Clinical pragmatism and the care of brain damaged patients: toward a palliative neuroethics for disorders of consciousness.

Unraveling the mysteries of consciousness, lost and regained, and perhaps even intervening so as to prompt recovery are advances for which neither the clinical nor the lay community are prepared. These advances will shake existing expectations about severe brain damage and will find an unprepared clinical context, perhaps even one inhospitable to what should clearly be viewed as important advances. This could be the outcome of this line of inquiry, if this exceptionally imaginative research can continue at all.

Death, dying and informatics: misrepresenting religion on MedLine.

Background: The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the three major monotheistic religions.

The globalization of education in medical ethics and humanities: evolving pedagogy at Weill Cornell Medical College in Qatar.

The authors discuss their experience in implementing a Medical Ethics and Humanities course for premedical students at Weill Cornell Medical College in the Arabian Gulf emirate of Qatar. The course, first offered in 2003, is designed to prepare these students for the medical school curriculum to follow and to make global medical knowledge meaningful for their local context. Pedagogical challenges included the cross-cultural tensions that could emerge when introducing themes from Western medical ethics and humanities into this overwhelmingly Islamic context.

Contracts, covenants and advance care planning: an empirical study of the moral obligations of patient and proxy.

Previously we had speculated that the patient-proxy relationship existed on a contractual to covenantal continuum. In order to assess this hypothesis, and to better understand the moral obligations of the patient-proxy relationship, we surveyed 50 patient-proxy pairs as well as 52 individuals who had acted as proxies for someone who had died. Using structured vignettes representative of three distinct disease trajectories (cancer, acute stroke, and congestive heart failure), we assessed whether respondents believed that proxies should follow explicit instructions regarding life-sustaining therapy and act contractually or whether more discretionary or covenantal judgments were ethically permissible.

Screening and cognitive impairment: ethics of forgoing mammography in older women.

Mammographic screening for breast cancer in cognitively impaired women poses significant ethical questions. Many woman with dementia should not be screened because of the greater harm than benefits and the difficulty in obtaining informed consent. This article reviews the current controversy about mammography and then suggests a risk/benefit analysis for this vulnerable population.

Postmortem sperm retrieval: the effect of instituting guidelines.

Purpose: Postmortem sperm retrieval (PMSR) raises serious medical and ethical concerns. In this study we report the effect of intra-institutional guidelines developed for the permissibility of the procedure on the number of procurement procedures performed.

Materials And Methods: The family members of 22 men who died suddenly sought PMSR.

From psychosurgery to neuromodulation and palliation: history's lessons for the ethical conduct and regulation of neuropsychiatric research.

As we contemplate the emerging era of neuromodulation and imagine the utility of deep brain stimulation for disease entities in neurology and psychiatry, our enthusiasm is immediately tempered by history. Just a generation ago, other confident investigators were heralding invasive somatic therapies like prefrontal lobotomy to treat psychiatric illness. That era of psychosurgery ended with widespread condemnation, congressional calls for a ban, and avow that history should never repeat itself.

Reflective practice and palliative care education: a clerkship responds to the informal and hidden curricula.

The authors discuss the damaging influence of informal and hidden curricula on medical students and describe a two-week clerkship in palliative care and clinical ethics at their school (Weill Medical College of Cornell University). This required clerkship, begun in 1999, uses reflective practice and a special pedagogic technique, participant observation, to counteract the influences of the informal and hidden curricula. This technique seeks to immerse the participant observer in the context of care.

Patently controversial: markets, morals, and the President's proposal for embryonic stem cell research.

This essay considers the implications of President George W. Bush's proposal for human embryonic stem cell research. Through the perspective of patent law, privacy, and informed consent, we elucidate the ongoing controversy about the moral standing of human embryonic stem cells and their derivatives and consider how the inconsistencies in the president's proposal will affect clinical practice and research.