Abstract:
:Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholders. Yet, the process described by this view contrasts with the actual processes involved in creating the Affordable Care Act (ACA) and in attempting to pass the Health Securities Act (HSA). Since the ACA seems to be legitimate, as the HSA would have been had it passed, there seem to be counterexamples to this view. In this essay, I clarify the concept of legitimacy as employed in bioethics discourse. I then use that clarification to develop these examples into a criticism of the orthodox view-that it implies that legitimacy requires counterintuitively large sacrifices of justice in cases where important advancement of healthcare rights depends on violations of publicity. Finally, I reply to three responses to this challenge: (1) that some revision to the orthodox view salvages its core commitments, (2) that its views of publicity and substantive considerations do not have the implications that I claim and (3) that arguments for it are strong enough to support even counterintuitive results. My arguments suggest a greater role for substantive considerations than the orthodox view allows.
journal_name
J Med Ethicsjournal_title
Journal of medical ethicsauthors
Smith WRdoi
10.1136/medethics-2017-104559subject
Has Abstractpub_date
2018-06-01 00:00:00pages
416-423issue
6eissn
0306-6800issn
1473-4257pii
medethics-2017-104559journal_volume
44pub_type
杂志文章abstract::A recurrent issue in the vast amount of literature on reasoning models in ethics is the role and nature of moral intuitions. In this paper, we start from the view that people who work and live in a certain moral practice usually possess specific moral wisdom. If we manage to incorporate their moral intuitions in ethic...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2008.026559
更新日期:2009-04-01 00:00:00
abstract::The feasibility of a common European code of medical ethics is discussed, with consideration and evaluation of the difficulties such a project is going to face, from both the legal and ethical points of view. On the one hand, the analysis will underline the limits of a common European code of medical ethics as an inst...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2015-102963
更新日期:2017-01-01 00:00:00
abstract::Discussions on the ethics and regulation of clinical research have a great deal to say about the responsibilities of investigators, sponsors, research institutions and institutional review boards, but very little about the responsibilities of research participants. In this article, we discuss the responsibilities of p...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2011-100319
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Desire for improvement in one's illness and having one's own doctor functioning as a researcher are thought to promote therapeutic misconception (TM), a phenomenon in which research subjects are said to conflate research with treatment. PURPOSE:To examine whether subjects' therapeutic motivation and own doc...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2013-101987
更新日期:2015-05-01 00:00:00
abstract:UNLABELLED:The difficulties of undertaking good quality effectiveness research in palliative medicine are well documented. Much of the ethical literature in this area focuses on the vulnerability of the palliative care population. It is clear that a wider ethical approach will need to be used to justify research in the...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.022632
更新日期:2008-10-01 00:00:00
abstract::Research that is initiated, designed or funded by sponsor agencies based in countries with relatively high social and economic development, and conducted in countries that are relatively less developed, gives rise to many important ethical challenges. Although clinical trials of HIV vaccines began ten years ago in the...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.26.1.37
更新日期:2000-02-01 00:00:00
abstract::The aim of regenerative medicine is to reconstruct tissue that has been lost or pathologically altered. Therapeutic cloning seems to offer a method of achieving this aim; however, the ethical debate surrounding human therapeutic cloning is highly controversial. Artificial parthenogenesis-obtaining embryos from unferti...
journal_title:Journal of medical ethics
pub_type: 历史文章,杂志文章,评审
doi:10.1136/jme.2004.010199
更新日期:2005-12-01 00:00:00
abstract::It is a common feature of debates on the regulation of reproductive medicine to find law portrayed as a crude form of intervention consisting in the imposition of inflexible rules on doctors and medical researchers. This paper argues that this view must be replaced by a more accurate assessment of the law's potential ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.16.1.35
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVES:To compare 2005 and 1995 ethics guidelines from journal editors to authors regarding requirements for institutional review board (IRB) approval and conflict-of-interest (COI) disclosure. DESIGN:A descriptive study of the ethics guidelines published in 103 English-language biomedical journals listed in the A...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2008.024299
更新日期:2009-01-01 00:00:00
abstract::A quiet revolution is occurring in the field of transplantation. Traditionally, transplants have involved solid organs such as the kidney, heart and liver which are transplanted to prevent recipients from dying. Now transplants are being done of the face, hand, uterus, penis and larynx that aim at improving a recipien...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2015-103348
更新日期:2017-11-01 00:00:00
abstract::The death toll from tobacco is staggering: it might contribute to one billion premature deaths over the course of the 21st century. In 'The case for banning cigarettes', Kalle Grill and Kristin Voigt argue that the well-being and equality benefits of a complete ban on cigarettes more than justify the restrictions on a...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2017-104172
更新日期:2017-06-01 00:00:00
abstract::A report of a problem-based learning project on the ethics of terminal care, offered as one of the options available to first year MB ChB students in Edinburgh University Medical School. The project formed part of the 'clinical correlation course' in the new curriculum. Six students took part under the supervision of ...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.7.2.62
更新日期:1981-06-01 00:00:00
abstract::In this article, we discuss the ethical dimensions for the prescribing behaviours of opioids for a chronic pain patient, a scenario commonly witnessed by many physicians. The opioid epidemic in the USA and Canada is well known, existing since the late 1990s, and individuals are suffering and dying as a result of the e...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2018-105099
更新日期:2019-04-01 00:00:00
abstract::The revised Declaration of Helsinki allows placebo-controlled trials to be used even when there is an established therapy, provided there are adequate 'methodological' reasons for doing so. This seems to violate the principle of beneficence: where there is an established therapy, physicians treating patients with a pl...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2016-103970
更新日期:2017-08-09 00:00:00
abstract::With so much attention being paid to the development and refinement of appropriate criteria and tests for death, little attention has been given to the broader conceptual issues having to do with its definition or with the relation of a definition to its criterion. The task of selecting the correct criterion is, howev...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.21.5.270
更新日期:1995-10-01 00:00:00
abstract::Recent studies using functional magnetic resonance imaging of patients in a vegetative state have raised the possibility that such patients retain some degree of consciousness. In this paper, the ethical implications of such findings are outlined, in particular in relation to decisions about withdrawing life-sustainin...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2008.029165
更新日期:2009-08-01 00:00:00
abstract::It is argued that the current policy of the British Medical Association (BMA) on conscientious objection is not aligned with recent human rights developments. These grant a right to conscientious objection to doctors in many more circumstances than the very few recognised by the BMA. However, this wide-ranging right m...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2015-103222
更新日期:2017-04-01 00:00:00
abstract::Elaborating on the concept of confidentiality of medical records and interdisciplinary communication discussed in earlier articles by D.J. Kenny and Derek F.H. Pheby, the author expresses concern about written communications to professional colleagues and verbal revelations to colleagues or to persons outside the ther...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.8.1.21
更新日期:1982-03-01 00:00:00
abstract:OBJECTIVES:To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN:Self-completion questionnaire administered from February to July 1997. SETTING:Different health regions i...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.25.1.51
更新日期:1999-02-01 00:00:00
abstract::Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autono...
journal_title:Journal of medical ethics
pub_type: 杂志文章,评审
doi:10.1136/jme.20.2.101
更新日期:1994-06-01 00:00:00
abstract::Currently, any dentist in the UK who is HIV-seropositive must stop treating patients. This is despite the fact that hepatitis B-infected dentists with a low viral load can continue to practise, and the fact that HIV is 100 times less infectious than hepatitis B. Dentists are obliged to treat HIV-positive patients, but...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2007.021972
更新日期:2008-03-01 00:00:00
abstract::Dr Neil Campbell suggests that when patients suffering extremes of protracted pain ask for help to end their lives, their requests should be discounted as made under compulsion. I contend that the doctors concerned should be referred to and then act upon advance directives made by those patients when of sound and calm...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/jme.25.3.245
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVES:This study investigated Finnish physicians' experiences of decisions concerning living wills and do not resuscitate (DNR) orders and also their views on the role of patients and family members in these decisions. DESIGN:A questionnaire was sent to 800 physicians representing the following specialties: gener...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/jme.2002.001081
更新日期:2004-08-01 00:00:00
abstract::The two tragedies argument (2TA) has been raised as a response to the argument against abortion from spontaneous abortion (or miscarriages). According to this argument against the antiabortion position (AAP), miscarriages should be of great concern for proponents of this position since they result in a greater amount ...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/medethics-2019-105770
更新日期:2020-03-01 00:00:00
abstract::Albertsen, in his recent article, offers an assessment of the recently introduced opt-out system for organ donation in Wales. However, he focuses on whether concerns raised prior to the enactment of the new system have been realised, rather than any positive impact on the number of actual donors. This side-lining of t...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/medethics-2018-104935
更新日期:2019-03-01 00:00:00
abstract::The new regulations on xenotransplantation pay insufficient attention to the broad ethical (and legal) problems raised by this technique and that the abandonment of a national body with overall regulatory authority in this area is a mistake. ...
journal_title:Journal of medical ethics
pub_type: 社论,评审
doi:10.1136/jme.2007.020768
更新日期:2007-07-01 00:00:00
abstract::This paper is a response to Dr Shinebourne's response to my recent paper assessing the relative merits of the Staffordshire Protocol on covert video surveillance. Dr Shinebourne does not take the opportunity to rebut the criticisms made of the text of the protocol. It is further suggested that judicial oversight of th...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/jme.22.6.349
更新日期:1996-12-01 00:00:00
abstract::The article considers the objection to a commercial market in living donor organs for transplantation on the ground that such a market would be exploitative of the vendors. It examines a key challenge to that objection, to the effect that denying poor people the option to sell an organ is to withhold from them the bes...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2012-100770
更新日期:2014-01-01 00:00:00
abstract::'Futility' is a contentious term that has eluded clear definition, with proposed descriptions either too strict or too vague to encompass the many facets of medical care. Requests for futile care are often surrogates for requests of a more existential character, covering the whole range of personal, emotional, cultura...
journal_title:Journal of medical ethics
pub_type: 杂志文章
doi:10.1136/medethics-2020-106232
更新日期:2020-04-24 00:00:00
abstract::This is a continuation of and a development of a debate between John Keown and me. The issue discussed is whether, in Britain, an unpaid system of blood donation promotes and is justified by its promotion of altruism. Doubt is cast on the notions that public policies can, and, if they can, that they should, be aimed a...
journal_title:Journal of medical ethics
pub_type: 评论,杂志文章
doi:10.1136/jme.25.6.532
更新日期:1999-12-01 00:00:00