The field of medical rehabilitation is relatively new, a product in great part of the rapid developments in medical science during and after the Second World War. Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, somtimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high technology acute care medicine or genetic engineering. With eyes focused on the dramatic and wrenching problems, those in biomedical ethics could and did easily overlook the quiet, less obtrusive, issues of rehabilitation. Comments © The Hastings Center. Reprinted by permission. This article originally appeared in the Hastings Center Report, Volume 17, Issue 4, August 1987, pages 1-20. Publisher URL: http://www.thehastingscenter.org/ publications/hcr/hcr.asp This journal article is available at ScholarlyCommons: http://repository.upenn.edu/bioethics_papers/3 Special Supplement: Ethical & Policy Issues in Rehabilitation Medicine Arthur L. Caplan; Daniel Callahan; Janet Haas The Hastings Center Report, Vol. 17, No. 4. (Aug. Sep., 1987), pp. 1-20. Stable URL: http://links.jstor.org/sici?sici=0093-0334%28198708%2F09%2917%3A4%3C1%3ASSE%26PI%3E2.0.CO%3B2-G The Hastings Center Report is currently published by The Hastings Center. Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at http://www.jstor.org/about/terms.html. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at http://www.jstor.org/journals/hastings.html. Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is an independent not-for-profit organization dedicated to and preserving a digital archive of scholarly journals. For more information regarding JSTOR, please contact support@jstor.org. http://www.jstor.org Thu Mar 8 09:54:45 2007

Equity in the selection of recipients for cardiac transplants.

Abstract: The problem of perceived inequities in the distribution of hearts and other solid organs for the purposes of transplantation. In recent years there has been a great deal of discussion of problems in the allocation of hearts and other organs for the purposes of transplantation."2 Charges of bias and discrimination have haunted those involved in the procurement and distribution of organs. Many observers of the transplantation field have worried about making organs procured in the United States available to recipients who are not American citizens,3 while others have bemoaned the practice of shipping kidneys procured in the United States overseas to those institutions willing to pay for them.4' Likewise, there have been many criticisms leveled at the everyday practice of most transplant centers of requiring those needing transplants to prove their ability to pay for such surgery in advance of any determination of their eligibility.6 Not all of the criticism has concerned the selection of adult recipients. An enormous controversy surrounded the initial decision at Loma Linda University Medical Center in California to reject a newborn infant, identified in the popular media as Baby Jesse, as a candidate for a heart transplant. The medical center cited "psychosocial" factors as the grounds for the decision not to accept the infant into the experimental infant heart transplant program at the medical school.7 Upon hearing of the decision, the child's family apparently enlisted the help of a local "Right-to-Life" organization to create a media campaign with the goal of pressuring the medical center to reverse its decision. Charges were made that the infant had been rejected as a candidate simply because his parents were not married. The media gave a great deal of play to the story that Baby Jesse had been rejected as a cardiac transplant candidate solely for the reason of illegitimacy.8 In fact, the hospital had followed what is standard practice in every cardiac transplant center in considering psychosocial variables as a part of determining

Scientific Controversies: Introduction: Patterns of controversy and closure: the interplay of knowledge, values, and political forces

Abstract: For some time the analysis of science by philosophers, sociologists, historians, and others has been dominated by discussions about theory change and development. Metascientific studies have not progressed far beyond bitter wrangles as to the adequacy of such concepts as “paradigms,” “research traditions,” “themata,” and “theories” for adequately describing developments over time in various fields of scientific inquiry. In many respects these disputes have shed a great deal of light on the manner in which scientific ideas change and evolve, but they have also obscured important questions that need to be asked about conceptual development in science in order to understand this process fully and to facilitate the formulation of public policy with respect to science and technology. This volume takes as its focus the notion of controversy. Controversies characterize intellectual change and developments within and about science. Disputes among scientists and between scientists and laymen are easy to locate in the history of science. Moreover, controversies play a central role in the way those who do science and those who depend upon its findings approach the subject. By analyzing controversies in and about science, this volume seeks to advance the analysis of scientific change beyond the sterile and confining boundaries of current disputes concerning the role of internal and external factors in fueling scientific change. Science, ethics, and politics are marked by controversies. As one would expect, the ways in which controversies in each area arise as matters of dispute and approach solution appear to be somewhat divergent. Scientific controversies, for example, are usually seen to be the sorts of disputes that are to be resolved by appeal to facts and to rigorous reasoning concerning facts.

A History and Theory of Informed Consent

Abstract: Not too long ago I witnessed an incident in a large teaching hospital in which consent to perform an amputation was secured from a patient in a particularly disturbing manner. A senior attending physician had been trying for a few days to persuade an older patient suffering from diabetes to give permission for a below-the-knee amputation of his gangrenous left leg. While taking a group of residents on rounds he mentioned that he had had an especially hard time obtaining permission for an operation that he believed was absolutely essential to save the patient's life. He pointed to one of the residents and said "part of the job of being a physician is to deal with problems like this—get the damn consent." The young resident trotted off to find the reluctant patient. About 20 minutes later he emerged triumphant from the patient's room waving a signed consent form for all

Organ transplant rationing: a window to the future?

Abstract: Those who advocate rationing access to health care to control escalating costs must adequately examine the field of organ transplantation, where rationing has been a harsh fact of life for many years. In our society, two paradigmatic cases illustrate rationing: a lifeboat with too many passengers aboard for the supply of food and water to keep alive, and battlefield triage with more wounded soldiers than medical personnel available to treat them. Examination of these cases reveals four criteria that must be fulfilled for rationing to be the only possible response to a resource shortage: Nothing can be done to stretch or divide the available resource to meet the needs of all seeking access to it. Those who seek access to the scarce resource need it to survive. Nothing can be done to increase the supply of the resource that is available. The resource is recognized as a benefit by both those who seek it and those who can provide it. For the most part, transplant decisions are surrounded by secrecy, and public input is minimal. Although many centers use psychosocial as well as medical criteria in deciding whom to admit to transplant programs, no consistent criteria have been developed among transplant centers. This secrecy and inconsistency could damage public support of organ transplant programs. If rationing is instituted in other areas of health care, public input must be sought in establishing equitable standards. The scarcity of organs for transplant cannot be changed, but this is not true in other areas of health care, where we can choose to build more facilities, eliminate waste, and dispense with unnecessary services.(ABSTRACT TRUNCATED AT 250 WORDS)

Social and health policy issues in total joint replacement surgery.

Abstract: Total joint replacement has restored function and provided comfort to many patients who would otherwise have suffered. However, success and widespread diffusion of this procedure pose a number of important questions. The patient's and the doctor's criteria of success may not be the same: Which are to be used? Health resources are becoming limited: Should money be spent to restore function and for pain relief to those late in life or past their work life? Who makes this choice? A medical technology is tested in the best of settings but routinely practiced in many: How should society and health care professionals monitor the results of surgery? Who should do surgery and where should it be done?