Karen E. Adams
- Physicians are independent moral agents whose values, like those
of nonphysicians, are shaped by personal experience, religious
beliefs, family, and lifetime mentors. Most individuals are free
to exercise their moral values in the ways that they see fit within
the boundaries of legality. Physicians' moral values take on special
significance, however, when considering services patients may request
but that contradict that physician's moral beliefs, such as
termination of pregnancy. In this article I analyze the competing
obligations to self and to patient that a conscientiously objecting
physician must consider when his or her personal morality affects
his or her relationship with the patient. Despite each physician's
freedom to choose his or her mode of practice and which services to
provide, a physician with a moral viewpoint that would prevent
even counseling on certain options should consider practicing in an
area of medicine in which the patient's right to full disclosure
of options and informed consent is not compromised by the physician's
personal moral stance.
Peter Bartmann
- Abstract: In this essay I shall describe and analyse
the current debate on physician assisted suicide in contemporary
German Protestant church and theology. It will be shown that the
Protestant (mainly Lutheran) Church in Germany together with her
Roman Catholic sister church has a specific and influential position
in the public discussion: The two churches counting the majority of
the population in Germany among their members tend to ''organize'' a
social and political consensus on end-of-life questions. This
cooperation is until now very successful: Speaking with one voice on
end-of-life questions, the two churches function as the guardians of
a moral consensus which is appreciated even by many non-believers.
Behind this joint service to society the lines of the theological
debate have to be re-discovered. First it will be argued that a
Protestant reading of the joint memoranda has to be based on the concept
of individual conscience. The crucial questions are then: Whose
conscience has the authority to decide? and: Can physician assisted
suicide be desired faithfully? Prominent in the current debate are
Ulrich Eibach as a strict defender of the sanctity of life, and on the
other side Walter Jens and Hans Küng, who argue for a right to
physician assisted suicide under extreme conditions. I shall argue
that it will be necessary to go beyond this actual controversy to the
works of Gerhard Ebeling and Karl Barth for a clear and instructive
account of conscience and a theological analysis of the concepts of life
and suicide. On the basis of their considerations, a
conscience-related approach to physician assisted suicide is
developed.
Ingela Berggren, Elisabeth Severinsson
- Aim. The aim of the study was to explore the decision-making style
and ethical approach of nurse supervisors by focusing on their
priorities and interventions in the supervision process.
Background. Clinical supervision promotes ethical awareness and
behaviour in the nursing profession.
Methods. A focus group comprised of four clinical nurse supervisors
with considerable experience was studied using qualitative
hermeneutic content analysis.
Findings. The essence of the nurse supervisors' decision-making style
is deliberations and priorities. The nurse supervisors' willingness,
preparedness, knowledge and awareness constitute and form their way
of creating a relationship. The nurse supervisors' ethical approach
focused on patient situations and ethical principles. The core
components of nursing supervision interventions, as demonstrated in
supervision sessions, are: guilt, reconciliation, integrity,
responsibility, conscience and challenge. The nurse supervisors'
interventions involved sharing knowledge and values with the
supervisees and recognizing them as nurses and human beings.
Conclusion. Nurse supervisors frequently reflected upon the ethical
principle of autonomy and the concept and substance of integrity. The
nurse supervisors used an ethical approach that focused on caring
situations in order to enhance the provision of patient care. They
acted as role models, shared nursing knowledge and ethical codes, and
focused on patient related situations. This type of decisionmaking
can strengthen the supervisees' professional identity. The clinical
nurse supervisors in the study were experienced and used evaluation
decisions as their form of clinical decision-making activity. The
findings underline the need for further research and greater
knowledge in order to improve the understanding of the ethical
approach to supervision.
Laura D. Briley
- Case: A pregnant woman contracts rubella. The woman is not
necessarily opposed to abortion, but she has not talked about it with
her physician. The physician is pro-life. When considering this case,
it must first be understood that the spread of rubella to the fetus
brings with it possible consequences, including congenital and
neurological abnormalities as well as miscarriage. Physicians in
these cases must decide if it is their duty to inform the patient of
options, and should they include abortion, a practice which they may
not morally support.
Brietta R. Clark
- Abstract: Police took a woman who was raped to
the emergency room of aCatholic hospital for treatment. Doctors
examined the woman, butdid not give her any postcoital contraception
(the"morning-after pill"), the standard medical treatment for
rapevictims used to prevent pregnancy. Even when the patient'smother
asked for information about the pill, the physicianrefused to provide
any information. The hospital prohibited thephysician from dispensing
the pill or giving information aboutit because it violated Catholic
doctrine. Consequently, theplaintiff did not obtain the contraception
within the 72-hourwindow necessary for it to be effective.
There is a long-standing conflict between patients andreligious
hospitals in the area of reproductive health. Thisconflict is getting
renewed media attention because of thegrowth of religious hospitals
and mergers that eliminatereproductive healthcare for underserved
communities. Tosafeguard these services, bills are being proposed that
wouldrequire all hospitals to provide such care as a condition
ofgovernment funding and other benefits. Catholic hospitals argue
that these laws would infringe ontheir First Amendment right to
deliver health care in a mannerthat is consistent with their religious
beliefs, and that theyshould be exempt from such laws. While the
First Amendmentprotects religious liberty, current jurisprudence does
notappear to provide religious hospitals protection from theselaws.
Under current law, as set forth in Employment Division v.Smith, only
laws that intentionally target conduct because ofits religious
significance can be challenged. There is noprotection from neutral
laws of general applicability thatunintentionally burden religiously
motivated conduct. Lawsrequiring all hospitals to provide
reproductive health care area prime example of neutral laws of
general applicability designed to protect the health and safety of
society, but whichunintentionally burden Catholic Hospitals'
religious freedom.
This conflict illustrates a fundamental debate about theproper scope
of free exercise protection and whether religiouslymotivated conduct
should be protected from unintentionalburdens. In this Article, I
argue that courts should abandon theSmith test in favor of a more
searching intermediate review, butshould not go as far as some states in
providing almost absolutefree exercise protection from government laws
serving importantinterests. Under this principle, religious freedom
should belimited by the government's interest in protecting third
partiesfrom harm. The Catholic Hospital conflict provides an
importantcase study to understand how this principle would work
inpractice. Religious freedom must be balanced against thepotential
harm to patients who cannot access medically necessaryreproductive
health care and information. Thus, even under thismore protective
principle, exemptions should be denied incertain cases, as for example,
with informed consent laws orrefusals to perform medically necessary
care without making safealternatives. In short, the scenario
described at the beginningof this Abstract should not recur.
Moreover, granting exemptionsin such cases would undermine, not protect,
religious libertybecause the patient is coerced into a making a
treatmentdecision based on religious beliefs to which s/he does
notsubscribe.
Jack Coulehan, Peter C. Williams, S. Van
McCrary, Catherine Belling
- Robert Coles' sentiment characterizes well the moral tenor of medical
education today. Indeed, medical educators are frequently "seized by
spasms of genuine moral awareness," as they try to cope with the massive
social and economic problems that face medical schools and teaching
hospitals. The perception among educators that we currently fail to
adequately teach several core aspects of doctoring, including
professional values and behavior, constitutes one such spasm. In this
case, the proposed remedy has generated considerable enthusiasm, but
whether the "core competencies" curriculum will make a difference, or
simply "accommodate to the prevailing rhythms of the world we inhabit,"
remains to be seen.
Clare Dyer
- A health authority has no power to require psychiatrists to act in a
way that conflicts with their conscientious professional judgment, the
House of Lords ruled last week. . .
Irving,DN. Ph.D
Which medical ethics for the 21st century?
Linacre Q. 2003 Feb;70(1):46-59. No abstract available. PMID: 14587485
Julia Lichtman
- Introduction: In the 1973 landmark case Roe v. Wade,
the Supreme Court held that a woman's right to have an abortion is
part of the fundamental right to privacy, and, consequently,
governmental infringement on that right should be subject to strict
judicial scrutiny.2 This groundbreaking opinion contained two exceptions
to reproductive freedom that would qualify as compelling state
interests, thus allowing states to restrict a woman's right to choose
to end her pregnancy: (1) a state could regulate an abortion
procedure occurring after the first trimester to protect the woman's
health and (2) a state could prohibit abortions after the point of
viability (usually twenty-four to twenty-eight weeks), except when the
woman's health or life is in danger.3 No sooner had the Court
established this fundamental right to choose did state legislatures,
the United States Congress, and the Supreme Court itself rally to
place restrictions on this liberty interest. These restrictions include
parental consent requirements, federal restrictions on the use of
public funding to finance abortions, and conscience clauses to
protect doctors, medical personnel, and medical entities from any
liability for refusing to perform abortions. . . .
Nelson, William A;Dark, Cedric K
- Several physicians at my facility have been citing the conscience
clause to opt out of providing certain treatments. How can I be certain
that their claims of conscience are sincere and thus warrant
honoring?
Kate Spota
- Imagine a woman running a routine errand in California: she enters
her local drug store, hands the pharmacist her prescription for a
wellknown drug approved by the Food and Drug Administration (FDA),
and then is surprised to learn that her prescription is not covered
under her insurance plan. Upon inquiry with her
religiously-affiliated employerone that provides health care
benefits-she learns that this particular prescription drug was the
only one intentionally excluded from her employee prescription plan.
The woman must then decide between a thirty-dollar out-of-pocket cost
each month or a change in her lifestyle to obviate the need for the
drug altogether. How did this situation arise?
Venke Sørlie, Lilian Jansson, Astrid Norberg
- Studies among physicians and nurses in paediatric care reveal
experiences of loneliness and lack of open dialogue. The aim of this
study was to illuminate the meaning of female Registered Nurses'
lived experience of being in ethically difficult care situations in
paediatric care. Twenty female Registered Nurses who had experienced
being in ethically difficult care situations in paediatric care were
interviewed as part of a comprehensive investigation into the
narratives of male and female nurses and physicians about being in
such situations. The transcribed interview texts were subjected to
phenomenological-hermeneutic interpretation. The results showed that
nurses appreciated social confirmation from their colleagues,
patients and parents very much. This was a conditioned confirmation
that was given when they performed the tasks expected from them. The
nurses, however, felt that something was missing. They missed
self-confirmation from their conscience. This gave them an identity
problem. They were regarded as good care providers but at the same time,
their conscience reminded them of not taking care of all the
'uninteresting' patients. This may be understood as ethics of memory
where their conscience 'set them a test'. The emotional pain nurses
felt was about remembering the children they overlooked, about bad
conscience and lack of self-confirmation. Nurses felt lonely because
of the lack of open dialogue about ethically difficulties, for
example, between colleagues and about their feeling that the wrong
things were prioritized in the clinics. In this study, problems arose
when nurses complied with the unspoken rules and routines without
discussing the ethical challenges in their caring culture. The rules
and the routines of the caring culture represented structural
barriers for creating open dialogue and an ethically justifiable
practice, called inauthentic existence, blindness related to our own
inauthentic understanding, which focuses on the routines, rules,
theories and systems.
M. von Cranach
Between 1939 and 1945 180.000 psychiatric patients were killed in
Nazi-Germany. After a brief introduction reflecting the ways of and
reasons for addressing this issue today, the details of the so called
euthanasia program are presented: The killing of patients by gas in
special hospitals between 1939 and 1941 in its first phase and the
continuation in the psychiatric hospitals until 1945. In this second
phase patients were killed with lethal injections and through the
introduction of a hunger diet. The fate of the Jewish patients and
forced labourers as well as human experiments are mentioned. Finally
some thoughts are presented to answer the question of why this could
happen. The giving up of individual responsibility in an
authoritarian system leads to the loss of the individual conscience
and soul.
Zellick
Private conscience: public duty.
Van Der Zyl Memorial Lecture 2003. European Judaism Vol. 36 No. 2,
Autumn, 2003
Graham Zellick
. . .I want to talk this evening about values and ethics. I do so
with some trepidation. I am no theoretician in general or moral
philosopher or ethicist in particular. I hope that you aren't either!
I shall be speaking partly from practical experience and partly as an
academic observer, but considering these matters from a practical or
experiential perspective. I am taking it as axiomatic that we have a
well-developed value system as individuals and that, as Progressive
Jews, we derive that value system in no small measure from our Jewish
heritage and the history of our people, tempered by the teaching and
thinking that underpin Progressive Judaism. . .