Primary central nervous system lymphoma: a practical guide for neurologists.

Primary central nervous system lymphoma is rare, comprising 4% of intracranial neoplasms. Although haematologists or oncologists subsequently manage the condition, it is often neurologists who first make, or at least suspect, the diagnosis. This article reviews the disease, its clinical and radiological features and details the work-up needed to achieve a diagnosis (namely histological or cytological confirmation) and to prepare the patient for treatment.

Eugène Bouchut's (1818-1891) Early Anticipation of the Concept of Brain Death.

The conventional historical account of the concept of brain death credits developments and discoveries of the twentieth century with its inception, emphasizing the role of technological developments and professional conferences, notably the 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. This essay argues that the French physician Eugène Bouchut anticipated the concept of brain death as early as 1846. Correspondence with Bouchut's understanding of brain death and one important contemporary concept of brain death is established then contrasted with current trends of defining death as the death of the brain.

Re-Examining the idea of internal morality in medicine.

This article considers the idea of medicine's internal morality as it is understood by its various proponents. Although the use of the phrase 'internal morality' in relation to medicine predates Edmund Pellegrino, he can be credited with cementing its place in the vocabulary of medical ethics. Yet, while 'internal morality' and its related terms are now readily recognizable, they are used to denote irreconcilable ideas.

Chronic inflammatory demyelinating polyneuropathy: a rare cause of falls.

This case of chronic inflammatory demyelinating polyneuropathy (CIDP) shows that a patient's condition can evolve from the point of admission, gradually manifesting its underlying cause. Our patient's initial presentation of backpain and lower limb weakness prompted investigations which ruled out compressive myelopathy and neuropathy. As upper limb weakness developed later, along with a more proximal and symmetrical pattern of lower limb weakness, the clinical picture suggested polyneuropathy.

Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm.

This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical judgment. Conscientious objection in healthcare is usually restricted to a handful of controversial ends (e.g.

Jacob Winslow (1669-1760): The surprising legacy of an anatomist.

Jacob Winslow (1669-1760), a celebrated anatomist in his day, made his name publishing numerous medical treatises and writing the four-volume . He gives his name to the foramen of Winslow, and is credited with numerous significant findings in neuroanatomy and biomechanics. His life is characterised by meticulous devotion to his discipline and divided by a torturous religious conversion.

Conscientious objection: unmasking the impartial spectator.

Hoping to bring some objectivity to the debate, Ben-Moshe has argued that conscientious objection in medicine should be accommodated based on its concordance with the 'impartial spectator', a metaphor for conscience drawn from the writings of Adam Smith. This response finds fault with this account on two fronts: first, that its claim to objectivity is unsubstantiated; second, that it implicitly relies on moral absolutes, despite claiming that conscience is a social construct, thereby calling its coherence and claims into question. Briefly, a traditional account of conscience is then described, before ending with a related thesis for future discussion.

Hormone replacement therapy: informed consent without assessment?

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy (HRT) is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model.

Against the nihilism of 'legal age change': response to Räsänen.

Räsänen has attempted to make a moral case for permitting some people to change their legal age: if someone considers that their chronological age does not correspond to their emotional age or biological age, and they face age-based discrimination as a result, they may change the legal record of their age. This response considers some of the problems with Räsänen's paper, including its reliance on equivocation. It concludes that what is billed as a moral argument turns out to be a conflicted case for deception which relies on a nihilistic outlook on reality.

Can conscientious objection lead to eugenic practices against LGBT individuals?

In a recent article in this journal, Abram Brummett argues that new and future assisted reproductive technologies will provide challenging ethical questions relating to lesbian, gay, bisexual and transgender (LGBT) persons. Brummett notes that it is likely that some clinicians may wish to conscientiously object to offering assisted reproductive technologies to LGBT couples on moral or religious grounds, and argues that such appeals to conscience should be constrained. We argue that Brummett's case is unsuccessful because he: does not adequately interact with his opponents' views; equivocates on the meaning of 'natural'; fails to show that the practice he opposes is eugenic in any non-trivial sense; and fails to justify and explicate the relevance of the naturalism he proposes.

Euthanasia in Belgium: legal, historical and political review.

This article describes and evaluates the Belgian euthanasia experience by considering its practice and policy, both before and after the formal decriminalisation of euthanasia in 2002. The pre-legal practice of euthanasia, the evolution of euthanasia legislation, criticism of this legislation, the influence of politics, and later changes to the 2002 Act on Euthanasia are discussed, as well as the subject of euthanasia of minors and the matter of organ procurement. It is argued that the Belgian euthanasia experience is characterised by political expedition, and that the 2002 Act and its later amendments suffer from practical and conceptual flaws.

The Moral Inadequacy of Cremation.

Cremation has substantial practical benefits. Not only is it much cheaper than traditional burial, but it also comes without its ecological burden. Despite this, we argue that cremation is an inadequate way of disposing of the dead because it entails the destruction of community memory, and, by extension, community and individual identity.

The history of autonomy in medicine from antiquity to principlism.

Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress' in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought.

Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection.

In her paper 'Cosmetic surgery and conscientious objection', Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism.

A medical curriculum in transition: audit and student perspective of undergraduate teaching of ethics and professionalism.

Introduction: The General Medical Council (GMC) stipulates that doctors must be competent professionals, not merely scholars and practitioners. Medical school curricula should enable students to develop professional values and competencies. Additionally, medical schools are moving towards integrated undergraduate curricula, Cardiff's being one such example.

We are not Gametes: Distinguishing between Abortion and Contraception.

It is sometimes argued that interruptions of the life's continuum which have the same end result are morally equivalent. In other words, abortion and contraception are ethically identical because both prevent birth and the development of persons. We will examine two major arguments in favour of this thesis: (1) all things that are potential persons have equal moral status.