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This study draws on analyses on a number of levels. First, it clarifies certain concepts often used loosely in the literature pertaining to nanotechnology. In particular, it focuses on the concept of "revolution" in order to determine whether nanotechnology is a revolution in the making or simply an evolution of scientific and technological development. I then examine the context in which nanotechnology has developed (i.e., postmodernity) and consider how the new scientific culture within the postmodern context ties the production of knowledge to the three key elements of what John Ziman calls post-academic science (i.e., transdisciplinarity; the marketability of knowledge; and the norm of utility). However, the context of postmodernity challenges the resolution of technopolitical controversies due to competing rationalities (modes of explanation) and moralities. To this end, I develop a procedural integrated approach that takes into account the consequences of postmodernity for moral theorizing and our understanding of science and technology. Other attempts have been proposed as integrated model in the field of medical ethics, i.e., principlism. However, this work shows why principlism fails as an integrated model and favors an integrated model based on H. T. Engelhardt, Jr. and Kevin Wm. Wildes' procedural ethics. Finally, I examine further philosophical and ethical implications of nanotechnology in the biomedical sciences. I argue that in order to prevent the absence of more robust reflections that characterizes bioethical reflections in contemporary debates, it is essential to create the conditions for moral substantial reflections (better integration of "trans-epistemic values" at the core of scientific research and technological development). This requires building bridges across disciplines within the natural sciences as well as between the natural sciences (nanotechnology) and the humanities social sciences. Subsequently, I raise some suggestive ethical and philosophical questions concerning the impact of these new technologies on the practice of medicine but also in relation to the use of humanized technologies that could transform our understanding of what it means to be a human being and our conception of the human body.

This paper examines legal and ethical issues facing physicians working in an environment of cost-cutbacks, competition for medical resources and lengthy waiting lists for treatment. The legal portion of the paper considers how a tort claim could be advanced by a (former) patient against a physician in the guise of a standard-of-care argument, as a breach of fiduciary duty, or as a failure to obtain informed consent. / The bioethics portion of the paper examines the short-comings of professional codes and presents a system of ethical analysis for physicians to follow as a practical tool for difficult decisions. / Since the extent of the physician's legal duty of care is unclear with respect to resource allocation issues, it is possible that bioethics, can provide assistance by heightening physician awareness regarding these types of dilemmas, by increasing physician-patient communication and by encouraging physicians to utilize a systematic method of ethical analysis.

Many individuals with chronic or degenerative diseases in Canada are in receipt of long-term artificial nutrition and hydration. Once an individual has been transferred to a chronic care facility, is the feeding tube viewed as a medical treatment, and subject to the same evaluations and discussions as other medical treatments, or does the feeding tube become an unquestioned permanent part of the life of the resident? How do clinicians who care for these residents view the ethical issues involved in long-term tube feeding? / Attitudes of physicians and health care professionals regarding the use and possible discontinuance of long-term tube feeding were evaluated using a 17-item questionnaire that was distributed in a chronic care facility in Victoria, British Columbia in 1997. The responses to this questionnaire were compared and contrasted with responses from previous studies, and with the literature in the area of medical ethics.

This thesis explores the concept of "Sanctity of Life" from the perspective of what "life," in particular human life, means today. With the rapid advances in science and modern medical practice, the concept of life has undergone many changes, shaking the foundations of what before made us view life as sacred. Modern thought has brought new forms of understanding to the concept of life. / I question the goals of modern medicine and biotechnology, and criticize the reductionist view of life. And finally, I highlight a new ethical approach that could bridge science and moral convictions about the concept of life. This approach explores the argument of sanctity of life and its utility in approaching assisted medical techniques and genetic intervention. It is my opinion that this ethical principle has not lost importance and could be reshaped and adapted to a contemporary understanding of life in the light of our democratic and pluralistic society.

Although the first steps in somatic gene therapy have already taken place, research on human germ-line gene therapy still remains taboo. However, the first protocol aiming to cure defective genes of mitochondria in germ cells has been published recently. Germ-line gene therapy is an entirely new method. Its effects and impact on future generations differ considerably from those of somatic gene therapy. / A systematic and critical analysis of the arguments for and against germline gene interventions, such as "playing God" and moving on the slippery slope to enhancement will be elaborated. Special attention will be focused on the irreversible changes of the genome of future generations as well as on ethical considerations raised by different therapeutic and experimental possibilities, such as In Vitro Ovum Nuclear Transplantation (IVONT) or the creation of transgenic organisms.

Debate has raged over terminating treatment for demented patients, those neither permanently unconscious nor terminally ill. Ronald Dworkin argues that the substituted judgment principle should be adhered to in making treatment decisions for demented patients, honoring the prior preference of even a "pleasantly senile" patient to reject treatment. Rebecca Dresser proposes adherence to a best interests standard focusing only on the current welfare of the patient, even if this would ignore her advance directive. / Few courts have directly faced the issue: When should treatment of demented patients be terminated? No court has justified its decision on the ground that the family of the demented patient should have the preeminent role in decisionmaking for their loved ones. Courts purport to apply the substituted judgment standard, but reach inconsistent results. / I argue that we need not choose between Dworkin's rigid adherence to a substituted judgment principle or Dresser's exclusive focus on the patient's current interests. I propose a new model: When a dilemma is in the moral "gray" zone--with no clearly right answer--the family decision should be granted presumptive validity so long as it is in the range of reasonable options. Reversing the orthodox approach, a family decision could be overridden only by a showing that it is clearly erroneous. This approach recognizes the critical fact that the patient is part of a family; a decision about treatment affects every member.

Within this thesis, I argue for an interpretive approach to bioethics in pediatric intensive care. I begin by outlining the dominant bioethical doctrine that defines standards for ethical care in critically ill children. I critique this doctrine as legalistic and acultural. Drawing largely on the ideas of Charles Taylor, I call for a reconception of bioethics and propose an interpretive framework that is centred on culture and context. Finally, I illustrate this interpretive approach through a comparative study of two cases in pediatric intensive care: the narratives of Marc and Larry.

This thesis attempts to answer the following question: Should it ever be legally permissible to buy a kidney from a living donor in Israel? / Existing legislation and government policy prohibit payment out of fear that the poor, minorities, and other vulnerable people will be coerced to exchange organs for money, i.e. it focuses on the potential harm to the donor. This thesis will address the issue of whether this prohibition is justified and how much risk a paid donor should be allowed to assume. / This essay will present a detailed investigation of an existing kidney trade in Israel, as well as a review of the nature and medical risks associated with kidney donation from a healthy kidney donor. It will also provide an overview of the legal provisions and case-law, pertaining to kidney transplant in Israeli law and Jewish law, and will seek answers to the silence of the legislator in different sources of law. This thesis will conclude with suggestions and recommendations for a statutory authorization of a market system of kidney transfer and will present a model of a health-transplant agency, in an effort to answer the growing demand for kidneys.

Our new civil code gives a new meaning to the cosmetic surgery contract. Given that this medical agreement is innominate, we believe that it is essentially a contract for services. Yet what makes it distinctive is the fact that the surgeon operates on a healthy organ. Cosmetic surgery is not a vital necessity but instead is based entirely on aesthetic appearances. In this light, the validation of the contract is handled very differently from a traditional medical contract. The goal of the cosmetic surgery contract is to render surgical services for the purpose of relieving the distress caused by a physical deformity. The capacity to exercise and consent is very restrictive in this field, a factor that is dictated by the non-urgent nature of the surgery and the fact that it leaves permanent results. We can conclude that consent in cosmetic care surgery requires the complete disclosure of risks and obliges the surgeon to refuse the surgery if the risks are disproportionate with its benefits.