Medical Ethics
GENERAL
Medicine, morality and humanity
Sean Murphy |The practice of medicine is an inescapably moral enterprise precisely because physicians are always seeking to do some kind of good and avoid some kind of evil for their patients. However, the moral aspect of practice as it relates to the conduct and moral responsibility of a physician is usually implicit, not explicit. . . .
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The Hippocratic "oath"
(Some further reasonable hypotheses)
Sergio Musitelli,
Ilaria Bossi | Although 65 treatises - either preserved or lost, but quoted by ancient
authors like Bacchius (3rd century B.C.), Erotian (1st century A.D.) and
Galen (c. 129-199 A.D.) - are ascribed to Hippocrates (c. 469-c. 399 B.C.)
and consist of nearly 83 books, nonetheless there is no doubt that none of
them was written by Hippocrates himself. This being the fact, we cannot help
agreeing with Ulrich von Wilamowitz Möllendorf (1848-1931), who maintained
that Hippocrates is a name without writings! . . .
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Medicine's Intrinsic Good
Teresa Iglesias |
What is good medicine? Who counts as a good doctor? These are very large
questions that cannot be fully addressed here. I want to focus on a basic
aspect of these two questions and on the ethical idea of "the good.". . .
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Why Medical Ethics?
Daniel Eisenberg |
When I lecture to audiences about the Jewish approach to medical ethics, one
issue always lurks below the surface: Why medical ethics? And why
particularly Jewish medical ethics? Isn't it sufficient to allow the medical
field to police itself? Aren't physicians moral people? . . .
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Is Bioethics Ethical?
Wesley J. Smith |
The author argues that control over public policy decisions in health care
has been ceded to [secular] bioethicists, "an elite group of academics,
philosophers, lawyers, and physicians, many of whom are openly hostile to
the sanctity of life and the Hippocratic traditions that most people still
take for granted." The result is that law and public policy are increasingly
shaped by beliefs that are not shared by the people whom they affect. . .
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The Bioethics Mess
Dianne N. Irving
| "Bioethics" -- the word sounds like old-fashioned medical ethics applied
to new medical technology. It's the application of traditional philosophical
or theological principles to the moral dilemmas created by, say, cloning or
experimenting with new AIDS drugs, right? Not really. . .
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Which Medical Ethics for the 21st Century?
Dianne N. Irving
|
. . . Abstracting from all the possible academic ethical
theories . . . I will focus narrowly instead on two theories of medical
ethics - secular bioethics and Roman Catholic medical ethics, pointing out
briefly what they are, comparing their conclusions about what is right or
wrong, and indicating where they have already lead us. . .
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'Bioethics' -- What It Really Means for Prolife Nurses
Dianne N. Irving
| . . .When you find yourself in a situation where you and your deepest gut
instincts are so pitted against some "theory" - any "theory" - then perhaps
it is time to stop and to question this "theory"? The specific "theory" in
question here is not really "ethics", but, I would suggest -- "bioethics". . .
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Is American Bioethics Lost in the Woods?
Michael Cook |
The debate between a libertarian bioethicist and a communitarian bioethicist
illustrates why American bioethics is becoming increasingly marginalised and
irrelevant to the democratic society that it intends to serve . . .
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Establishment Bioethics
Sean Murphy | Ethical differences between one theory of bioethics and another may be quite as dramatic as doctrinal differences between religions, though, like religions, there are also similarities. Problems for ethical minorities arise when one version of bioethics becomes predominant, and its practitioners attain positions of influence and power in government, academic and professional circles
. . .
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Freedom of conscience in health care: "an interesting moral swamp"?
Responding to Caplan AL. Whose rights come first: Doctors or patients?
Sean Murphy |
"Whose rights come first?" asks Professor Arthur Caplan in a recent
Medscape column. "Doctors’ or patients?" "You can't have physicians, pharmacists, nurses, and social workers saying they are not going to do legally allowed medicine or standard-of-care treatment because it violates their rights," says Professor Caplan. . .
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The Impact of International Bioethics on the Sanctity of Life
Ethics and the Ability of Ob Gyn's to Practise According to Conscience
Dianne N. Irving
| . . . the key to understanding any philosophical or theological ethical
theory is to identify its philosophical or theological "anthropology"-- or
definition of "a human being" or "person". . . Bioethics tries to claim that
its theory really has no "anthropology", i.e., the "personhood" issue. . .
However, almost all bioethics arguments do incorporate a "delayed
personhood" claim, whether or not they know or admit it -- . . .
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Suggestions for the Future of Bioethics
Daniel P. Sulmasy |
I suggest that bioethics has evolved through three phases: a religious phase
in the 1950s and '60s, a philosophical phase in the '70s and '80s, and a
political-empirical phase from the '90s to the present. . . Where should
bioethics go next? I will make six suggestions. I am sure they will not be
uniformly popular, but I'd like to think they might provoke some interesting
discussion. . .
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The Costs of Taking Conscience
Michael A Fragoso
| . . .There is already a growing physician shortage . . . The shortage will
increase
without any of the supply reductions that are likely to
occur as a result of decertifying practicing obstetricians who refuse to
perform abortions and deterring future obstetricians who will choose a
different career or specialty rather than violate their consciences. . .
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Observing Bioethics
Renee C. Fox, Judith P. Swazey (Oxford: University Press, 2008)
Sally Satel
|. . . Whether bioethics has achieved its goal is the urgent question at
the core of this useful book . . .Through enjoyable interviews with
major figures in the field and a rich trove of personal observations,
the book perceptively, if densely, chronicles the growth of bioethics as
a profession. . .Fox and Swazey portray bioethics as a field in turmoil.
. . [Their] own prescription-to expand the bioethics' franchise into
global justice and activism-will not help. Bioethics would become
politicized, thereby undermining the already shaky credibility of the
field. . . .
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Right (and Wrong) Answers)
World Medical Association
Project commentaries on WMA policy proposals
MEDICAL PRACTICE AND CONSCIENCE
Critical Review of College of Physicians and Surgeons of NS Policy Conscientious Objection
Sean Murphy | The College of Physicians and Surgeons of Nova Scotia (CPSNS) has adopted Professional Standards Regarding Conscientious Objection (Conscientious Objection) that expands existing CPSNS policies. This critique of Conscientious Objection is limited to issues directly or indirectly related to the protection of physician freedom of conscience and can be applied to all CPSNS policies. . . continue reading
Canadian Medical Association and Referral for Morally Contested Procedures
Sean Murphy |
The Canadian Medical Association (CMA) has variously expressed support for physician freedom of conscience in codes of ethics, resolutions at successive General Councils and in policies concerning specific procedures. For over fifty years it has insisted that physicians should not be compelled to make referrals for procedures to which they object for reasons of conscience.
It appears that the great majority of CMA members support this position, but are unaware of its history. This paper revisits this history at a time when increasingly strident claims have culminated in demands that the state should force objecting physicians to collaborate in euthanasia and assisted suicide by referral. . .
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Proposed revision to WMA International Code of Medical Ethics
European Institute of Bioethics | Comment on the draft International Code of Medical Ethics of the World Medical Association. . .
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Anscombe Bioethics Institute | Submission to the World Medical Association Public Consultation on a draft devised version of the International Code of Medical Ethics. . .
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Protection of Conscience Project| Submission to the World Medical Association Re:
WMA International Code of Medical Ethics. . .
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The caricature of the conscientiously objecting physician
Objecting doctors are the bad guys, obstructing care.
How will disciplining conscientious doctors or driving them from the profession improve health care?
Catherine Ferrier |
Canadian doctors who object to directly causing the death of their patients, once the near-totality of the profession, have, since the enactment of laws permitting "medical assistance in dying" suddenly become outliers.
. .
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Physician, heal thyself: the potential crisis of conscience in Canadian medicine
What if your faith in doctors having conscience was shaken?
Gabrielle Horne | . . . When illness strikes, [patients] must often put their lives, their confidence and their most vulnerable selves in the hands of doctors they barely know. The expectation of conscience is at the core of the medical pact.
But what if your faith in doctors having conscience was shaken? . .
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Patients' Rights - A World View
The Patients' Rights Act 20 years on – Achievements and Challenges
Dr. Otmar Kloiber
| . . . to understand patient rights and the relation of health professionals
to them it is important to be clear what patients are. Towards the end of
the last century, particularly during the 1990s, the notion came into being
that patients are "customers". Now some prefer the word "clients", which
sounds much more elaborate and elegant, however it is merely the French word
for "customer". It is undeniable that in any relationship where one pays money for a
service there is an aspect or an expectation that classifies one party as
a "customer" and the other as a "provider" or "vendor". But transferring
this paradigm as the description for the patient/physician relationship
falls dangerously short of reality. . .
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Six questions about
physician-assisted death, from a conscientious
objector
Ewan C. Goligher
| Canadian policy makers have recently proposed
to require all doctors to provide an effective
referral for physician-assisted death (PAD) upon
the patient's request. Forcing doctors to
knowingly send their patient to another doctor
willing to cause the patient's death will
seriously compromise the moral integrity of
conscientiously objecting doctors and risks
undermining the quality of patient care. To
understand the position of conscientiously
objecting doctors, consider the following
questions. . .
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The Hidden Professions of Conscientious
Objection
Bob Parke
| . . . While interpreters and clinical informatics team members may be
asked to participate in euthanasia their right to conscientious
objection is not recognized as it is for doctors, nurses, pharmacists
and other frontline staff. As such, they need to be considered and
supported in organizational policies addressing [euthanasia/assisted
suicide] . . .
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Personal Beliefs and Professional Duties: Maintaining Your
Integrity
Dr. Larry Reynolds
| In modern heath care the role of the physician is at risk of being
reduced to becoming a mere tool of the patient's will. The doctor's role
will be just to provide services that patients demand. Autonomy of the
patient trumps all. This view impoverishes our profession, degrades
doctors to mere technicians and will accelerate the moral wasting
disease presently plaguing Canadian health care. . .
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Are tribunals the solution to disruptive conscientious objectors?
Michael Cook
| While some bioethicists believe that conscientious objection has no
place in modern medicine, others feel that they could be accommodated by
setting up tribunals. Here are three proposed this year in the
Journal of Medical Ethics. . .
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There's no "mushy middle" on euthanasia
Margaret Somerville
| Many know the saying "You have to fish or cut bait". Many fewer know the
law's equivalent, "You can't approbate and reprobate". But the Canadian
Medical Association's recent dealing with their 2007
Policy on
Euthanasia and Assisted Suicide makes it seem they are unaware of the
warning and wisdom these axioms communicate. . .
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Entrenching a 'duty to do wrong' in medicine
Canadian government funds project to suppress freedom of
conscience and religion
Sean Murphy
|A 25 year old woman who went to an Ottawa walk-in clinic for a birth
control prescription was told that the physician offered only Natural Family
Planning and did not prescribe or refer for contraceptives or related
services. She was given a letter explaining that his practice reflected his
"medical judgment" and "professional ethical concerns and religious values."
She obtained her prescription at another clinic about two minutes away and
posted the physician's letter on Facebook. The resulting crusade against the
physician and two like-minded colleagues spilled into mainstream media and
earned a blog posting by Professor Carolyn McLeod on
Impact Ethics. . . continue reading
Conscience in the Practice of the Health Professions
The President's Council on Bioethics: 11 September, 2008
A.D.
Lyerly | . . . If we want to talk about the conditions that must be met to conscientiously refuse to inform, refer, or provide care, how we balance may be different depending on what morally is at stake. . .
H.
Brody | . . . we're going to have to say in some cases that a professional with such stringent dictates of conscience ought not choose that particular career, that they cannot at the same time promise they're going to serve the interests of the patients if their individual personal integrity requires them to say no . . .
F.
Curlin | . . . with respect to the present controversies, it
cannot be that conscientious refusals per se are ethically problematic. What
we are after are criteria by which to distinguish those refusals that are
consistent with physicians' professional obligations from those that
contradict those obligations. To find such criteria, we have to figure out
what in fact physicians are obligated to do. . . unless and until consensus is forged regarding the ends of medicine, refusals of controversial practices cannot be shown to violate physicians' professional obligations.
R.P. George | . . .The [ACOG] report, in other words, in its driving
assumptions, reasoning, and conclusions is not morally neutral. Its analysis
and recommendations for action do not proceed from a basis of moral
neutrality. It represents a partisan position among the family of possible
positions debated or adopted by people of reason and goodwill in the medical
profession and beyond. Indeed, for me, the partisanship of the report is its
most striking feature. . .
Discussion | Robert P. George, Anne Lyerly, Howard Brody, Farr Curlin, Gilbert C. Meilaender, Jean Beth Elshtain, Peter Ausgustine Lawler, Donald W. Landry, Paul McHugh, Jane D. Rowley, Rebecca S. Dresser, Benjamin S. Carson, William B. Hurlbut, Alfonso Gomez-Lobo
Freedom of Conscience and the Needs of the Patient
Sean Murphy |
. . . I am going to focus on the terms in the title of this presentation -
freedom, conscience, and needs - touching, in one place, upon ethics, and
concluding with a reflection upon faith and the notion of moral neutrality.
. . I have not attempted an apology for freedom of conscience, so you will
not leave here with slogans to brandish, a handy list of pros and cons or
practical advice on how to avoid being sued. Instead, I have offered a
number of observations and reflections on words that we too often take for
granted, and cause us to stumble: needs, ethics, freedom, conscience, and
faith. . .
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The Role of Conscience in Medical Decisions
Daniel P. Sulmasy |
In this lecture, Dr. Daniel Sulmasy will discuss how medical professionals
can strive to preserve their moral integrity while also respecting and
serving patients with whom they might have deep moral disagreements.
. .
see video
Presentation to President's Council on Bioethics
Christian Medical Association | . . . Because the way
things are going, some would actually force out of the profession those
physicians who have moral objections to procedures such as abortion. And
that loss of physicians--especially Obstetricians and Gynecologists who are
already leaving because of malpractice insurance costs--would have a severe
impact on the delivery of healthcare. . .
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Liberty of conscience is critical for individual doctors
Dr. Lachlan Dunjey | "Liberty of conscience is critical
for individual doctors as it lies at the very heart of our integrity," he
said. "It is conscience that must compel doctors to refuse to participate in
treatments they believe to be un-ethical. It is not enough for doctors to
simply be providers of medical services on demand from consumers or third
parties, providing all that is legal whether or not it is consistent with
their ethical base. To sacrifice conscience and be concerned only with
service provision is to destroy the heart and soul of medicine." . . .
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Medicine, Strasbourg, and conscientious objection
European Court of Human Rights decision
Julian Sheather
| . . .Conscientious objection is a live issue in medicine. . . Given the
prevailing political pluralism-given the co-existence in our culture of
different value systems-to what extent should medicine accommodate such
objections? Should those whose consciences differ be treated differently?
What forms of conscientious objection should be tolerated and on the basis
of what criteria? . . .
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[Legal Commentary]
Confronting Conscientious Objection
Maggie Little
| Conscientious objection. . . is not something lightly invoked. Its
legitimate exercise brings with it strong obligations. Objecting providers
must disclose their limitations early and often to minimize patient burdens.
And they must convey those restrictions with compassion and respect.
. . . The very premise of protecting conscientious refusal, after all, is
that deeply good and reasonable people disagree on the issue. . .
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SPECIFIC ISSUES
Abortion
Abortion: Where do we draw the line?
Margaret Somerville
| The conferral of an honorary degree on Dr. Henry Morgentaler provided a
flashpoint for yet another explosion in the long-standing, deeply
acrimonious war as to the values that should govern abortion. The two polar
positions are well defined, but I want to speak for those, like me, who
regard all abortion as raising serious ethical issues, but who would not
legally prohibit early abortion . . .
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Abortion, Conscience and Health Care Provider Rights
E. Christian Brugger
| In this essay, I will elaborate the ACOG
account, juxtapose it to what I call the "classical account" as defended
in Western philosophy, and finally answer the question whether
healthcare providers have a right to refuse to treat some patients. . .
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A Tough Call: Does conscience protection excuse a health
professional from providing after-abortion care?
Cristina Alarcon |
Last November a Planned Parenthood nurse in Idaho rang a local pharmacist
and asked for methergine -- a drug used to prevent bleeding after childbirth
or an abortion. Considering the source of the request it is quite likely to
have been the latter, and the pharmacist, who has a conscientious objection
to abortion, asked whether that was the case. The caller refused to say,
citing federal privacy law, and the pharmacist refused to fill the
prescription. The caller then asked for a referral to another pharmacy and
the pharmacist hung up on her. . .
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Artificial reproduction
Australian women complain of 'gender disappointment'
Michael Cook
| "Gender disappointment" is not a recognised medical
condition. But many women in Australia – where gender
selection is illegal -- attribute their depression to it.
Speaking to
Australia's ABC network, a woman using the pseudonym Kate
described it as as "a guilt-ridden, debilitating depression". She has
two boys and she desperately wants a daughter.. . .
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Assisted nutrition and hydration
Tube Feeding: Medical Treatment or Basic Care?
Adrian Treloar,
Philip Howard | The authors argue that feeding tube placement is a medical procedure and as such requires consideration of the benefits and risks as for any other medical treatment. However, the day-to-day use of feeding tubes, to provide hydration and nutrition, constitutes ordinary care that does not require medical supervision. Withdrawal of tube feeding raises major ethical and legal questions. . .
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Birth control
Clearing Rhetorical Minefields
Sean Murphy |
Progress towards understanding the importance of freedom of conscience for
health care workers is not infrequently hindered by rhetorical minefields .
. .What follows is an attempt to clarify some of the points of dispute and
identify key issues. It introduces the term "embryocide" and specifies the
meaning of "abortifacient" and "contraceptive" based upon what is common to
parties who hold contrary views about abortion and contraception. . .
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Contraception for the Unmarried
Christian Medical Fellowship [United Kingdom] | . . .I
came to the conclusion that I could only provide contraception to married
couples, and that my contraceptive advice to unmarried couples would be
limited to that of advising them not to have intercourse. I would advise
them that if they rejected my advice they should go elsewhere and obtain
their contraception from another doctor. I was not forcing my opinion on
them, because they were perfectly free to reject my advice and obtain their
contraception elsewhere. . .
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Over the counter conscience vote
Beth Doherty |
Every now and again, stories hit the media about pharmacists who refuse to
stock condoms, dispense the contraceptive pill and, more recently, the
morning-after pill. Contrary to what we are led to believe, this is not an
irregular occurrence, nor is it a particularly surprising stance for a
Christian pharmacist. . .
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Body reconfiguration
If sex reassignment surgery is the answer, what is the
question?
Michael Cook
| Sex reassignment surgery requires the intervention of
doctors. But what kind of treatment is it? Is it a therapy
for a disease which should be offered only after psychiatric
authorization? Or is it a biomedical enhancement which
anyone can freely choose?. .
.
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Michael Cook
| More and more young people believe they were born in the wrong body. . . .However, there are no long-term studies which support medical interventions for children, which can include “top” and “bottom” surgery for children over 16. What are the ethics of treating children with untrialled treatment? Surprisingly little has been written about this. . .
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Criteria for determining death
Report Prompts Protocols for Diagnosis of Brain Death
MY Wang P Wallace JP Gruen | After reviewing the 78
brain deaths documented at the hospital in 1999, J. Peter Gruen, MD, and
colleagues at the Keck School of Medicine of the University of Southern
California in Los Angeles, discovered that the diagnosis was highly variable
and concluded that standards for practice and documentation were sorely
needed. . .
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Drugs
Idaho Case of Pharmacist Refusal
Wesley J. Smith |
. . .based on the reporting of the story, this isn't even a close call. This
is not a proper conscience clause (from my criteria) case and in Wesley
World, the pharmacist would not be protected. . .
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Eugenics
New Genetics Functions as Eugenics
Margaret Somerville
| One effect of intense individualism in the context of reprogenetics is
that the accumulation of individual decisions are resulting in an overall
outcome that would never be acceptable as public policy. In short, the new
genetics is functioning as eugenics, but that fact is not identified. . .
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Euthanasia, assisted suicide
Assisted Suicide and Euthanasia: pharmacists must also have the right to conscientious objection
Bernadette Flood | In jurisdictions where euthanasia and/or assisted suicide is legal, experience shows there are profound implications for pharmacy practice. Little attention in the current euthanasia debate has been paid to the role of Irish pharmacists. . .
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Canadian Medical Association plans for physician assisted
suicide, euthanasia
Commentary on draft
framework (June/July, 2015)
Sean Murphy
| On 6 February, 2015, the Supreme Court of Canada ordered the
legalization of physician-assisted suicide and euthanasia in Canada,
effective in February, 2016. . . The Canadian Medical Association (CMA)
had been preparing for legalization of physician assisted suicide and
euthanasia since 2014. In the months following the ruling, CMA
officials and the Board of Directors finalized draft guidelines ("draft
framework") on the subject and published them in June. An internal CMA
on-line consulation concerning the draft framework ran from 8 June to 20
July, 2015. . .
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Assisted Suicide: What Role for Nurses?
Carrie Farella |
Initially, when [Oregon's assisted suicide law] was designed, the assumption
was that physicians would be the first ones to explore PAS with patients," .
. . "but in reality, nurses are usually the ones in the line of fire.
Patients often feel nurses understand their wishes for good quality of life
and good quality of death, too."
. . .
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'Pulling the plug' isn't euthanasia
Margaret Somerville
| . . .The ongoing transformation in the methods and ethics of medicine
raises profound moral questions for doctors, nurses, pharmacists, and others
who believe in the traditional virtues of Hippocratic medicine that
proscribe abortion and assisted suicide and compel physicians to "do no
harm.". . . Tolerance toward dissenters of what might be called the "new
medicine" is quickly eroding. . .
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Institutional freedom of conscience in relation to euthanasia and assisted suicide
Sean Murphy | The subject of this paper is an institution's refusal to provide or facilitate euthanasia/assisted suicide (EAS) for reasons of conscience: the exercise of preservative freedom of conscience. This typically reflects desire to preserve institutional moral integrity by refusing to be complicit in, cooperate in or otherwise support or encourage the killing of patients, and a desire to prevent harm to others. Institutional religious integrity is not addressed. . .
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Execution
Should American doctors participate in executions?
Michael Cook
| The American state of Arkansas executed four prisoners in
April. They were given a lethal injection with a three-drug
cocktail, a procedure which requires some medical skills.
Should doctors take part in such executions? . . . In an
unusual intervention in the bitter debate, cardiologist Sandeep Jauhar
has written an op-ed . . .arguing that the presence of doctors is
ethical. . .
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Harm reduction
Give them sterile razors: controversial self-harm
strategy
Michael Cook
| Some people who self-harm should be provided with sterile
razors, says a mental health expert in the
Journal of Medical Ethics. Patrick Sullivan, of the
University of Manchester, argues that this approach may be more
respectful of patients' autononomy. He suggests that a harm-minimisation strategy for
self-harming individuals could include provision of sterile
cutting implements, education on how to self-injure more
safely to avoid blood poisoning and infection, as well as
therapy and alternative coping strategies. . . .
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Informed consent
The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors
Margaret Somerville | The COVID-19 pandemic has raised a multitude of complex ethical issues — and new ones present themselves daily. . . In many COVID-19 related decision-making situations at each of these levels, decision makers face what is called in bioethics a “world of competing sorrows” — that is, decision making in which there is no “no harm” option, but in which, instead, they must choose to whom harm will be allocated. . .
What I want to focus on here is a particular micro- level issue: that of a healthcare professional’s obligation to obtain a person’s informed consent to COVID-19 vaccination. . .
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Research
Complicity after the fact: moral blindness becomes a virtue and
necessity
US scientists were "accomplices after the fact" in Japanese doctors' war
crimes
Michael Cook
| . . .hundreds of Japanese medical personnel . . . experimented on
Chinese civilians and prisoners of war . . .They killed an
estimated 3,000 people in the infamous Unit 731 in Harbin, in
northeastern China before and during World War II – plus tens of
thousands of civilians when they field-tested germ warfare. . . the
Americans struck a deal with the doctors. They traded immunity from
prosecution for access to scientific information from the ghastly
Japanese experiments – many of which are too grim to detail here. . .
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Daniel P. Sulmasy | Al Rabadi et al compare statistics on physician-assisted suicide (PAS) available from public databases for the states of Washington and Oregon and find similar profiles and trends, which is unsurprising given the similarity of the laws and demographic characteristics of these states. Among the unanswered questions are what such a study can contribute to medical ethics (about PAS or any other ethical controversy) and what the limits are of such work. . .
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Sedation
Consensus Guidelines on Analgesia and Sedation in Dying Intensive
Care Unit Patients
Laura A Hawryluck
William RC Harvey
Louise Lemieux-Charles
Peter A Singer |
(Research Paper) Intensivists must provide enough analgesia and sedation to
ensure dying patients receive good palliative care. However, if it is
perceived that too much is given, they risk prosecution for committing
euthanasia. The goal of this study is to develop consensus guidelines on
analgesia and sedation in dying intensive care unit patients that help
distinguish palliative care from euthanasia. . .
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Surgery
Is it ethical to refuse a patient surgery for body
art?
Michael Cook
| The "bioartist" Stelarc has an ear surgically implanted
on his forearm. Like him, a number of other people have
hacked their own bodies with implants and prostheses. With
growing interest in transhumanism, more and more people are
likely to request enhancements to turn them into cyborgs. .
.
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If sex reassignment surgery is the answer, what is the
question?
Michael Cook
| Sex reassignment surgery requires the intervention of
doctors. But what kind of treatment is it? Is it a therapy
for a disease which should be offered only after psychiatric
authorization? Or is it a biomedical enhancement which
anyone can freely choose?. .
.
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Conscientious objection to "patriarchal norms"
Hymen restoration and
'virginity certificates' in Sweden
Michael Cook
| Informed consent and conscientious objection are easy to fulminate about,
but tricky to discuss with consistency. Take, for instance, the delicate
topic of requests for hymen restorations and virginity certificates.
Worldwide, an estimated 5,000 women were victims of honour killings in 2000.
If a young woman from a culture which sanctions honour killing approaches a
doctor, what should he or she do? . . .
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Torture and interrogation
Psychologists criticised in CIA torture report
(USA: December, 2014)
Michael Cook
| Two psychologists contracted by the CIA to create enhanced interrogation
techniques for al-Qaeda detainees have come under fire for violating human
rights and medical ethics. Although pseudonyms were used in the 480-page
report published this week by the Senate Select Committee on Intelligence,
it was clearly referring to
Bruce Jessen and James Mitchell, who were paid US$81 million for their
work. . . .
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Complicity after the fact: moral blindness becomes a virtue and
necessity
Moral blindness becomes a virtue and necessity:
US scientists were "accomplices after the fact" in Japanese doctors' war
crimes
(1945)
Michael Cook
| . . .hundreds of Japanese medical personnel . . . experimented on
Chinese civilians and prisoners of war . . .They killed an
estimated 3,000 people in the infamous Unit 731 in Harbin, in
northeastern China before and during World War II – plus tens of
thousands of civilians when they field-tested germ warfare. . . the
Americans struck a deal with the doctors. They traded immunity from
prosecution for access to scientific information from the ghastly
Japanese experiments – many of which are too grim to detail here. . .
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Doctors launch online pledge against torture
Michael Cook
| Physicians for Human Rights (PHR) has launched an online
pledge for health professionals across the United States to
reject torture as an absolute wrong which can never be
sanctioned. . .
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Torture: sometimes a man's gotta do what a man's gotta do, say bioethicists
Michael Cook
| Torture is an issue on which the public might expect
bioethicists to be moral absolutists. Never again! Never ever!
It was somewhat surprising, then, to read in the
New York
Times that one of the world's leading animal rights
theorists, Oxford's Jeff McMahan, support torture. . .
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Psychologists and Abusive Interrogations: Acting on Conscience
Dr. Mary Pipher |
. . . For the past few years, I have been troubled by various media
and Department of Defense reports that psychologists have designed protocols
and trained and supervised interrogators in the use of sophisticated methods
for breaking the human spirit and destroying mental functioning . . .
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American Psychological Association removes infamous "Nuremberg Defense"
from ethics code
Stephen Soldz*
| . . . like every change in APA's policies on psychologists providing
interrogation support, this change is too little too late. APA
leadership waited till over a year after the end of the Bush regime and
its "enhanced interrogation" torture program before changing this clause
which provided protection for psychologists aiding the torturers. . .
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Vaccination
Compulsory Vaccination
Dave Stevens |
I spent a lot of time learning about immunization practices while a
missionary in Africa. I had an isolation ward full of children with measles
complications and a quarter of them died in the hospital. . . It is clear to
me that Steve LeBlanc's, the author of this article, comments are less about
immunizations and more about right of conscience. . .
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The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors
Margaret Somerville | The COVID-19 pandemic has raised a multitude of complex ethical issues — and new ones present themselves daily. . . In many COVID-19 related decision-making situations at each of these levels, decision makers face what is called in bioethics a “world of competing sorrows” — that is, decision making in which there is no “no harm” option, but in which, instead, they must choose to whom harm will be allocated. . .
What I want to focus on here is a particular micro- level issue: that of a healthcare professional’s obligation to obtain a person’s informed consent to COVID-19 vaccination. . .
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Is mandatory vaccination ethically justifiable? Yes — the flow-on harms are too great.
Margaret Somerville |
What ethical issues do mandatory interventions to limit the spread of the Covid-19 virus raise — in particular, mandatory vaccination? Asked another way, what weight should be given to the arguments of “anti-vaxxers” who oppose mandatory vaccination?
I am not addressing here “involuntary vaccination” — namely, rounding up people and vaccinating them against their will, although in highly dangerous infectious disease situations, Public Health authorities can have powers to impose treatment. Rather, I am focussed on what could be described as “non-voluntary vaccination”, the person can avoid vaccination, but only by making a choice they do not want to make.
. . .
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