Coming soon to the "genetic supermarket" near you

Recent medical studies have indicated that synthesized human growth hormone (hGH) may cosmetically enhance short, but otherwise perfectly healthy, individuals by adding inches to their final predicted height. In this note, Curtis Kin examines the legal and ethical implications of such a discovery, arguing that nontherapeutic hGH treatment is likely the first of many biotechnology and gene therapy enhancements that may be available to the public in a "genetic supermarket" of enhancement products. Mr. Kin finds that the current regulatory framework for biotechnology and gene therapy inadequately regulates unapproved uses of hGH and fails to address properly its implications for a genetic "race to perfection." He proposes changes to the current regulatory framework that will enforce a strict distinction between therapeutic and enhancement applications of biotechnology and gene therapy. These changes in the law, Mr. Kin reasons, will help to solve the social and ethical problems posed by these emerging developments in technology.     

义务冲突——艾滋病防治中的伦理法律难题

随着艾滋病预防对策的深入研究,新的伦理难题——义务冲突凸显出来。一方面,放弃艾滋病患者的隐私将其患病实情告之其性伴侣以保护其生命权、健康权还是保护艾滋病患者的隐私而漠视其性伴侣的人身权利？同时,鉴于当前艾滋病人犯罪已成为一种新型、危害性比较大的犯罪形式,是保护病人自主、保障艾滋病患者的隐私,还是维护公共健康、放弃艾滋病患者的隐私权？利益权衡中,只能取救死扶伤的道德、法律义务而舍弃保护患者隐私的法律义务,取公共健康而放弃个人权利。     

由谣谚所见的民间伦理观念

民间社会村夫野老口耳相传的谣谚,是包含着民间伦理生活真实信息的"活化石".在传统社会,谣谚所映射出的民间伦理观念具有多元复合的特点,儒、道、墨等诸家观念大量充斥其间.谣谚所传达的伦理观念,既有与官方正统教化伦理高度一致的一面,同时也不乏异质的声音.其主要表现是谣谚以有限认同、阳奉阴违、分庭抗礼的姿态,构成了对正统教化伦理的反对性回应.谣谚作为一种小传统文化,与作为大传统文化的主流意识形态之间互渗互用、相生相长,构成了传统社会伦理生活的真实景观.     

Displaced agendas: current regulatory strategies for germline gene therapy

Recent developments in biotechnology are radically affecting the nature of reproduction and the manner in which we approach disease. In particular, germline gene therapy, or the insertion of genetic material into cells while they are developing and dividing, offers the promise of eradicating genetic defects in humans during embryonic development. In this article, the authors argue that the social and ethical implications of the developments in the field of germline gene therapy have not yet received adequate consideration. Unlike previous technologies which targeted already-developed cells, germline gene therapy can potentially correct and eliminate genetic deficiencies at the developmental stages of a cell. This raises issues of genetic enhancement beyond the therapeutic applications of this technology. However, the authors submit that an established pattern of subordinating social and ethical issues to technical and scientific debate in the regulatory arena is repeating itself in the case of discussions over germline gene therapy. The authors suggest that the American scientific regulatory process fails to fully meet the challenges of this technology, particularly because social and ethical issues are not formally considered in the existing process. They therefore suggest that American regulatory agencies should look to the approach taken by Europe with regard to germline gene therapy as an emerging technology, and that it may be necessary to incorporate effective public debate over social and ethical concerns into a regulatory process which is primarily concerned only with the efficacy of new technologies.     

论刑法适用中道德评价因素的考量

道德评价能否在刑法适用中予以考虑,是刑事司法中的难题。一方面,道德评价在刑事司法中的体现是普遍存在的实然现象;而另一方面,法治原则一般又要求道德评价不应介入司法领域,否则,依法司法的理念将受到冲击。从理论上来看,道德评价可以在刑法适用解释中予以考虑,与其让道德评价潜在地、非理性地影响刑法的解释与适用,不如理性地承认和接受道德评价因素,并对其规范、限制和合理运用。道德评价因素在刑法解释和适用中的考量既是法理的要求,也是刑法原则所许可的,那种绝对排斥道德评价的观点,看似符合法治原则,但实际上并不能成立。从社会学的视角判断,刑法适用中考量道德评价因素是社会和谐的需求,也是社会学解释方法的题中应有之义。当然,对道德评价的考量与运用,应当在法律方法论的范围内,并在对其认真甄别、选择的基础上进行。     

Forensic medical assessment of the validity of medical risk

The notions of an unfavorable outcome as accepted in medical practice as well as those of defected medical care and of iatrogeny are presented in the paper alongside with examples from forensic medical practice. An algorithm is suggested for the thanatogenetic analysis applicable to detection and evaluation of the cause-and-effect relations between the therapeutic-and-diagnostic measures, on the one hand, and the above outcome, on the other hand. Risk criteria are substantiated with reference to medical practice. Finally, a objective assessment scheme is suggested to confirm that the diagnostic and treatment tools, related with a higher risk, were justifiable.     

The federal government and academic texts as barriers to informed consent

Informed patient consent for medical treatment is required by both law and medical ethics. Yet, both federal agencies and academicians are participating in the suppression of information about the heightened risk of breast cancer posed by oral contraceptives and induced abortion. There is historical precedent in the long-delayed acknowledgement of the smoking/lung cancer link. By law, a patient has the right to be fully informed of the nature of her medical condition and any proposed course of therapy. It is assumed that a patient will be given the complete and true scientific basis of her diagnosis and treatment, to ensure that her well-being and her autonomy in decision-making are protected. Informed consent is the process by which a patient can participate in choices about medical treatment. It originates from the legal and ethical right of the patient to direct what is done to her body, and from the ethical duty of the physician to involve the patient in her medical care. Our federal government has become a barrier to informed consent concerning oral contraceptive drugs and induced abortion.     

Ethical and legal consideration of prisoner's hunger strike in Serbia

Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48-year-old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15 days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as "heroin intoxication" in keeping with detection of 6-MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made.     

La maternidad subrogada: una confrontación entre italia y méxico

The development of assisted reproductive technologies has amplified the procreative expectations and has changed the traditional conception of parenthood. A significant example of this phenomenon is offered by surrogacy, whose practice has raised several questions. The present article, suggests considering two perspectives of the contemporary debate, the ethical and the juridical. On the one hand the ethical context points out the deepest problems of the practice, analyzing the role f thepeople involved and establishing a comparison between two bioethical currents, the liberal and the personalist. On the other hand, the legal perspective sets some considerations about the Italian and Mexican laws.     

医疗物品致人损害责任的举证制度研究

医疗物品致人损害责任是医疗损害责任的一种特殊形式,同时又具有产品责任的某些特点。对外,药品、消毒药剂和医疗器械致损的归责原则是无过错原则;而血液致损的归责原则是过错原则。对内,医疗机构承担的是无过错责任,因此在无过错时有权向最终的责任主体追偿。医疗物品责任实行的是谁主张,谁举证的归责原则,因此受损害方承担了证明医疗损害责任三个构成要件的证明责任;而医疗产品生产商和医疗机构都可以通过举证《产品质量法》规定的法定情况的存在而免责,但医疗机构不得对未投入流通这一情况而免责,血液提供机构承担了证明自己不存在过错的举证责任。为了更好的平衡举证责任和举证能力,我国应该对与证据价值密切相关的两个制度证据保全和医疗鉴定予以完善。     

Expert testimony in historical perspective

The ethical problems surrounding expert testimony depend directly on the historically specific relationship between science and scientists, on the one hand, and society on the other. In the seventeenth century, when modern experimental science was beginning to emerge, it drew upon legal experience to bolster its methodological arguments. In the eighteenth century, after the successes of Sir Isaac Newton, science gained in authority, and even in law courts the epistemological authority of science went unchallenged. In the nineteenth century, the more empirical sciences, such as chemistry and physics, entered the courts, and juries found the testimony of experimental chemists and physicists useful for their decisions. In the twentieth century, experimental psychology entered the courts. Pushed by Hugo Munsterburg, who saw in legal recognition a way of advancing psychology as a scientific profession, experimental psychology in the courtroom raised ethical problems at the beginning of the century that are still matters of controversy.     

法官的权力——中国法官权力约束制度研究

对法官权力的约束一般是在三个制度框架范围内进行的 :政治与行政的 ,道德与宗教的 ,法律与程序的。中国的法官在法律领域拥有重要的、无序的权力 ;在政治与行政制度框架内权力则极其微小 ;宗教与道德的多元化则使在该领域中法官的权力未能受到有效制约。权力制约是柄双刃剑 ,既可能对有条件产生腐败行为的权力领域构成约束 ,也可能加剧该领域腐败现象的蔓延。由于中国的法官在承担公正司法和维护社会正义的责任方面缺乏条件和能力 ,而在法官真正滥用权力时 ,国家与社会则又缺乏有效的法律约束能力 ,因此 ,通过建立一个要求法官必须充分、公开说理的法律制度 ,在特定的法庭空间内 ,在法律的框架内 ,保证同时又约束法官的权力 ,才能真正做到司法独立 ,也才能真正约束法官权力     

Ethical issues in child and adolescent forensic psychiatry: a review

Ethical challenges in child and adolescent forensic psychiatry arise, on the one hand, from the dilemmas commonly faced in forensic psychiatry with adult patients, such as the dual role of the forensic psychiatrist, questions of criminal responsibility, autonomy and competence and involuntary treatment, and, on the other, from the immaturity and dependent position of the minor. Child and adolescent forensic psychiatry deals with minors involved in crime, not only as offenders, but also as victims. In this review, we attempt to describe ethical challenges in child and adolescent psychiatry using as a frame of reference the principles of biomedical ethics according to Beauchamp and Childress.     

Codes of medical ethics

With one of the oldest codes of ethics in history, the medical profession continues to arouse controversy. This author examines the fifth major revision of the American Medical Association's code of ethics, published in 1957. Within this revision are the basic premises in establishing a medical code of ethics. Subsequent ethical dilemmas, involving technology, for example, can still be applied to the 1957 fundamental code.     

Ethical, professional and legal regulation of medical practice

Moral or ethical codes of practice represent one of the oldest forms of medical regulation. Legislation such as the Medical Practice Act 1992 (NSW) enables regulatory bodies to create codes of practice for medical practitioners. Such codes can become an important aspect of disciplinary proceedings by providing the yardstick against which practitioners' conduct is evaluated. An important aspect of the New South Wales Board's Code of Professional Conduct 2005 is the obligation for doctors to report adverse events which reflect on the performance or conduct of colleagues. This is part of an increasing impetus to report adverse events in the interest of public safety. In the long- term this is a constructive development as it is likely to lead to improvements in identification of risks and hazards and thereby to result in better service provision and community health.     

Public expectations of health professionals when patients telephone for medical advice

This article focuses on the ethical, social and liability implications of patients obtaining unsolicited medical advice over the phone. The ethical discussion centres on the demise of paternalism and the increase in patient autonomy and individualism and the growing public expectations of health professionals. The article then discusses the advantages and disadvantages of telephone consultations from a social and policy perspective. In light of these considerations it considers what the liability implications are for phone consultations. It argues that the ethic of individualism, coupled with recent Australian tort reforms, suggests that only in limited circumstances would a doctor be found liable for negligence in relation to telephone consultations. However, the increasing expectations being placed on medical personnel, as evidenced by the increase in unsolicited telephone consultations, if left untempered, may lead to a situation with which the health care system is ill equipped to deal.     

The ethics of managed care: a dose of realism

This article examines the ethics of medical practice under managed care from a pragmatic perspective that gives physicians more useful guidance than existing ethical statements. The article begins by stating the authors' starting premises and framework for constructing a realistic set of ethical principles: namely, that bedside rationing in some form is permissible; that medical ethics derive from physicians' role as healers; that actual agreements usually trump hypothetical ones; that ethical statements are primarily aspirational, not regulatory; and that preserving patient trust is the primary objective. The authors then articulate the following concrete ethical guides: financial incentives should influence physicians to maximize the health of the group of patients under their care; physicians should not enter into incentive arrangements that they would be embarrassed to describe accurately to their patients or that are not in common use in the market; physicians should treat each patient impartially, without regard to source of payment, and in a manner consistent with the physician's own treatment style; if physicians depart from this ideal, they must tell their patients honestly; and it is desirable, although not mandatory, to differentiate medical treatment recommendations from insurance coverage decisions by clearly assigning authority over these different roles and by having physicians to advocate for recommended treatment that is not covered.     

Clinical studies in the intensive care unit: ethical and legal aspects

This article draws on international experience to explore the ethical and legal aspects of performing clinical studies on patients in intensive care units. It discusses aspects of consent relevant to clinical studies in this medical environment, it considers the involvement of ethical committees, and the role and appropriate level of intensive cover.     

Prearraignment forensic evaluation: the odyssey moves east of the Pecos

Although the ethical guidelines of both the American Psychiatric Association and the American Academy of Psychiatry and the Law explicitly prohibit the forensic examination of criminal defendants before appointment of counsel, except for the purpose of providing emergency medical care and treatment, the practice continues in many parts of the country. This article presents a recent case in which this practice was challenged on appeal, to serve as a focus for discussion of the evolution of, and rationales for and against, these ethical positions. It will also serve as a focus to examine the legal views concerning such examinations, derived from the appeal of the decision in the case itself as well as decisions in similar cases.     

Research on medical records without informed consent

Observational research involving access to personally identifiable data in medical records has often been conducted without informed consent, owing to practical barriers to soliciting consent and concerns about selection bias. Nevertheless, medical records research without informed consent appears to conflict with basic ethical norms relating to clinical research and personal privacy. This article analyzes the scope of these norms and provides an ethical justification for research using personally identifiable medical information without consent.