To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Advances in medical technology and transplantation lead to the re-defining of death to include death by virtue of brain death. The determination of whole brain death requires the demonstration of three things: an irreversible comatose state; the loss of brainstem reflexes; and brainstem inactivity leading to apnea. Protocols for the clinical determination of brain death vary among institutions but must generally be made by more than one doctor in one of several relevant specialties. Neurophysiologic determinations of cerebral circulatory arrest include four-vessel cerebral angiography as well as various scintigraphic perfusion studies. In all countries where brain death is recognized legally, the diagnosis rests with physical examination, at times supported by further medical testing. Philosophical arguments for the integrity of brain death as a definition of death rest in historic religious and social concepts of what constitutes life, or with ideas that loss of personhood may be equivalent to death.
Female genital cutting (FGC) has wide acceptance in many cultures across the globe despite gender-related and more general human rights concerns raised by the practice. This chapter presents a case study on a healthy 5-year-old female patient scheduled for surgical correction of clitoral phimosis. Physicians must understand the potential medical sequelae of FGC to make reasoned decisions about whether or not to participate in the procedure. Immediate adverse outcomes of FGC include pain, post-operative infection, shock, tetanus, hemorrhage, and death. Whether an anesthesiologist should participate in FGC depends on his or her interpretation of ethical considerations. Mostprofessional societies provide only guidance, without a binding effect on members.Physician participation in FGC may prevent some health consequences but also perpetuates objectionable social practices. Physicians' decisions to participate in FGC currently rely on personal judgments, weighing adverse medical and psychological consequences against potential cultural benefits and harms.
This chapter considers what it means to say that a being deserves moral consideration. It addresses the question what it means to say that a being has a right to life. The chapter explores the meaning of a right to life and considers the claim that, even if a being lacks a right to life, it deserves to have its interests taken into account. It considers three distinct answers: the conservative view, liberal view, and the moderate view to the issue of moral distinctiveness about humanity. Despite the fact that Immanuel Kant's philosophy encourages the humane treatment of animals, critics charge that it gives insufficient regard to animals. The chapter presents Peter Singer's seven ideas of argument against certain forms of animal experimentation. For Singer, the ethically crucial requirement is that our actions produce as much pleasure and happiness and as little pain and misery as possible for all beings.
The ethical principle of respect for patient autonomy is firmly grounded in western ethical principles valuing individual freedoms. This chapter talks about autonomous choices, presenting a case of a 35-year-old man with colectomy. Of the four foundational principles in medical ethics: beneficence, nonmaleficence, respect for autonomy, and justice, the principle with the strongest influence in the United States is respect for personal autonomy. Three conditions must be met in order for an act (or choice) to be autonomous: a person must act with intention, with understanding, and without controlling influences. In the informed consent process, physicians have ethical obligations to avoid controlling influences that invalidate autonomous choice. Generally speaking intentional acts require planning, although not necessarily reflective thought or strategy. Coercion and manipulation are unethical because they violate the principle of respect for patient autonomy, and because manipulation often involves deception and violates physician obligations of veracity.
Anesthesiologists should choose to involve children in medical decision-making with the ethical objective of enhancing the child's self-determination, while keeping the child engaged in their care. Anesthesiologists can use the patient's age as a first approximation of a patient's cognitive and emotional development. This chapter discusses the issues raised by incorporating the ethical concept of pediatric patient assent into the traditional process of parental (surrogate) informed consent. Competency is a legal term while decision-making capacity is the ability to make a specific decision at a specific time. It is important to resolve disagreements among the pediatric patient-parent-physician triad about the appropriate clinical plan. Response to requests for nondisclosure by parents must weigh the goal of the best Znterests of the patient. Emancipated minor and mature minor status pose distinct ethical and practical issues. Confidentiality must be honored, and failure to do so may be harmful to the patient.
A one-size-fits-all approach to pain management is not practical, nor ethically justifiable. This chapter explains pain management using the case study of a 61-year-old woman with metastatic colon cancer and intractable abdominal pain, as an example. Technological advancements within science and medicine have enabled prolongation of the lifespan for those patients with incurable diseases. Interventional techniques may be especially useful because of their capacity to effectively reduce pain, make patients more amenable to other therapeutics, and enhance patients' quality of life. Interventional pain management techniques and integrative pain medicine are underutilized, due to misperceptions by hospital operators and insurance companies about cost effectiveness. Employment of collaborative interventional techniques, however, has been shown to be both cost and time effective. Physicians should advocate policy development that is directed toward developing and enabling the profession and practice of pain/palliative care.