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A Critical Examination of Ethics in Health Care and Biomedical Research Voices and Visions International Library of Ethics, Law, and the New Medicine International Library of Ethics, Law, and the New Medicine 60 Richard M. Zaner A Critical Examination of Ethics in Health Care and Biomedical Research Voices and Visions International Library of Ethics, Law, and the New Medicine Volume 60 Series editor David N. Weisstub, Montreal, Canada The book series International Library of Ethics, Law and the New Medicine comprises volumes with an international and interdisciplinary focus. The aim of the Series is to publish books on foundational issues in (bio) ethics, law, interna- tional health care and medicine. The 28 volumes that have already appeared in this series address aspects of aging, mental health, AIDS, preventive medicine, bioeth- ics and many other current topics. This Series was conceived against the back- ground of increasing globalization and interdependency of the world’s cultures and governments, with mutual influencing occurring throughout the world in all fields, most surely in health care and its delivery. By means of this Series we aim to contribute and cooperate to meet the challenge of our time: how to aim human technology to good human ends, how to deal with changed values in the areas of religion, society, culture and the self-definition of human persons, and how to formulate a new way of thinking, a new ethic. We welcome book proposals representing the broad interest of the interdisciplinary and international focus of the series. We especially welcome proposals that address aspects of ‘new medi- cine’, meaning advances in research and clinical health care, with an emphasis on those interventions and alterations that force us to re-examine foundational issues. More information about this series at http://www.springer.com/series/6224 Richard M. Zaner A Critical Examination of Ethics in Health Care and Biomedical Research Voices and Visions Richard M. Zaner Ann Geddes Stahlman Professor Emeritus of Medical Ethics and Philosophy of Medicine Department of Medicine, Primary Vanderbilt University Nashville, TN, USA ISSN 1567-8008 ISSN 2351-955X (electronic) International Library of Ethics, Law, and the New Medicine ISBN 978-3-319-18331-2 ISBN 978-3-319-18332-9 (eBook) DOI 10.1007/978-3-319-18332-9 Library of Congress Control Number: 2015938605 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Preface I should note at the outset that an early version of this book was published several years ago in Mandarin Chinese.1 The reason for this is that a good friend, Chen-yun Tsai, Professor of Philosophy at the National Chengchi University in Taipei, asked me if I would write a book that would lay out the principal topics and themes of my several decades of work in medical humanities and clinical ethics. Since only two of my books had at that time been published in Taiwan, both including only clinical ethics narratives, he was concerned that persons in that still-developing field there should know of my philosophical views on those and other themes. His invitation came at the conclusion of a seven-lecture tour of universities in Taiwan in 2004, and it was with the many responses to and discussion of those lectures in mind that I agreed with Professor Tsai’s suggestion, but only after he had agreed to undertake the book’s translation into complex Chinese Mandarin, used among professionals in colleges and universities. Working with him and the editor of his university’s press, Chu-po Chen, the book was in due course completed and the translation done— although, I must add, given the complexities of the language and those of transla- tion, especially from my own not always Standard English usages, this took several years to complete. When I decided to try and publish the book in English, however, it was clear to me that it had to be thoroughly rewritten. In the years that had passed since I undertook that project, rereading that initial text brought home to me that much of it needed rethinking and some restructuring. I am hopeful that the result, presented here, will be found to be helpful to readers. I had already come to appreciate, as I noted in one of my early books, that the act of writing and publishing a book seems audacious. That’s true, in its way; but how 1 Published as Voices and Visions: Clinical Listening, Narrative Writing, tr. by Cheng-yun Tsai, National Chengchi University Press (NCCU), Taipei, Taiwan, 2009 (published in Mandarin Chinese only). v vi Preface much more audacious, then, is writing this book, one which takes up the major parts of a lifetime of writing and attempts to put it all together in a single place? Indeed. Still, as things have worked out, there is much that is quite new here. More than that, this is the only place where many of these ideas can be found connected together, where they are able to knock up against as well as complement each other. So, I do not hesitate at all at this time in my life to try and share these ideas with others, to give them a kind of public presence, available to one and all. I am thus happy to engage the challenge of yet another book, exploring themes that have long been a close part of my life as a philosopher making my way in the world of clinical and research medicine. I must say, too, that several of my colleagues have played an important part in my efforts to articulate my vision and find my voice. Principal among these are Stuart G. Finder2 and Mark J. Bliton,3 both of them colleagues for many years at what I first set up as the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. The three of us worked very closely together at both Vanderbilt and in the clinical ethics program where we were asked to set up at Nashville’s St. Thomas Hospital (1991–1994). Daily conversations, joint teaching, writing, and publication went on for more than a decade, one result of which was helping me to articulate and clarify the conception of clinical ethics that finds expression here. From what I know, too, this conception has been carried over to a good many other institutions—by them, and by a number of outstanding graduate students who worked and studied with us at the Center and have subsequently become well known in their own right. Prominent among these are Tarris “Terry” Rosell, DMin, PhD, the Rosemary Flanigan Chair at the Center for Practical Bioethics4; Denise Dudzinski, PhD, Associate Professor and Director of Graduate Studies in the Department of Bioethics and Humanities at the University of Washington5; and Paul Ford, Director and Associate Professor of Bioethics, the Cleveland Clinic.6 I am grateful to all of them and for much of what we together achieved at when we were together.7 Clearly, I learned much from each of them, then and later through their writings. 2 Director, Center for Healthcare Ethics, Cedars-Sinai Medical Center, Los Angeles, CA. 3 After serving as Associate Professor in the program at Vanderbilt, Mark moved to Kaiser Permanente in Los Angeles, working as head of Ethics and Applied Philosophy. 4 Terry is also Professor at the Central Baptist Theological Seminary in Kansas City; Clinical Associate Professor, at the School of Medicine, University of Kansas Medical Center; and Clinical Associate Professor (Ethics) at the University of Kansas Medical Center. 5 Associate Professor in Bioethics at the University of Washington, she is also Adjunct Associate Professor in the School of Law, Adjunct Associate Professor in Family Medicine, and Affiliate Faculty in the Treuman Katz Center for Pediatric Bioethics. She is Chief of the Ethics Consultation Service and Associate Chair of the Ethics Advisory Committee at the University of Washington Medical Center. 6 He is also Director of the Neuroethics Program. 7 There were of course many others who worked and studied with us in the Center and in various academic programs at Vanderbilt, especially as Finder, Bliton and I were active in various graduate programs. Preface vii I want also to be sure to mention my lovely wife. It has been my deepest joy to have been with her for nearly 59 years and not only for her warmth as my close companion. For during all the time I’ve spent in teaching and writing, she has become an impressive and important artist, working in many fields: sculpture (stone and steel), drawing and painting, soft sculpture, fashion design, and more recently becoming known and published as an important poet and fiction writer.
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