Glenn C. Graber

On Paternalism and Health Care

The model called to mind by the word ‘paternalism’ is the way a father acts towards his children. Of course, we should not think in terms of a malicious or self-centered father, but rather of a benevolent and loving father who does only what he sincerely believes is in the best interests of his children. Generalizing from this model, we can say that a person is acting paternalistically whenever she or he does something for or to another person without that person’s consent and on the basis of the justification that “this is for your own good.”

When Danny said no! Refusal of treatment by a patient of questionable competence

The patient we call Danny was a mildly mentally retarded male in his mid-thirties who adamantly refused kidney dialysis when it was offered as the only therapeutic option for his progressive kidney failure. It was uncertain how fully Danny understood the implications of his refusal. To complicate the case still further, several “advocates” emerged to speak on Dannys behalf — each with a somewhat different interpretation of the situation and different sets of value presuppositions and ethical principles to apply to the choice. We chronicle the development of this situation through a series of scenes; and in each scene we also attempt to clarify the ethical and medico-legal issues involved at that point. Danny was finally permitted to make this decision for himself — though more by default than by an agreement by all parties to honor his autonomy. Our hope is that this presentation will lead to further discussion and clarification of these important issues.

Ought a Defendant Be Drugged to Stand Trial

This question was recently at issue before the Tennessee Court of Criminal Appeals in the case of State of Tennessee v. William Earl Stacy [556 SW 2nd 552]. At the time of the appellate trial, several indictments were pending against the defendant Stacy in the lower criminal court, including a first-degree murder charge. Stacy was accused of fatally shooting a ticket agent at a bus station during what police theorized was an attempted robbery. In addition, Stacy was also accused of robbing a store shortly afterwards. Through his court-appointed counsel, the defendant filed a motion asking the court to find him mentally incompetent to stand trial.

The range of autonomy: Informed consent in medicine

On the basis of the characterization of autonomy set out by Beauchamp and Childress in Principles of Biomedical Ethics, we first explore some of the parameters along which autonomy may vary in degree through a series of hypothetical examples drawn from various settings; and, second and in more detail, we examine how the range of autonomy is affected through informed consent to various medical diagnostic tests. Our conclusions are (1) that there are significant implications for patient autonomy inherent in new and forthcoming diagnostic modalities, and (2) that attention should be paid to these implications in formulating policies for both clinical practice and research. We close with (a) some specific policy recommendations for clinical practice and research, and (b) some metaphysical speculations raised by our explorations.

University-Industry Relationships in Genetic Research: Potential Opportunities and Pitfalls

Changes in the environment in which university research is conducted, in conjunction with the development of new research technologies such as biotechnology, are contributing to the proliferation and diversification of university‐industry relationships. This paper describes and documents university‐industry relationships in five categories: research contracts, technology transfer activities, consultancies, employment, and gifts. Special emphasis is given to biotechnology research relations. Conflicts that may arise from these relations are discussed and studies evaluating the potential impacts of university‐industry relationships are summarized. While wide‐spread abuse has not been reported, subtle changes in university research may be occurring. Using the University of Tennessee as a case study, the paper ends with a discussion of the difficulties of establishing guidelines and procedures to prevent and settle conflicts of interest that might result from university‐industry relationships.

Should Abnormal Fetuses Be Brought to Term for the Sole Purpose of Providing Infant Transplant Organs

I would deny that a woman who is pregnant with an anencephalic fetus has an obligation to continue the pregnancy in order to provide organs for transplant. Furthermore, if a woman in this situation were to ask me for advice about doing so, I would counsel against it. However, if I were consulted by an obstetrician with a patient who had already made up her mind and was determined to continue such a pregnancy for such a purpose, I would urge the physician to cooperate with her in this attempt (with certain qualifications to be explained below). To put my position in another way, I am convinced that there is no duty on the part of the mother to provide organs in this way; I am not even convinced that it is a wise thing for her to do; but I see no reason for saying that it would be wrong, if the woman strongly wanted to do so and understood what she was getting into.