Showing papers by "Arthur L. Caplan published in 2004"

Is it ethical to use enhancement technologies to make us better than well

Abstract: Background to the debate: A variety of biomedical technologies are being developed that can be used for purposes other than treating disease. Such “enhancement technologies” can be used to improve our appearance and regulate our emotions, with the goal of feeling “better than well.” While these technologies can help people adapt to their rapidly changing lifestyles, their use raises important ethical issues.

Health, Disease, and Illness: Concepts in Medicine

Abstract: Foreword: renewing medicine's basic concepts / Edmund D. Pellegrino -- Pt. I. Historical discussions of health, disease, and illness -- Ch. 1. From On the Natural Faculties II, VIII / Galen - - Ch. 2. Diseases of the soul / Maimonides -- Ch. 3. Prometheus's vulture: the renaissance fashioning of gout / Roy Porter and G.S. Rousseau -- Ch. 4. Report on the diseases and physical peculiarities of the negro race / Samuel A. Cartwright -- Ch. 5. The normal and the pathological-introduction to the problem / Georges Canguilhem -- Ch. 6. The myth of mental illness / Thomas S. Szasz -- Ch. 7. The need for a new medical model: a challenge for biomedicine / George L. Engel -- Ch. 8. When do symptoms become a disease? / Robert A. Aronowitz -- Pt. II. Characterizing health, disease, and illness -- Ch. 9. On the distinction between disease and illness / Christopher Boorse -- Ch. 10. Malady: a new treatment of disease / K. Danner Clouser, Charles M. Culver,and Bernard Gert -- Ch. 11. Health: a comprehensive concept / Roberto Mordacci and Richard Sobel -- Ch. 12. The distinction between mental and physical illness / R.E. Kendell -- Ch. 13. The "unnaturalness" of aging-give me reason to live! / Arthur L. Caplan -- Ch. 14. Diagnosing and defining disease / Winston Chiong -- Pt. III. Clinical applications of the concepts of health and disease: controversies/consensus -- Ch. 15. "Ambiguous sex"- or ambivalent medicine? / Alice Domurat Dreger -- Ch.16. The discovery of hyperkinesis: notes on the medicalization of deviant behavior / Peter Conrad -- Ch. 17. Suffering and the social construction of illness: the delegitimation of illness experience in chronic fatigue syndrome / Norma C. Ware -- Ch. 18. The premenstrual syndrome: a brief history / John T.E. Richardson -- Ch. 19. The politics of menopause: the "discovery" of a deficiency disease / Frances B. McCrea -- Ch. 20. Aging, culture, and the framing of Alzheimer disease / Martha Holstein -- Pt. IV. Normalcy, genetic disease, and enhancement: the future of the concepts of health and disease -- Ch. 21. The medicalization of aesthetic surgery / Sander Gilman -- Ch. 22. The quest for medical normalcy-who needs it? / George C. Williams -- Ch. 23. The concept of genetic disease / David Magnus -- Ch. 24. Concepts of disease after the human genome project / Eric T. Juengst -- Ch. 25. From "enhancing cognition in the intellectually intact" / Peter J. Whitehouse, Eric T. Juengst, Maxwell Mehlman, and Thomas H. Murray -- Ch. 26. Treatment, enhancement, and the ethics of neurotherapeutics / Paul Root Wolpe -- Ch. 27. What's morally wrong with eugenics? / Arthur L. Caplan - - Acknowledgments -- Contributors -- Permissions and credits -- Index

Cultural Sutures: Medicine and Media

Abstract: Medicine and the media exist in a unique symbiosis. Increasingly, health-care consumers turn to media sources—from news reports to Web sites to tv shows—for information about diseases, treatments, pharmacology, and important health issues. And just as the media scour the medical terrain for news stories and plot lines, those in the health-care industry use the media to publicize legitimate stories and advance particular agendas. The essays in Cultural Sutures delineate this deeply collaborative process by scrutinizing a broad range of interconnections between medicine and the media in print journalism, advertisements, fiction films, television shows, documentaries, and computer technology. In this volume, scholars of cinema studies, philosophy, English, sociology, health-care education, women’s studies, bioethics, and other fields demonstrate how the world of medicine engages and permeates the media that surround us. Whether examining the press coverage of the Jack Kevorkian–euthanasia controversy; pondering questions about accessibility, accountability, and professionalism raised by such films as Awakenings, The Doctor, and Lorenzo’s Oil; analyzing the depiction of doctors, patients, and medicine on E.R. and Chicago Hope; or considering the ways in which digital technologies have redefined the medical body, these essays are consistently illuminating and provocative. Contributors. Arthur Caplan, Tod Chambers, Stephanie Clark-Brown, Marc R. Cohen, Kelly A. Cole, Lucy Fischer, Lester D. Friedman, Joy V. Fuqua, Sander L. Gilman, Norbert Goldfield, Joel Howell, Therese Jones, Timothy Lenoir, Gregory Makoul, Marilyn Chandler McEntyre, Faith McLellan, Jonathan M. Metzl, Christie Milliken, Martin F. Norden, Kirsten Ostherr, Limor Peer, Audrey Shafer, Joseph Turow, Greg VandeKieft, Otto F. Wahl

Is Biomedical Research Too Dangerous to Pursue

Abstract: Biomedical research has come under sustained ethical attack in recent years. Critics argue that the continued advance of biomedicine will inevitably change human nature, lead to the commodification and objectification of human beings, and rob us of meaningful lives. Although presented with great verve, these worries are not persuasive to the [author][1] of this Policy Forum. Given the stakes involved (i.e., the lost opportunities for development of cures, palliation, and the prevention of disability) better arguments must be forthcoming in order to justify slowing or stopping biomedical research. [1]: http://www.sciencemag.org/cgi/content/full/303/5661/1142

Organs.com: new commercially brokered organ transfers raise questions.

Abstract: On October 20, 2004, surgeons removed a kidney from Robert Smitty and transplanted it into Robert Hickey, a fifty-eight-year-old physician with renal failure, at Denver's Presbyterian/St Luke's Medical Center. Hickey had paid MatchingDonors.com, a commercial website, a $295 monthly fee to have his need for a kidney advertised on the website. Smitty, a thirty-two-year-old sometime photographer from Chattanooga, Tennessee, had found Hickey on the MatchingDonors.com website. He is the first person in the United States known to have arranged an organ donation to a stranger using a commercial company as middleman. The media paid a lot of attention to the Smitty/Hickey transplant, and much of it was very, positive. They were fascinated with the scenario of those dying of organ failure turning to the Internet to save themselves. Good Samaritans in cyberspace could learn about those in need, weigh their respective plights, and select a fortunate supplicant to save. Unfortunately this first case did not have the happy ending the media had envisioned. On October 28, 2004, Robert Smitty became the first person involved in an organ transfer brokered by a commercial Web site to land in jail. Smitty had failed to pay his child support and, partly as a result of the media attention that the transplant generated, was arrested and jailed upon his return to Tennessee. Suspicion that he had sold his kidney was and remains rampant. The story of Robert Smitty's kidney highlights the need to find ways to allow those waiting for transplants to locate living persons who want to donate an organ to a complete stranger. In contrast to cadaver donation, a national system for bringing donors and recipients together does not exist. Smitty's story also highlights the absolute lack of any oversight for this new form of organ donation. In 1997, there were no documented instances of absolute strangers donating organs. By 2003, there were dozens of such cases, and the numbers continue to grow, as does the number of sites on the Web "brokering" organs. So what is wrong with giving those who need organs a chance to find them? The practice of soliciting strangers for organ donation is fundamentally unfair. Those who can pay middlemen to publicize their plight will have greater access to potential lifesaving transplants. Moreover, those who for whatever reason are not as "attractive" as other potential recipients will not fare well in a begging competition. The Web is not a haven for the forthright. In matters of mating and mortgages, which dominate Internet brokerage, lying abounds. …

Straining their brains: why the case against enhancement is not persuasive.

Abstract: Your kid’s schoolwork not up to par? Looking for Mr. or Ms. Right? Any other problems caused by a mind’s eye seemingly not quite on the ball? Answers might lie in a brain-enhancing pill. Some argue this is merely better living through chemistry and in line with humanity’s self-improving actions throughout history, but others suggest that quick-fix medications could well distort the very things that make us human. Here a leading bioethicist squares off with a member of the President’s Council on Bioethics on the controversy about pursuing better brains with a little help from biotechnology. Comments © 2004. Permission from Dana Press. Reprinted from Cerebrum, Volume 6, Issue 4, Fall 2004, pages 13-29. Publisher URL: http://www.dana.org/books/press/cerebrum/ This journal article is available at ScholarlyCommons: https://repository.upenn.edu/neuroethics_pubs/29

The hidden cost of health care

Abstract: Is biomedical research justified on moral and ethical grounds?

Taken to Extremes: Newspapers and Kevorkian’s Televised Euthanasia Incident

Abstract: Book Description: Medicine and the media exist in a unique symbiosis. Increasingly, health-care consumers turn to media sources—from news reports to Web sites to tv shows—for information about diseases, treatments, pharmacology, and important health issues. And just as the media scour the medical terrain for news stories and plot lines, those in the health-care industry use the media to publicize legitimate stories and advance particular agendas. The essays in Cultural Sutures delineate this deeply collaborative process by scrutinizing a broad range of interconnections between medicine and the media in print journalism, advertisements, fiction films, television shows, documentaries, and computer technology. In this volume, scholars of cinema studies, philosophy, English, sociology, health-care education, women’s studies, bioethics, and other fields demonstrate how the world of medicine engages and permeates the media that surround us. Whether examining the press coverage of the Jack Kevorkian–euthanasia controversy; pondering questions about accessibility, accountability, and professionalism raised by such films as Awakenings, The Doctor, and Lorenzo’s Oil; analyzing the depiction of doctors, patients, and medicine on E.R. and Chicago Hope; or considering the ways in which digital technologies have redefined the medical body, these essays are consistently illuminating and provocative. Disciplines Bioethics and Medical Ethics | Broadcast and Video Studies | Communication | Criminology | Critical and Cultural Studies | Health Communication | Journalism Studies | Mass Communication | Medicine and Health | Other Medicine and Health Sciences | Social Control, Law, Crime, and Deviance | Social Influence and Political Communication This book chapter is available at ScholarlyCommons: http://repository.upenn.edu/asc_papers/388 Taken to Extremes Newspapers and Kevorkian’s Televised Euthanasia Incident Arthur L. Caplan and Joseph Turow Jack Kevorkian, who is currently serving a prison sentence in Michigan, played a crucial role in putting the issue of physician-assisted suicide center stage in the arena of American politics. Beginning in 1990, his actions to help various persons to die set off storms of controversy in the popular media and in academic medical and bioethical circles (W. Smith 1997; Snyder and Caplan 2000). Yet despite his influence, Kevorkian was often described, even by admirers, as a zealot. The American Heritage Dictionary defines a zealot as “a fanatically committed person, . . . a person possessed by excessive zeal for and uncritical attachment to a cause or position.” It goes on to characterize zealotry as an incident that reflects a person’s “excessive and uncritical commitment” to an idea or ideal. Clearly, whether a person or act is zealous is in the eye of the beholder. Press historians and sociologists have confronted the social meaning of extreme zeal through explorations of the ways in which the mainstream press has constructed individuals and groups as zealots, marginalizing them and their actions in the process. With the exception of the abortion controversy, when researchers have focused on contemporary coverage of zealots and zealotry by American media, their work has centered on ‘‘terrorist’’ activities (e.g., Weimann and Winn 1994; Schnuck 1992). Their analyses have spoken to the media’s reflection of U.S. government foreign policy as well as to the relative lack of interest in international news by the American press (Picard and Alexander 1991; Martin and Hiebert 1990). Missing from these discussions, however, is an understanding of the extent to which zealous actions function as critical incidents that encourage a broadening of press discussions of social issues underlying the events. Does a startling or shocking domestic incident that the American press labels as zealotry catalyze the nation’s news outlets to explore a wide range of views about the issues involved and their public relevance? The question reflects on a gamut of bizarre events that individuals and groups carry out at least partly to rivet public attention to their political cause, from the so-called Unabomber’s booby-trapped packages to the exploits of the Ku Klux Klan to cyber-sabotage. More generally, the question addresses an enduring issue about press coverage itself. Does the journalistic reliance on storytelling narrow or expand public discourse about contentious domestic sociopolitical issues? To understand the way in which the press treated the ‘‘zealotry’’ of Jack Kevorkian, we examined print media coverage of a videotaped euthanasia that was broadcast by the popular CBS news magazine program 60 Minutes. Kevorkian planned the death with an eye toward having it broadcast on national television, carried out the killing on a patient with ALS disease, taped the killing with the patient’s permission, and subsequently offered it to the CBS show. The tape was aired as part of a segment hosted by Mike Wallace on 22 November 1998. Kevorkian said he did this to force the public and politicians to accept the legitimacy of euthanasia and assisted suicide. Did he succeed? How did press discussions of euthanasia and assisted suicide change as a result of the broadcast? Using those terms as keywords, we conducted a content analysis on a large random sample of U.S. newspapers during the months before, during, and after the broadcast. The results were startling. The broadcast killing sparked a large rise in articles that mentioned euthanasia or physician-assisted suicide. The increase in articles did not, however, lead to a broadened discussion of bioethical or legal issues surrounding euthanasia, end-of-life care, and the pros and cons of physician-assisted suicide. Instead, the articles overwhelmingly framed Kevorkian’s activities as a crime-and-personality story. The comments of prosecutors and defense attorneys dominated the media coverage accorded the incident. Their statements far, far outnumbered other sources such as physicians, nurses, ethicists, patients, and advocacy group representatives who could shed light on the substantive ethical, social, and clinical issues surrounding end-of-life care and assisted suicide. The crime-and-personality coverage of Kevorkian’s act muted the slight coverage in the media of philosophical, social, and political issues surrounding euthanasia and assisted suicide already present in media accounts in the weeks and months before the broadcast of Kevorkian’s killing. Diminished attention to these topics remained weeks after the videotape aired on national television. Kevorkian’s act brought discussion of the ethics of assisted suicide and euthanasia to a grinding halt as the media concentrated on whether he was crazy, whether he ought be punished, and, if so, how. Past Coverage of Social Activism Many writers have noted that the ideology of mainstream news in the United States is inherently conservative: it depicts historically normative institutional practices as preferable to challenges to those practices. It should come as no surprise, then, that throughout the nation’s history, mainstream press outlets tend to dub as ‘‘fanatics’’ individuals and groups that have been fiercely committed to rapid or unusual forms of political or social change. Nerone (1994) and Solomon (1991) underscore this dynamic in descriptions of the ways major American newspapers treated abolitionists, labor unions, and suffragists during their formative periods. Nerone notes, for example, that ‘‘mainstream [press] forces cherished an image of abolitionists as wild subversives’’ (87) who exploited taxpayer-funded services such as the post office for demonic, propagandistic ends. Writing about the growing labor movement of the early twentieth century, Nerone describes how the Los Angeles Times ‘‘appealed constantly to the image of the sober industrious worker and demonized unionists as the opposite: vicious, lazy, jealous’’ (173). Solomon reveals a similar dynamic with respect to newspaper coverage of turn-of-the-century suffragettes. Explorations of mainstream press conflicts with social movements during the 1970s provide evidence that the pattern of marginalization continued to the modern era. Gitlin (1980) captures this process nicely in his description of the way reporters framed Students for a Democratic Society as a dangerous organization and, in the process, delegitimized its radical ideological platform against the Vietnam War. Tuchman (1978) suggests that the New York Times treated the ‘‘women’s liberation’’ movement in a similarly marginalized way. She shows how female workers within the Times were able to expand and normalize coverage of political aspects of women’s lives, if not of the actual women’s lib groups themselves. These studies are important for detailing the way in which mainstream journalism has often reflected the interests of society’s establishment when dealing with people whose worldviews appear to pose a threat to middle-of-the-road values and politics (Gans 1979). At the same time, the studies do not address a key related question: Having dubbed persons or groups as fanatic and their action as dangerous, do mainstream press outlets go beyond that? That is, do they use events that the fanatics stage to explore the social issues that underlie them and present a range of (presumably more socially acceptable) solutions? Broader scholarly literature on journalism does not offer clear-cut answers to these questions. Barnhurst and Mutz (1997) state that ‘‘there is a growing consensus that contemporary reporting has altered [the definition of news] to deemphasize events in favor of news analysis’’ (27). They concede, however, that most conclusions about increased analysis in news have centered on political reporting. In their own research, they found increased analytical coverage of crime, accidents, and employment in three major newspapers throughout the twentieth century. The categories in