A Critical Examination of Ethics in Health Care and Biomedical Research: Voices and Visions PDF
Preview A Critical Examination of Ethics in Health Care and Biomedical Research: Voices and Visions
International Library of Ethics, Law, and the New Medicine 60 Richard M. Zaner A Critical Examination of Ethics in Health Care and Biomedical Research Voices and Visions International Library of Ethics, Law, and the New Medicine Volume 60 Series editor David N. Weisstub, Montreal, Canada The book series International Library of Ethics, Law and the New Medicine comprises volumes with an international and interdisciplinary focus. The aim of the Series is to publish books on foundational issues in (bio) ethics, law, interna- tionalhealthcareandmedicine.The28volumesthathavealreadyappearedinthis seriesaddressaspectsofaging,mentalhealth,AIDS,preventivemedicine,bioeth- ics and many other current topics. This Series was conceived against the back- groundofincreasingglobalizationandinterdependencyoftheworld’sculturesand governments,withmutualinfluencingoccurringthroughouttheworldinallfields, most surely in health care and its delivery. By means of this Series we aim to contribute and cooperate to meet the challenge of our time: how to aim human technology to good human ends, how to deal with changed values in the areas of religion, society, culture and the self-definition of human persons, and how to formulate a new way of thinking, a new ethic. We welcome book proposals representing the broad interest of the interdisciplinary and international focus of the series. We especially welcome proposals that address aspects of ‘new medi- cine’,meaningadvancesinresearchandclinicalhealthcare,withanemphasison thoseinterventionsandalterationsthatforceustore-examinefoundationalissues. More information about this series at http://www.springer.com/series/6224 Richard M. Zaner A Critical Examination of Ethics in Health Care and Biomedical Research Voices and Visions RichardM.Zaner AnnGeddesStahlmanProfessorEmeritus ofMedicalEthicsandPhilosophyofMedicine DepartmentofMedicine,Primary VanderbiltUniversity Nashville,TN,USA ISSN1567-8008 ISSN2351-955X (electronic) InternationalLibraryofEthics,Law,andtheNewMedicine ISBN978-3-319-18331-2 ISBN978-3-319-18332-9 (eBook) DOI10.1007/978-3-319-18332-9 LibraryofCongressControlNumber:2015938605 SpringerChamHeidelbergNewYorkDordrechtLondon ©SpringerInternationalPublishingSwitzerland2015 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodologynowknownorhereafterdeveloped. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationinthis book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained hereinorforanyerrorsoromissionsthatmayhavebeenmade. Printedonacid-freepaper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Preface Ishouldnoteattheoutsetthatanearlyversionofthisbookwaspublishedseveral yearsagoinMandarinChinese.1Thereasonforthisisthatagoodfriend,Chen-yun Tsai,ProfessorofPhilosophyattheNationalChengchiUniversityinTaipei,asked meifIwouldwriteabookthatwouldlayouttheprincipaltopicsandthemesofmy severaldecadesofworkinmedicalhumanitiesandclinicalethics.Sinceonlytwo ofmybookshadatthattimebeenpublishedinTaiwan,bothincludingonlyclinical ethicsnarratives,hewasconcernedthatpersonsinthatstill-developingfieldthere shouldknow ofmyphilosophicalviews onthoseandotherthemes.Hisinvitation cameattheconclusionofaseven-lecturetourofuniversitiesinTaiwanin2004,and it was with the many responses to and discussion of those lectures in mind that I agreedwithProfessorTsai’ssuggestion,butonlyafterhehadagreedtoundertake thebook’stranslationintocomplexChineseMandarin,usedamongprofessionalsin collegesanduniversities.Workingwithhimandtheeditorofhisuniversity’spress, Chu-po Chen, the book was in due course completed and the translation done— although,Imustadd,giventhecomplexitiesofthelanguage andthoseoftransla- tion,especiallyfrommyownnotalwaysStandardEnglishusages,thistookseveral yearstocomplete. WhenIdecidedtotryandpublishthebookinEnglish,however,itwasclearto me that it had to be thoroughly rewritten. In the years that had passed since I undertookthatproject,rereadingthatinitialtextbroughthometomethatmuchofit needed rethinking and some restructuring. I am hopeful that the result, presented here,willbefoundtobehelpfultoreaders. Ihadalreadycometoappreciate,asInotedinoneofmyearlybooks,thattheact ofwritingandpublishingabookseemsaudacious.That’strue,initsway;buthow 1PublishedasVoicesandVisions:ClinicalListening,NarrativeWriting,tr.byCheng-yunTsai, National Chengchi University Press (NCCU), Taipei, Taiwan, 2009 (published in Mandarin Chineseonly). v vi Preface muchmoreaudacious,then,iswritingthisbook,onewhichtakesupthemajorparts ofalifetimeofwritingandattemptstoputitalltogetherinasingleplace?Indeed. Still, as thingshaveworked out, there is much thatis quite newhere. Morethan that,thisistheonlyplacewheremanyoftheseideascanbefoundconnectedtogether, wheretheyareabletoknockupagainstaswellascomplementeachother.So,Idonot hesitateatallatthistimeinmylifetotryandsharetheseideaswithothers,togive themakindofpublicpresence,availabletooneandall.Iamthushappytoengagethe challengeofyetanotherbook,exploringthemesthathavelongbeenaclosepartofmy lifeasaphilosophermakingmywayintheworldofclinicalandresearchmedicine. Imustsay,too,thatseveralofmycolleagueshaveplayedanimportantpartinmy efforts to articulate my vision and find my voice. Principal among these are Stuart G.Finder2andMarkJ.Bliton,3bothofthemcolleaguesformanyyearsatwhatIfirst set up as the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. The three of us worked very closely together at both Vanderbilt and in the clinical ethics program where we were asked to set up at Nashville’s St.ThomasHospital(1991–1994).Dailyconversations,jointteaching,writing,and publicationwentonformorethanadecade,oneresultofwhichwashelpingmeto articulateandclarifytheconceptionofclinicalethicsthatfindsexpressionhere.From what I know, too, this conception has been carried over to a good many other institutions—bythem,andbyanumberofoutstandinggraduatestudentswhoworked andstudiedwithusattheCenterandhavesubsequentlybecomewellknownintheir own right. Prominent among these are Tarris “Terry” Rosell, DMin, PhD, the Rosemary Flanigan Chair at the Center for Practical Bioethics4; DeniseDudzinski, PhD, Associate Professor and Director of Graduate Studies in the Department of BioethicsandHumanitiesattheUniversityofWashington5;andPaulFord,Director andAssociateProfessorofBioethics,theClevelandClinic.6 Iamgratefultoallofthemandformuchofwhatwetogetherachievedatwhen we were together.7 Clearly, I learned much from each of them, then and later throughtheirwritings. 2Director,CenterforHealthcareEthics,Cedars-SinaiMedicalCenter,LosAngeles,CA. 3After serving as Associate Professor in the program at Vanderbilt, Mark moved to Kaiser PermanenteinLosAngeles,workingasheadofEthicsandAppliedPhilosophy. 4Terry is also Professor at the Central Baptist Theological Seminary in Kansas City; Clinical AssociateProfessor,attheSchoolofMedicine,UniversityofKansasMedicalCenter;andClinical AssociateProfessor(Ethics)attheUniversityofKansasMedicalCenter. 5AssociateProfessorinBioethicsattheUniversityofWashington,sheisalsoAdjunctAssociate ProfessorintheSchoolofLaw,AdjunctAssociateProfessorinFamilyMedicine,andAffiliate FacultyintheTreumanKatzCenterforPediatricBioethics.SheisChiefoftheEthicsConsultation ServiceandAssociateChairoftheEthicsAdvisoryCommitteeattheUniversityofWashington MedicalCenter. 6HeisalsoDirectoroftheNeuroethicsProgram. 7TherewereofcoursemanyotherswhoworkedandstudiedwithusintheCenterandinvarious academicprogramsatVanderbilt,especiallyasFinder,BlitonandIwereactiveinvariousgraduate programs. Preface vii Iwantalsotobesuretomentionmylovelywife.Ithasbeenmydeepestjoyto have been with her for nearly 59 years and not only for her warmth as my close companion. For during all the time I’ve spent in teaching and writing, she has becomeanimpressiveandimportantartist,workinginmanyfields:sculpture(stone andsteel),drawingandpainting,softsculpture,fashiondesign,andmorerecently becomingknownandpublishedasanimportantpoetandfictionwriter.Ihavebeen profoundlyinspiredbyherandhermany,manyworks.Ihavebeenmostfortunate indeedtohavebeenwithherandtheothersforsomanyyears. Nashville,TN,USA RichardM.Zaner Contents 1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2 ThemesandSchemes:APrelude. . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1 PreliminaryReflectionsonThemes. . . . . . . . . . . . . . . . . . . . . . 13 2.2 IssuesRemainComplicated,OftenOpaque. . . . . . . . . . . . . . . . 17 2.3 ABitofHistory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.4 ThePhilosopher’sResponsetothePhysician’sAppeal. . . . . . . . 22 2.5 HowDidPhysiciansRespondtoThisResponse?. . . . . . . . . . . . 25 2.6 BriefOverviewofMedicine. . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.7 AnInterlude:Gyges,AesculapiusandtheHistory ofMedicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.8 Medicine’sClinicalPractice. . . . . . . . . . . . . . . . . . . . . . . . . . . 34 2.9 IllnessandDisease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 3 AttheBeginningandEndofLife:AMeditation ontheSubtleHoaxofMatter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.1 IntheEarlyDays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.2 AnOverview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 3.3 SocialStructureofClinicalEncounters. . . . . . . . . . . . . . . . . . . 45 3.4 OnEmbodiment:Preliminary. . . . . . . . . . . . . . . . . . . . . . . . . . 46 3.5 AsymmetryofthePhysician-PatientRelationship. . . . . . . . . . . . 49 3.6 HistoricalIronies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 3.7 ExcursusonSelf.. . . . .. . . . .. . . . .. . . . .. . . .. . . . .. . . . .. 53 3.8 ConflictingValues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 3.9 OnEmbodiment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 3.10 Birth,BecomingandtheEcstasisofSelf. . . . . . . . . . . . . . . . . . 61 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 ix
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