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Byline: David C. Thomasma (1) Keywords: bioethics; community consent; communitarianism; diminished capacity; ethics of research; family consent; health care givers; incompetence; philosophy of medicine; moral capacity Abstract: Persons of diminished capacity, especially those who are still legally competent but are de facto incompetent should still be able to participate in moderately risky research projects that benefit the class of persons with similar diseases. It is argued that this view can be supported with a modified communitarianism, a philosophy ofmedicine that holds that health care is a joint responsibility that meets foundational human needs. The mechanism for obtaining a substituted consent I call ``community consent,'' and distinguish this from the usual family or surrogate consent for treatment. Care givers are included in the community that might consent for an individual who has no identifiable family members. Author Affiliation: (1) Medical Humanities Program, Loyola University Chicago Medical Center, Maywood, IL, 60153, USA Article History: Registration Date: 08/10/2004

The ethical problems associated with caring for conjoined twins are perplexing and complicated. They involve questions of medical and clinical uncertainty as well as problems ranging from the role of [...]

The healthcare system in the US needs to be transformed, so that the elderly have equal access to it. Since some degree of healthcare rationing for the elderly is needed, measures should be taken to make it more efficient, so that more is spent on patient care and less on administration. Furthermore, its provision should be flexible to meet individual requirements and should be decided in advance. Many claim that the elderly place an excessive burden on the health care system, but they have made sacrifices during their lives and fulfilled their obligations to the younger generation.

Events throughout the country are cited that point to the public's growing fears of infection with human immunodeficiency virus (HIV, associated with AIDS) by health care workers. Since initial reports that one patient of an HIV-infected Florida dentist was infected by him, concern has mounted; a law in this is under consideration that would require disclosure by HIV-infected health care workers of their status to a medical board. The ethical aspects and possible implications of such rulings are considered. Admitting that one is infected with HIV would lead to compassion, care, and help in a perfect society, whereas disclosure in our society brings ostracization. Irrational fears of the dangers of transmission from health care worker to patient abound, and public trust in the safety of donated blood, transplanted organs, and hospital safety procedures has been eroded. People's fears are intensified by the certainty that HIV infection leads to death. The American Medical Association (AMA) and the American Dental Association (ADA) have explicitly stated their views that physicians and dentists are ethically obligated to treat people infected with HIV. In early 1991, both the AMA and ADA recommended that HIV-infected health professionals stop performing invasive procedures or inform their patients that they are infected. Opponents to this recommendation cite the disastrous consequences of disclosure for the professional's career and financial security, and the difficulty of deciding which procedures are hazardous. According to one recent report, three-fourths of the dentists surveyed believed that patients should be told if their dentist was HIV-infected. Several recommendations are presented, including: (1) development of safer instruments and procedures; (2) development of reimbursement procedures to finance health care for HIV-infected people; (3) mandatory reporting of HIV-positive health care workers to a panel of experts; and (4) the requirement that HIV-infected patients inform their doctor or dentist of their status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Edmund D. Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is presented in the following areas: methodology, relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes.

The aim of 'What do I do now' is not to provide answers but to offer readers a range of reasonable and defensible options with which to inform their own [...]