1998
Dianne Nutwell Irving, Adil E. Shamoo
- The problem of inaccurate, misapplied or fraudulent scientific data could
be addressed by government regulations, or by self-regulation from within
science itself. To many, self-regulation implies the grounding of research
activities in some "neutral"; standard of "ethics"; acceptable in a "pluralistic"; society. Yet, there is no such thing as a
"neutral ethics";
and many "contemporary"; theories contain such serious theoretical
deficiencies and contradictions that they are practically inapplicable. As a
viable alternative to these theoretical and practical problems, an
objectively based realistic framework of ethics is considered, and used to
ground both the individual scientific and the collective public policy
decision making processes. This is an ethics of properly integrated
relationships. It is then applied to an analysis of many of the causes of
incorrect scientific data, as well as of many of the internal and external
pressures and abuses often experienced by scientists today. This approach
respects the integrity of each decision maker as a human being and a moral
agent - which in turn better insures the integrity of the protocol, the data,
and the public policy decisions which follow - and ultimately, the integrity
of the scientific enterprise itself. The alternative is government
regulations.
Dianne Nutwell Irving
- Abstract: "Scientific misinformation" or inaccuracies
are problematic within the field of science itself. However, perhaps few
scientists are aware of or concerned about the possible impact which
scientific misinformation apparently has on several other seemingly
unrelated fields - e.g., philosophy, theology, biomedical ethics, and public
policy. To demonstrate such an influence, I will take only one issue
currently debated in these other fields -i.e., the biological "marker events
of human personhood" during human embryogenesis, and trace the impact that
seemingly contradictory scientific claims have had on the theoretical
structures and practical conclusions of the several interrelated fields.
Concern is expressed about the serious need for more accurate scientific
input into these discussions and issues, and for scientists to help sort out
which scientific data and theories are actually the most accurate and
scientifically acceptable.
Ann-Marie Begley
- For the purposes of this article, the term 'beneficent voluntary active
euthanasia' (BVAE) will be used: beneficent from the prima facie
principle of beneficence, to do good, and voluntary to indicate that this
must be carried out at the request of a competent client. This implies
adherence to another prima facie principle, that of respect for autonomy.
Active implies that something is done or given with the intention of
hastening death. The word euthanasia itself simply means 'good death'.
This article examines the moral positions of two nurses and one junior
doctor towards the subject of BVAE and an attempt is made to represent
the main conflicting moral positions. The central arguments against BVAE
and counterarguments are presented. The conclusion reached is that
consenting adults should not be prevented from availing themselves of
BVAE if another consenting adult (a medical doctor) is available and capable
of carrying out their wishes. This being the case, it is suggested that BVAE
should be available as an option in hospices and in the community.
The aims of this article are: to generate debate among professionals; to
present a threeway discussion that might be useful as a focus for
educational purposes, particularly at undergraduate level; to challenge
professionals to confront the issue of euthanasia; and to plead the case
of those who request assistance in exercising autonomy by gaining control
over their own deaths.
John F. Crosby
- Abstract: Central to the Cowdin-Tuohey paper is
the concept of a moral authority proper to medical practitioners. Much as
I agree with the authors in refusing to degrade doctors to the status of
mere technicians, I argue that one does not succeed in retrieving the moral
dimension of medical practice by investing doctors with moral authority.
I show that none of the cases brought forth by Cowdin-Tuohey really
amounts to a case of moral authority. Then I try to explain why no such
cases can be found. Developing an insight that is common to all the major
moral thinkers in the philosophia perennis, I show that doctors are
professionally competent with respect only to a part of the human good;
morally wise persons are competent with respect to that which makes man
good as man. I try to show why it follows that a) professional expertise
has no natural tendency to pass over into moral understanding, and that
b) doctor and non-doctor alike start from the same point in developing
their understanding of medical morality. It follows that the authors fail in
their attempt to de-center the moral magisterium of the Church by setting
up centers of moral authority outside of the Church.
Thomas Maeder
- The most widespread human health problem is malnutrition. The
"Green Revolution" has dramatically increased food production through
the introduction of fertilisers and high-yield grain cultivars. The
revolution was crucial to staving off large-scale starvation, but now a
second wave of innovation is needed to meet the needs of a population
that will double again in the next 30 years.
Osamu Muramoto
- Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently
gained support in the medical community because of the growing
popularity of "no-blood" treatment. Many physicians, particularly
so-called "sympathetic doctors", are establishing a close relationship
with this religious organization. On the other hand, it is little
known that this blood doctrine is being strongly criticized by
reform-minded current andformer_JWs who have expressed conscientious
dissentfrom the organization. Their arguments reveal religious
practices that conflict with many physicians' moral standards. They also
suggest that a certain segment of "regular" or orthodox J7Ws may have
different attitudes towards the blood doctrine. The author considers
these viewpoints and argues that there are ethicalflaws in the blood
doctrine, and that the medical community should reconsider its supportive
position. The usual physician assumption that JWs are acting autonomously
and uniformly in refusing blood is seriously questioned.
Rubia Vila FJ.[The
unconscious conscience] An R Acad Nac Med (Madr) 1998;115(2):483-95 (Addresses) [Article in Spanish] PMID:
9882835
Donnie J. Self, Joy D. Skeel
- In contrast to the teaching of medical ethics in the classroom,
considerable interest has developed in recent years concerning clinical
medical ethics activity in general, and hospital ethics committees (HECs)
in particular. The initial development of medical ethics as an academic
discipline was mostly classroom urientoo with an emphasis on getting
curriculum time, primarily in the first two years of medical education
(1)(2). In recent years there has been much more emphasis on expanding
medical ethics into the clinical years in both clerkship and residency
training as well as in direct patient care through the establishment of
HECs and clinical ethics consultation services (3)(4). The activities of
HECs and clinical ethics consultation services should always be to improve
patient care, although there are many ways to accomplish that task.
Ultimately all of these ways, however, should at least promote the
principles of autonomy, beneficence, and justice and not just attempt to
provide legal protection and risk management.
- Abstract: No matter the future of healthcare
financing and management, physicians of conscience and integrity must still
be an important force in the consideration of ethical issues. The
traditional role for the conscientious physician--being the only or even the
major determinant of the morality of specific clinical decisions--is, for
better or worse, no longer in effect. Much of this authority now belongs to
patients and HECs are the mechanism within HCOs to help maintain this
authority and to observe, comment on, recommend, and occasionally "regulate"
the ethics of the healthcare arena. It is natural that these mechanisms for
addressing areas of moral uncertainty create a certain tension. This tension
should be acknowledged by conscientious physicians and HEC members. Total
agreement on all moral issues in the clinical setting is impossible and
should not be a goal. However, the respectful recognition of the importance
of each perspective by both HEC members and conscientious physicians, and
cooperation in developing effective mechanisms to address real differences,
are possible and desirable. All who are interested in the ethics of
healthcare now and in the future should support these endeavors.
Iréne von Post
- The aim of the study was to gain a better insight into perioperative
nurses' experience in a value conflict that has arisen in the
perioperative caring environment and how they deal with it. In order to
obtain as full and objective a picture as possible the critical incident
technique was chosen. Perioperative nurses were asked to write down stories
about value conflicts which they have experienced in the perioperative
caring environment. When interpreting the textual content of the stories the
aim has been to understand the meaning of nurses' experiences and how the
nurses act in a value conflict situation. A value conflict is something
that nurses have become part of against their own will. They are prevented
from giving the good care they want to give, they are in conflict with
themselves and have a bad conscience, and they feel guilt and shame for not
having prevented the value conflict. The nurse who is involved in a value
conflict aims, for the sake of the patient, to be a professional caring
nurse. The nurse chooses to be the patient's neighbour, the one who suffers
along with the patient and represents the patient's cry for help.
Sally L. Webb, Mary Faith Marshall, Flint Boettcher, Marty Perlmutter
- Introduction: This paper describes and analyzes a
problematic fictionalized case in health care ethics. Inherent in the
case is the complex interplay between adolescent decision-making, clinical
uncertainty and religious beliefs that most health care providers find
alien and that challenge their professional norms. The paper examines the
way the case unfolded, paying special attention to the "consciences" of
the health care providers involved in the case, and ends with a few
reflections on some of the conflicts of conscience that emerged.
Laurie Zoloth-Dorfman, Susan B. Rubin
- Introduction: Practicing what we preach - One of the
most unsettling questions that can be asked of any professional who
purports to give advice and help people for a living is whether she
practices what she preaches. The practice of bioethics and of medicine
have much in common, but one of the unsettling parallels may well
surround the difficulty in following our own best advice. In the
healthcare arena as every other, it is only too easy to locate the
contradictions: the physician who speaks of regular exercise and healthy
nutrition over an extravagantly catered dinner meeting; the surgeon who
lectures on informed consent and routinely fails to adequately to disclose
patients the actual risks of surgery; the nurse who emphasizes truth telling
and hesitates when directly asked her opinion; the respiratory therapist
who smokes a pack a day; the ethicist who speaks of duty and virtue and
yet falters when the strength of her moral fiber is at stake, or who teaches
the centrality of courage and character but will fail when the character
that is tested is his own. In each instance, one could note the obvious: it
is enormously challenging to struggle with desire, and it takes skill and
experience successfully to navigate the distance between theory and
practice. . .