Compiling the ethical, legal and social implications of nanotechnology

This paper maintains that although there is much interest at the moment in exploring the Ethical, Legal and Social Implications (ELSI) of nanotechnology, the ability to do so in a critical and reflective way, in part, depends on how nanotechnology's future is envisioned. It is argued that, at present, this vision is articulated through the novum, a narrative device borrowed from the science fiction (SF) genre. The paper concludes by arguing that the widely shared narratives about nanotechnology's future, structured by the novum, not only limit the types of ELSI questions that can be addressed but also lead to a polarized debate. It is also suggested that the device of the novum also obscures the heterogeneous nature of nanotechnology itself.     

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.     

Physician-assisted suicide: legal and ethical considerations

As medicine's technical limits have become increasingly clear, Americans seem more willing to address end-of-life decisionmaking. A major development during the 1990s was physician assistance in dying: physician-assisted suicide in Michigan, Oregon's Death with Dignity Act, and developments in Europe, most notably The Netherlands. This evolution toward recognizing the appropriateness of assistance in dying raises legal and ethical issues for physicians and healthcare institutions such as nursing facilities and acute care hospitals. These issues include the effects on providers' values systems, the trust between patient and provider, and the "slippery slope" that voluntary, active assistance in dying will become involuntary, active assistance. This Article addresses the policy issues that institutions must confront in a changing environment.     

Wrongful life actions: the legal and ethical hurdles

This article discusses the various legal and ethical issues arising out of the cause of action for wrongful life. This action involves a claim by a child that but for the negligence of the doctor, hospital or other medical institution, his or her mother would have terminated the pregnancy and he or she would not have been born. The courts have generally rejected this cause of action on the basis of legal, ethical and policy considerations. The author proposes that the legal hurdles can be overcome and that the ethical and policy considerations do not outweigh the desirability of upholding wrongful life claims.     

"Holding the child down" for treatment in paediatric haematology: the ethical,legal and practice implications

Very little has been written about involuntary treatment for adult patients and even less about such treatment for paediatric patients. Ethical dilemmas for nurses in such situations have not been clearly articulated and there are no clear guidelines available in this area. The following findings from a qualitative, longitudinal study on the psycho-social aspects of treatment for childhood leukaemia and related diseases are offered as preliminary work on this important professional issue. The feelings of parents when confronted with the necessity of holding their child down so that they may receive probably curative treatments for acute lymphoblastic leukaemia are described and some of the ethical and legal issues confronting nurses who provide these treatments are explored.     

Why public opinion changes: the implications for health and health policy

Research on stasis or change in public opinion toward health, health policy, and medical care tends to focus on short-term dynamics and to emphasize the impact of discrete messages communicated by individual speakers in particular situations. This focus on what we term "situational framing," though valuable in some respects, is poorly equipped to assess changes that may occur over the longer term. We focus, instead, on "structural framing" to understand how institutionalized public health and health care policies impact public opinion and behavior over time. Understanding the dynamics of public opinion over time is especially helpful in tracking the political effects of the Patient Protection and Affordable Care Act of 2010 as it moves from the debate over its passage to its implementation and operation.     

Medicare reimbursement for hospice care: ethical and policy implications of cost-containment strategies

In several areas of health policy, current concern over rising costs has generated considerably political support for reforms that many in the business have advocated unsuccessfully on philosophical, ethical, or humanitarian grounds for years. Thus, for example, the spiraling cost of caring for the mentally ill and the developmentally disabled in an institutional setting has breathed new life into proposals to bring these groups out into the community where they can live more independently--and more cheaply. But this overlap of quality and frugality goals is only partial. Although alliances with cost-cutters can bring reform, health policy reformers are discovering that they may have to accept a lot of bathwater along with the baby. Medicare reimbursement for hospice care, authorized by Section 122 of PL 97-248, the Tax Equity and Fiscal Responsibility Act of 1982, provides one recent example of this dilemma. This article discusses the results of a survey--conducted by the Office of the Inspector General of the Department of Health and Human Services--to discover how many hospices would seek certification for reimbursement by Medicare, how many patients would be served, and the consequences of this legislation for cost, access, and quality of service.