Methods and principles in biomedical ethics.

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the "standard" Jehovah's Witness case that having autonomously chosen the authority of his religious institution, a Jehovah's Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author's view of the child of a Jehovah's Witness scenario is that it is morally required-not merely permitted-to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure.

Internal and external standards for medical morality.

What grounds and justifies conclusions in medical ethics? Is the source external or internal to medicine? Three influential types of answer have appeared in recent literature: an internal account, an external account, and a mixed internal/external account. The first defends an ethic derived from either the ends of medicine or professional practice standards. The second maintains that precepts in medical ethics rely upon and require justification by external standards such as those of public opinion, law, religious ethics, or philosophical ethics. The third claims that distinct medical ethics have emerged from distinct cultural frameworks, each with norms that govern physicians. There is merit in each perspective, but each over reaches its supporting arguments and fails to appreciate what is legitimate in the theses of its competitors. I propose a fourth account that offers a way to escape limitations of the other three, while retaining their most attractive features.

Hume on the nonhuman animal.

Hume wrote about fundamental similarities and dissimilarities between human and nonhuman animals. His work was centered on the cognitive and emotional lives of animals, rather than their moral or legal standing, but his theories have implications for issues of moral standing. The historical background of these controversies reaches to ancient philosophy and to several prominent figures in early modern philosophy. Hume develops several of the themes in this literature. His underlying method is analogical argument and his conclusions are generally favorable regarding the abilities in animals. Hume does not attribute a moral sense or capacity of judgment to animals, but he does suggest that their actions exhibit moral qualities, such as other-regarding instincts. Hume allows in-kind differences in both demonstrative reason and moral judgment, but in the domains of both causal reason and moral agency he believes there are differences of degree rather than of kind. Hume's most significant philosophical contribution was to move as far as anyone before him to a naturalistic explanation of human and nonhuman minds that invited psychological and epistemological examination of minds by using the identical methods and categories for man and beast.

Ethics, scientific validity, and the design of epidemiologic studies.

Ethical conflicts between moral principles and methodologic standards sometimes occur in epidemiologic research. When dilemmas are discerned, they may be analyzed using the ethical principles of beneficence, nonmaleficence, justice, and respect for the autonomy of persons. We argue that, in addition to scientific validity, the welfare and rights of research subjects should be taken into account in making decisions regarding all aspects of the design and conduct of epidemiologic studies, and that the commitment of epidemiologists to the advancement of scientific knowledge should not outweigh or override all other considerations.

Ethical theory and epidemiology.

The stream of ethics questions that arise in science seems endless. These questions concern how one determines responsibilities, rights, obligations, policies, and the like. But neither a "code of ethics" nor customary practice-standards may adequately justify a moral belief. An ethical theory is sometimes necessary to make progress on our moral problems. This form of theory consists of a diverse set of ways of developing moral concepts and giving philosophical reasons that explain, augment, and criticize the rules of social morality. Moral theory provides a basis for moral reasoning about problems; this reasoning is analogous to legal reasoning, where one appears before a court with a well reasoned case in defense of one's conduct. Moral theory is no panacea for our contemporary moral concerns, but it is valuable ally in the attempt to resolve them.

Baby Jane Doe in the media.

A review of national television, magazine, and newspaper coverage of the case of Baby Jane Doe indicates that most of it lacked perspective and context; stories were generally incomplete and often imprecise; reporting was sometimes inaccurate; and overall, inadequate attention was paid to the medical, legal, philosophical, and social implications of the case. Human-interest and political elements of the story were generally well covered. Even after taking account of the pressures and constraints of daily and weekly news reporting, we conclude that the print press and television could have done a better job without devoting more space or time to the story. This could have been done by assigning reporters with greater expertise and by paying more attention to the needs of a hypothetical "reasonable reader."

KIE: A critical analysis is presented of the news coverage of the Baby Jane Doe case, in which a Long Island baby born with multiple birth defects in October 1983 became the focus of a national controversy over treatment decisions for such newborns. The authors examined stories about the case carried by the major television networks, newspapers with national circulation, and national news magazines. They concluded that these stories were frequently incomplete, imprecise, and lacking in perspective. Most of the stories were written by reporters without experience in covering medicine and bioethical issues. Klaidman and Beauchamp contend that, while human interest and political elements of the case were generally well covered, inadequate attention was paid to its medical, legal, philosophical, and social implications. Accordingly, the moral responsibilities of journalism were not fulfilled.