Ethics consultation on demand: concepts, practical experiences and a case study.
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Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study. (+info)
Survey of medical ethics in US medical schools: a descriptive study.
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In light of the fact that the incidence of revocation of physician licenses is on the rise, a survey was sent to 118 allopathic and 16 osteopathic medical schools in the United States to assist in appraising the current resources of US medical schools training in bioethics. The author contends that, in view of the statistics on increasing actions against postgraduate physicians, the time has come to determine what constitutes an effective experience for our students. It is hoped that the details of this investigative process will give educators and researchers insight into the current state of medical school ethics curriculum and increase awareness of the need to address the problems. (+info)
American health care and the law--we need to talk!
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The first section of this paper highlights five critical legal developments over the past half-century that, while not reflecting considered policy judgments about how the health care industry should operate, put American health care on some surprising paths. The second part then observes five fundamental policy contradictions discernible in health care law today, each of which reflects severe ambivalence in public attitudes toward health care. Although such confusion in the law is interesting in itself, the main purpose of the paper is to propose, in section three, the creation of a permanent high-level forum, perhaps in the Institute of Medicine, where leaders from the health and legal worlds could meet regularly with a view to helping the legal system resolve some of the policy confusion that exists. (+info)
Causal authorship and the equality principle: a defence of the acts/omissions distinction in euthanasia.
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This paper defends the acts/omissions distinction which underpins the present law on euthanasia, from various criticisms (including from within the judiciary itself), and aims to show that it is supported by fundamental principles. After rejecting arguments that deny the coherence and/or legal relevance of the distinction, the discussion proceeds to focus on the causal relationship between the doctor and the patient's death in each case. Although previous analyses, challenging the causal efficacy of omissions generally, are shown to be deficient, it is argued that in certain cases of causing death by omission the causal authorship of the doctor lapses. The final part of the paper examines why this should be morally significant and proposes an answer in terms of the principle of equality. Assuming all other factors are equal, the infringement of this principle provides an additional reason against actively killing a patient, which is not present in cases of passively letting die. (+info)
Are medical ethicists out of touch? Practitioner attitudes in the US and UK towards decisions at the end of life.
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OBJECTIVES: To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. DESIGN, SUBJECTS AND SETTING: A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". RESULTS: Practitioners accept the relevance of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. CONCLUSIONS: Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (+info)
Choices without reasons: citizens' juries and policy evaluation.
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Citizens' juries are commended as a new technique for democratising health service reviews. Their usefulness is said to derive from a reliance on citizens' rational deliberation rather than on the immediate preferences of the consumer. The author questions the assertion of critical detachment and asks whether juries do in fact employ reason as a means of resolving fundamental disagreements about service provision. He shows that juries promote not so much a critically detached point of view as a particular evaluative framework suited to the bureaucratic idiom of social welfare maximisation. Reports of jury practice reveal a tendency among juries to suppress by non-rational means the everyday moral language of health care evaluation and substitute for it a system of thought in which it can be deemed permissible to deny treatment to sick people. The author concludes that juries are chiefly concerned with non-rational persuasion and because of this they are morally and democratically irrelevant. Juries are no substitute for voting when it comes to protecting the public from zealous minorities. (+info)
Backing onto sacred ground.
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It is widely recognized that the health of individuals and communities is determined by the interaction of physical, mental, social, and spiritual factors. Public health leaders can find precedent for the resulting holistic strategies in the collaboration with religious structures that characterized the early years of public health. The modern context is more pluralistic, democratic, and complex in terms of its institutional array of partners. (+info)
Discipline responses: influences of parents' socioeconomic status, ethnicity, beliefs about parenting, stress, and cognitive-emotional processes.
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Direct and indirect precursors to parents' harsh discipline responses to hypothetical vignettes about child misbehavior were studied with data from 978 parents (59% mothers; 82% European American and 16% African American) of 585 kindergarten-aged children. SEM analyses showed that parents' beliefs about spanking and child aggression and family stress mediated a negative relation between socioeconomic status and discipline. In turn, perception of the child and cognitive-emotional processes (hostile attributions, emotional upset, worry about child's future, available alternative disciplinary strategies, and available preventive strategies) mediated the effect of stress on discipline. Similar relations between ethnicity and discipline were found (African Americans reported harsher discipline), especially among low-income parents. Societally based experiences may lead some parents to rely on accessible and coherent goals in their discipline, whereas others are more reactive. (+info)