bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ethics of Withholding and Withdrawing Critical Care
Authors: Sanders Lee M. , Raffin Thomas A.
Published: July 2009

For the 17 centuries since Hippocrates called for “the most desperate remedies in desperate cases,” physicians have adhered steadfastly to two cooperative goals: to prolong life and to relieve suffering. ut during the past 50 years, mechanical interventions at the edge of life have thrown those aims into dramatic conflict. Cardiopulmonary resuscitation, mechanical ventilation, feeding tubes, and the intensive care unit have postponed physiologic death for many patients who are anencephalic, comatose, or in a persistent vegetative state or prefer death to a life of suffering and pain. Demands from patients' families and cries for social justice have compelled physicians, hospital personnel, and the Supreme Court to analyze concepts long reserved for university philosophers. Although decisions are made daily to withhold and withdraw life support, society is gradually agreeing upon an ethical framework that balances hopeful science with dignified death. This article outlines that ethical framework, reviews recent legal precedents, and suggests practical guidelines for their application.
Prognostic Scoring Systems: Facing Difficult Decisions with Objective Data
Authors: Sasse Kent
Published: July 2009

In the United States, at least 6% of all hospital beds are in the intensive care unit (ICU) or coronary care unit. The cost of treating a patient in an intensive care unit averages from $2,000 to $3,500 per day. At least 10–40% of intensive care patients will not survive to hospital discharge. Today, every major category of disease may be found in the modern ICU; common diagnoses are septicemia, postsurgical complications, cerebrovascular accidents, gastrointestinal bleeding, neoplasia, and respiratory failure. ICUs employ some of the most sophisticated medical technology, routinely monitoring the cardiopulmonary performance of patients and often providing assisted ventilation. ICUs are high intensity in terms of their staffing, involving 24-hour physician supervision and nurse:patient ratios from 1:3 to 1:1.
Medical Futility in Resuscitation: Value Judgement and Clinical Judgement
Authors: Coogan Michael
Published: July 2009

Mr. F. Smith was a 63-year-old man admitted to the Veterans Administration hospital with fever, respiratory distress, and a possible recurrent pneumonia. He had entered a community hospital with pneumonia approximately 18 months earlier. His 80 pack-year tobacco history and 10-year emphysema history complicated the clinical course on the first admission, and his status worsened to the point of respiratory failure. He suffered a cardiac arrest while on a ventilator in an intensive care unit. He was asystolic for approximately 5 minutes but was resuscitated.
The Object of Morality
Authors: Warnock Geoffrey
Published: July 2009

The Object of Morality is the title of a book I wrote a good many years ago shortly before I deviated irreversibly into university administration (often an intellectually terminal condition). I do not want to plug that book; nevertheless, it may not be completely irrelevant to say something of what it was about and take a rather rapid trot over its theme.
Force Majeure (Legal Necessity): Justification for Active Termination of Life in the Case of Severely Handicapped Newborns after Forgoing Treatment
Authors: Leenen H. J. J. , Ciesielski-Carlucci Chris
Published: July 2009

The health of newborns has always been subject to the natural lottery. When in the past a severely disabled baby was born, nature provided the “solution,” and the child did not survive. Medical technology has brought about a change; fetuses who would have died during pregnancy or newborns who once would have had little chance to survive are now kept alive. Although these technological advances do benefit many children, the dark side is that more severely handicapped babies are surviving.

When a severely disabled baby is born, all persons concerned are faced with emotional difficulties as well as moral and legal dilemmas. Questions that arise include whether it is acceptable, morally and legally, to allow the severely handicapped newborn to die by forgoing treatment or by direct intervention.
The Role of Women in Abortion Jurisprudence: From Roe to Casey and Beyond
Authors: Martin Patricia A.
Published: July 2009

In many ways, Roe v. Wade marked a new chapter in American life. By assuring women of greater reproductive freedom., It gave women greater economic and social freedom, Inflamed a partisan battle between pro-life and pro-choice camps, and provoked a public debate regarding the proper sphere of judicial action. Hence, just as Roe has been critical to the changing politics of gender, it has been the focus of a political debate about the meaning of personhood and morality of abortion, the scope of individual freedom, and the judiciary's role in effecting social change.
In Vitro Fertilization: Regulations in Germany
Authors: Wiesing Urban
Published: July 2009

In Germany — as probably worldwide — in vitro fertilization (IVF) has provoked disapproval, fears, and dread, but it also raises hope and gives feelings of pride and satisfaction in a new scientific achievement. Critics look for convincing argu- ments that could ban IVF completely or at least restrict it considerably. Some of the most important arguments are outlined below.

The main aspect of IVF that was new to society was that conception could take place outside the female body. Although this fact has made a deep impression on us, no ethical relevance has been attributed to it. One must look further for arguments against IVF.
Impaired Physicians: What Should Patients Know?
Authors: Bok Sissela
Published: July 2009

What should patients know about the degree to which their physicians may be impaired—unable, in the words of the American Medical Association (A.M.A.), “to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence”? What patients do in fact find out about such matters as alcohol or other drug abuse by, say, the surgeon or the anesthesiologist in charge of their care is another matter altogether; most patients learn about such impairment the hard way. But what should they know beforehand, if at all possible?
Michael Tooley on Possible People and Promising
Authors: Kuhse Helga
Published: July 2009

In Abortion and Infanticide, Michael Tooley argues that it is not wrong to destroy potential persons, such as fetuses and newly born infants. His argument presupposes the following: 1)that the destruction of potential persons is not directly wrong because potential persons do not have a right to life; 2)that destroying a potential person—a fetus or an infant—is morally the same as preventing the existence of an (as-yet-unconceived) possible person by, for example, using a contraceptive or refraining from, intercourse during a woman's fertile period; and 3)that it is not wrong to prevent the existence of additional persons who are likely to lead happy or satisfying lives. Here I am concerned with the third presupposition. On this presupposition, the prima facie permissibility of abortion and infanticide hinges on the “moral neutrality” of those of our reproductive decisions on which the existence of additional people depends.
Malpractice Liability for the Failure to Adequately Educate Patients: The Australian Law of “Informed Consent” and Its Implications for American Ethics Committees
Authors: Chalmers Don , Schwartz Robert
Published: July 2009

At first glance, the first informed consent case to be decided by the High Court of Australia appears to be little more than a clear and simple description of the substantive law accepted in most American jurisdictions - although that is no small accomplishment in and of itself. In Rogers v. Whitaker, the highest court in Australia succinctly and persuasively rejected informed consent as a species of battery law, accepted it as a form, of ordinary professional negligence law, and adopted the “American” patient-oriented standard (rather than the British doctor-oriented standard) for measuring the breach of a healthcare professional's duty to her or his patients. On second look, however, the opinion is an even more significant one because it reveals that the law of informed consent is now based on principles broad enough to create a duty on the part of healthcare providers to offer adequate health education to all of their patients. In Implicitly recognizing the physician's duty to educate her or his patients, the High Court's judgment is consistent with a view increasingly held In the medical and ethical communities that teaching patients about how to maintain their health is just as much a part of the doctor's function as diagnosing and treating disease. It may have taken 2,500 years for medicine to progress from, the Hippocratic notion that physicians should apply treatment to patients who are kept in blissful Ignorance of their condition and Its remedy, but there Is little doubt that medicine finally has entered a post-Hippocratic era.
Some Suggestions for Holding Bioethics Committees and Consultants Accountable
Authors: Fry-Revere Sigrid
Published: July 2009

Last year, the Joint Commission on Accreditation of Healthcare Organizations for the first time included provisions in its Hospital Accreditation Manual requiring institutions to have mechanisms in place to consider ethical issues arising in the care of patients and to educate care givers and patients on bioethical issues. This new requirement is notably vague. There is no indication of what type of mechanisms would be appropriate or how those involved in considering ethical issues should conduct themselves. This vagueness is by no means accidental, but it reflects a recognition that clinical bioethics is still in its formative stages and that there are currently almost as many different mechanisms for dealing with bioethical issues in the healthcare setting as there are institutions that have such mechanisms. The Joint Commission's action, however, also implies that the time for experimentation will soon be over.
Invoking the Law in Ethics Consultation
Authors: Spielman Bethany
Published: July 2009

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability (personal observation). At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting.
The Ethics Consultant and Ethics Committees, and their Acronyms: IRBs, HECs, RM, QA, UM, PROs, IPCs, and HREAPs
Authors: Schiedermayer David , La Puma John
Published: July 2009

Much has been written about the role of hospital ethics committees. Ethics committees may have begun in Seattle in the early 1960s, but they were reified in. New Jersey by the Quinlan Court in the 1970s and thrived in the national bioethics movement of the 1980s.

In this flurry of ethics activity, several new forms of ethics committees have evolved. New forms of ethics committees include patient care-oriented ethics committees (RM, QM, & QA). Many ethicists are familiar with mission-oriented ethics committees (IRBs & HECs). Such committees have taken on new roles, and Include PROs, IPCs, and HREAPs. In general, these committees are regulatory in nature and may often rely on rules and regulations to assess patient cases, research protocols, and health professional practices.
The Ethical Role of the Consultant
Authors: Weeks William B. , Nelson William A.
Published: July 2009

In the United States, physicians are Increasingly functioning In the consultative role. This change in role Is undoubtedly a result of a surge in the numbers of specialists, the relative decreasing number of primary care physicians, and the emergence of tertiary care centers as primary treatment providers. This change In the style of practicing medicine has led to role confusion In attending physician-patient-consultant relationships.
Does Depression Invalidate Competence? Consultants' Ethical, Psychiatric, and Legal Considerations
Authors: Young Ernlè W. D. , Corby James C. , Johnson Rodney
Published: July 2009

The ethical principle of respect for autonomy has come into its own In American medicine since World War II as equal in importance to the traditional medicomoral principles of nonmaleficence and beneficence. Respect for autonomy provides the ethical underpinning for the patient's right to exercise an informed choice – whether to consent to or to refuse recommended medical treatment. However, an informed choice demands a certain level of competence. Typical criteria for patient competence to accept or to refuse medical treatments Include ability to make a choice and ability to comprehend the nature of the treatment, as well as the risks and benefits of accepting or refusing the treatment.
A Matter of Conscience: Legal Protection for the Rights of Conscience of Healthcare Providers
Authors: Wardle Lynn D.
Published: July 2009

A growing number of healthcare practices implicate serious moral concerns for growing numbers of healthcare providers. Social, legal, and medical developments, including abortion, contraception, euthanasia, withdrawal of feeding, blood transfusions, organ transplants, and routine autopsies, have put healthcare providers in the vortex of some of society's most controversial moral dilemmas.
An Open Letter to Physicians
Authors: Alexander Shana
Published: July 2009

Some weeks ago, we learned that the matriarch of a family, my good friend Anna, is dying. She is 75 and has inoperable esophageal cancer, and the doctors say it will only take a few more weeks or months. Anna is dying the way I want to die–at home, surrounded and lovingly tended by her family: her devoted husband of 54 years, her three daughters, her three worshipful sons-in-law, her adoring granddaughters. All of them see her every day. All of them are a part of a mutual struggle to give Anna a “good death” Anna, too, is a part of it. And, in a very small way, I am part of it, because I have been invited to be. Every few days, I walk next door and spend a few minutes talking to Anna.
The Care of a Good Caregiver: Legal and Ethical Reflections on the Good Healthcare Professional
Authors: van der Burg Wibren , Ippel Pieter , Huibers Alex , de Kanter-Loven Babette , Smalbraak-Schieven Ina , van Veenendaal Laurens
Published: July 2009

A central concept in Dutch health law is the care of a good caregiver (de zorg van een goed hulpverlener). We find this standard in various (proposed) statutes and in legal doctrine. This concept is, however, vague and open and must be made more concrete in professional practice, in moral theory, and in law. In this article, we explore the implications of this complex standard and analyze what moral philosophy and jurisprudence can contribute to its clarification and implementation in professional practice and law. We start with some reflections on how practitioners see this norm and try to live up to it.
Resurrection of the Hippocratic Oath in Russia
Authors: Tichtchenko Pavel
Published: July 2009

I graduated from, medical school in 1972. According to orders signed at the Kremlin by the Chairman of the Supreme Soviet of the USSR, I was obliged, along with every graduating medical student, to swear to a new professional code, “The Oath of the Soviet Physicians.” This was the second year the oath was used. Incorporated in the oath were promises to “conduct all my actions according to the principles of the Communist morality, to always keep in mind … the high responsibility I have to my people and to the Soviet government” I felt no discomfort joining with my friends in repeating words about the communist morality which by that time had already become a ritualized and meaningless official decoration of our life. The text of this oath fit into the political and medical ideology of that time. Not surprisingly, “The Oath of the Soviet Physicians” died along with the Soviet Union.
Physicians, Friendship, and Moral Strangers: An Examination of a Relationship
Authors: Loewy Erich H.
Published: July 2009

It is often said that because physicians and other healthcare professionals frequently play a critical role in determining the fate of their patients, they ought if at all possible to be their patient's friend. The relationship of necessity is intimate: physicians have knowledge of their patients' histories and of their bodies which under other circumstances would be reserved to the most intimate of friends, and physicians and patients meet under more or less critical (or at least anxiety-producing) situations. In this paper, I briefly examine the role of the physician as “friend,” an Issue to be much more extensively explored In a book In preparation.
The Physician–Patient Relationship and Medical Ethics in Japan
Authors: Ishiwata Ryuji , Sakai Akio
Published: July 2009

In April 1991, a general meeting of the Japanese Medical Conference (called ev 4 years) was held in Kyoto and attracted 32,500 participants, the largest number ever. The theme of the meeting was “Medicine and Health Care in Transition,” and the program Included panel discussions on “How to Promote the Quality of Health Care” and “How Terminal Care Should Be Provided” and symposia on “Diagnosis of Brain Death and Its Problems,” “The Propriety of Organ Transplantation,” and “Brain Death and Organ Transplantation.” These titles reveal not only how medical professionals in Japan perceive the present situatior healthcare but also the Issues that most concern them.
HMO Doctor – for Nonsmokers Only?
Authors: Herring Marvin E. , Erde Edmund L.
Published: July 2009

When patients join a Health Maintenance Organization (HMO), they choose a primary care physician from among a set whose members are approved by a board according to preestablished criteria. To assist patients in making their choice of physician, the HMO provides them an information packet about each physician.

Recently, a physician (let us call him Dr. Exchs) requested permission to include in the information packet about himself that he would not accept patients who smoke and would not continue the care of current patients who smoke. His poignant statement follows.
Hospital Roommates: An Interview with a Terminally III Patient
Authors: Veatch Robert M. , Veatch Laurelyn L.
Published: July 2009

Among the important functions of the healthcare provider in providing quality care is the monitoring of the social environment of the patient. Although it is increasingly recognized that caring activity must include the whole patient and not merely the technical and pharmacological aspects of the patient's needs, the impact of the social environment upon the total health state (which includes physical, emotional, and social components) has not been explored and debated to the extent that It might be.
Infinite Needs–Finite Resources: The Future of Healthcare
Authors: Lamm Richard D.
Published: July 2009

The single greatest challenge facing managers in the developed countries of the world is to raise the productivity of knowledge and service workers. This challenge, which will dominate the management agenda for the next several decades, will ultimately determine the competitive performance of companies. Even more important, it will determine the very fabric of society and the quality of life of every industrialized nation. … Unless this challenge is met, the developed world will face increasing social tensions, increasing polarization, increasing radicalization, possibly even class war.
A Healthcare Planner's Conscience
Authors: Evans Donald
Published: July 2009

Across the world, healthcare providers must wrestle with the twin ogres of finite resources and infinite demand. Successful healthcare delivery creates its own legacy of need. For example, a renal failure patient may now be given a greatly extended life by means of dialysis or organ transplantation. In the process, the healthcare provider has created a permanent demand for services during that extended life. It has been estimated that the recurrent cost of maintaining a patient on hemodialysis for 1 year in the United Kingdom is in the region of £20,000.
Futility: Are Goals the Problem? Part Two
Authors: Gregory Dorothy Rasinski , Cotler Miriam Piven
Published: July 2009

Recent contributions to the literature on the topic of futility have focused primarily on two areas: 1) definitions of the term and 2) the suggestion that cardiopulmonary resuscitation (CPR) may be futile in certain patients. This suggestion is based on “scientific” measures and analyses of outcomes, describing the low probability of success of CPR in patients over age 70, those with cancer, those with multiorgan failure, etc. The research reported suggests that with such patients the physician need not get the patient's (or the surrogate's) consent to withhold resuscitation; the physician need only inform either the patient or the surrogate that CPR will not be Instituted in the event of an arrest.
Mental Retardation: The Reality Behind the Label
Authors: Bourguignon Henry J.
Published: July 2009

I'd like to say a few things about the quality of life of people like me. We can have – and now I do have – a good quality of life, but we still have to fight for it. We have to take back control of our lives from the KEEPERS, from the professionals.
Substituted Judgment, Best Interests, and the Need for Best Respect
Authors: Martyn Susan R.
Published: July 2009

Perhaps the most troublesome medical decisionmaking cases facing state courts concern serious healthcare decisions involving patients with severe or profound retardation. The courts who face this issue encounter a difficult dilemma. A decision to terminate a medical treatment of a dependent, vulnerable person requires considerable solicitude. Allowing a helpless person to die sooner than is medically possible directly conflicts with that person's most basic right – the right to live. However, continuing treatment in the face of terminal illness may not only prolong but also increase intense mental and physical suffering. Perpetuating near torture in the name of protecting a person's life may be equally worrisome.
Sterilization and a Mentally Handicapped Minor: Providing Consent for One Who Cannot
Authors: Applebaum Gabrielle M. , Puma John La
Published: July 2009

The moral standing of involuntary sterilization has long been subject to debate but has only recently been looked upon with disfavor. When sterilization of a mentally handicapped minor is entertained, issues of eugenics, medical ethics, and legal precedent specially arise. Ethics consultants and ethics committees have been asked to consider such cases.
Professional Organizations and Healthcare Industry Support: Ethical Conflict?
Authors: Hazlet Thomas K. , Sullivan Sean D. , Leisinger Klaus M. , Gardner Laura , Fassett William E. , May Jon R.
Published: July 2009

A good deal of attention has been recently focused on the presumed advertising excesses of the healthcare industry in its promotion techniques to healthcare professionals, whether through offering gratuities such as gifts, honoraria, or travel support2-6or through deception. Two basic concerns have been expressed: Does the acceptance of gratuities bias the recipient, tainting his or her responsibilities as the patient's agent? Does acceptance of the gratuity by the healthcare professional contribute to the high cost of healthcare products? The California Society of Hospital Pharmacists was recently asked by its members to formulate a policy for an appropriate relationship between the Society and the healthcare industry, addressing these concerns. In formulating its policy, it became clear that the Society depended on healthcare industry support, gathered through journal advertising, fees for booths at its various educational events, and grants for speakers.
The Problem of Futility: III. The Importance of Physician-Patient Communication and a Suggested Guide through the Minefield
Authors: Gregory Dorothy Rasinski , Cotler Miriam Piven
Published: July 2009

As noted In Part II of this series (CQ 1994;3:133–142), perhaps the most critical elements to define in deciding when treatment Is futile are the goals of therapy from, both the physician's and the patient's point of view. A patient's personal goals are based upon value system., life goals, and personal definition of “quality of life.” These personal goals must then be interpreted and applied in a reasonable and realistic fashion against what the physician has previously described as the legitimate, objective, and attainable therapeutic goals. As far as possible, both, parties must work together to eliminate the uncertainties in their discussion. The ideal situation includes a competent, alert patient and a prudent, caring physician who have had a long-term ongoing relationship. The key to collaboration is communication: a sincere interest in and professional concern for the patient; a willingness to be honest and open; a commitment to talk and to listen; an attempt to make one another feel comfortable in the collaboration; and an effort to recognize and to overcome barriers to communication, whether barriers are personal to either the patient or the physician or are professional, institutional, or societal.
How Abstract Is My Thinking as an Ethicist in Clinical Settings?
Authors: Erde Edmund L.
Published: July 2009

Philosophy is generally considered to be very abstract. How philosophical and abstract Is ethical thinking In clinical situations? This paper sketches an answer In the form of a case study (I am the case) and offers me the chance for some self-reflection and readers the chance to eavesdrop on that self-reflection. Aside from any Intrinsic worth of the questions and answers, they also have Implications for how clinical ethicists should be educated or trained, i.e., how abstract should one's work in moral philosophy be?
Bioethics Common Market: An International Exchange
Authors: Hall Maggie
Published: July 2009

Bioethics Common Market is an international bulletin board to post notices regarding such things as networking contacts among people interested in a specific area of concern, hospitality, research underway for which collaboration is desired or possible, sources of scarce or hard-to-find materials, reports or papers available in sufficient numbers to share, textbooks or study materials desired, and, for travelers to any state or country, names of local people with possible common interests.
Intercultural Reasoning: The Challenge for International Bioethics
Authors: Marshall Patricia , Thomasma David C. , Bergsma Jurrit
Published: July 2009

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because our beliefs about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments.
Telling the Truth to Patients: A Clinical Ethics Exploration
Authors: Thomasma David C.
Published: July 2009

In this essay I will examine why the truth is so important to human communication in general, the types of truth, and why truth is only a relative value. After those introductory points, I will sketch the ways in which the truth is overridden or trumped by other concerns in the clinical setting. I will then discuss cases that fall into five distinct categories. The conclusion emphasizes the importance of truth telling and its primacy among secondary goods in the healthcare professional-patient relationship.
Distributive Justice and the Regulation of Fertility Centers: An Analysis of the Fertility Clinic Success Rate and Certification Act
Authors: Baker Doris J. , Paterson Mary A.
Published: July 2009

The right to conceive and bear children has been protected both in law and in policy. Human society has from its earliest time valued children and defended procreation as a basic right.

Modern health technology offers the possibility of conception to the estimated 2.5 million infertile couples who may wish to have children. For these persons, infertility treatment offers the hope of having children, an activity deemed basic and essential in human society.

In general, the state has been reluctant to directly interfere in the reproductive decisions of individuals. However, the state may act to increase or reduce access to reproductive services in a variety of ways. For example, recent legislation regulating fertility clinics affects the distribution of assisted reproductive technology (ART) in the United States. The purpose of this paper is to describe this legislation, project its probable effects on the distribution of ART services, and analyze these effects based on distributive theories of justice.
Anchor and Course for the Modern Ship of Casuistry
Authors: Macpherson-Smith Malcolm
Published: July 2009

So much philosophical theory is irrelevant for the practice of ethics! How many wasted volumes of tortuous arguments and counterarguments have been written in search of an elusive theory of ethics that could be applied deductively, without modification, to produce “correct” answers under all circumstances to any ethical problem? The practice of ethics is much closer to the common sense casuistry approach outlined by Jonsen and Toulmin, in which we work from. intuitively grasped, paradigm, cases by way of analogy to provide presumptive answers to more complex problems. Alasdair Maclntyre argued however that we cannot trust such individualistic intuitive judgements. Thus we should start by looking at his critique of modern ethics.
The Educational Needs of Ethics Committees
Authors: Griener Glenn G. , Storch Janet L.
Published: July 2009

Hospital ethics committees must be knowledgeable if they are to perform consultations, advise administrators on policy, or offer educational programs. Because the membership of the committee is interdisciplinary, with most drawn from the healthcare professions, the individuals who join cannot be expected to bring knowledge of bioethies with them. Therefore, a new committee must spend time developing expertise before it can appropriately serve the hospital community. Although the need for committee self-education is generally recognized, it is seldom discussed in any detail. When discussed at all, expertise in bioethies is usually described as composed of a familiarity with an identifiable body of knowledge and mastery over techniques of moral reasoning. It is assumed that a committee can develop this expertise early in its life through a short course of study.
Consultants and Committees: A Cooperative and Mutually Educational Enterprise
Authors: Loewy Erich H.
Published: July 2009

It is logical that to function properly ethics committees must be properly trained, and I believe that Griener and Starch's paper in this issue of CQ is an important contribution to such a point of view and to this field. Although written from the Canadian perspective, the paper should find broad resonance in other settings. Differences between national medical settings are interesting but not critical to the point Griener and Starch make, i.e., ethics committees should be trained and should continue to be trained.

Not all will agree on this position, because it rests on several presuppositions that not everyone will accept. According to such a thesis, ethics in general and medical ethics in particular has its own peculiar way of thinking, is based on a recognizable and acknowledged body of literature, and can be acquired by study. Further, such a view presupposes that persons who have acquired such a skill and broadened it by continual practice have developed an expertise lacking in others who have no familiarity with the field.
Misconduct and the Development of Ethics in the Biological Sciences
Authors: Reiser Stanley Joel
Published: July 2009

A variety of cases of scientific misconduct have been documented since the 1980s among biological scientists. These cases have focused the attention of the public and scientific community on this behavior and made it the centerpiece of the concern about ethics in the biological sciences. In contrast, the ethics movement in clinical medicine, which arose in the 1960s, was not basically directed at the problems of wrong-doing. Instead it concentrated on the difficult ethical choices that had to be made In the practice of medicine.

In this essay, I discuss the two movements. The attention given to misconduct In the biological sciences has become excessive and diverts its ethics movement from exploring and teaching about the difficult ethical decisions scientists must make in weighing obligations to self, science, and society. A more balanced and selective approach to developing an ethical framework in the biological sciences is needed.
Making Research Consent Forms Informative and Understandable: The Experience of the Indian Health Service
Authors: Freeman William L.
Published: July 2009

The mission of the Indian Health Service (IHS) affects what research is done and how It is reviewed and managed and in turn affects the forms and process used to obtain informed consent. Consent forms must be Informative and understandable to American Indian and Alaska Native (AI/AN) potential volunteers; the process used to obtain informed consent must minimize any institutional pressure to participate. The IHS Institutional Review Boards (IRBs) developed seven research Model Volunteer Consent Forms (available from the author).
How Much Influence Do Various Members Have within Research Ethics Committees?
Authors: McNeill Paul M. , Berglund Catherine A. , Webster Ian W.
Published: July 2009

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death of many women diagnosed with carcinoma in situ.
Surrogate Decision Making for Severely Cognitively Impaired Research Subjects: The Continuing Debate
Authors: DeRenzo Evan
Published: July 2009

As research into Alzheimer's disease and other dementing disorders becomes more complex, risky, invasive, and commonplace, the need intensifies for discussion of the ethics of involving persons with dementia in research, specifically research of greater than minimal risk and of no expected direct benefit to the subject. (It is beyond the scope of this paper to consider the ethical issues related to research involvement of cognitively impaired children or children or adults with intermittent and/or reversible cognitive or psychiatric impairments. For such discussions, refer to the references in notes 1–6.) Reviewing such studies pushes our traditional analysis tools to their limits. Simply balancing and prioritizing the basic ethical principles of respect for persons, beneficence, and justice that serves us well in reviewing the vast majority of studies is inadequate when reviewing research of such ethical complexities as studies with marked risks and no expectation of direct benefit to subjects unable to consent or withdraw. Moving up to the level of theory, placing these principles within the commonly applied frameworks of consequentialism, deontology, or virtue ethics bring us no closer to reducing the tensions such research creates between upholding individual autonomy and advancing society's need to learn how to treat and cure these devastating diseases. What is needed is the introduction of more contemporary moral analyses. Specifically, we need to become more inclusive of the diversity of values perspectives of our general citizenry. In more theoretical terms, we ought to elevate to a more central role a communitarian perspective and a feminist ethics emphasis on relationships and context as we rush to keep in step, ethically, with this rapidly expanding area of medical inquiry.
Review of Legal Instruments and Codes on Medical Experimentation with Children
Authors: Choudhry Sujit
Published: July 2009

Medical research with children has been the subject of ongoing debate. The reason for controversy is clear. As with research on adults, one must strike a balance between two goals – promoting the health of children through advances in scientific knowledge and protecting child research subjects from exploitation and harm. However, because of their age and relative immaturity, children cannot protect their own interests as well as adult subjects can. Yet as they progress toward adulthood, increasing care must be taken to involve children in decisions that affect them, even to the extent of allowing them to make choices that may have serious and long-term consequences.
Response of Buddhism and Shintō to the Issue of Brain Death and Organ Transplant
Authors: Hardacre Helen
Published: July 2009

Japan has no law recognizing the condition of brain death as the standard for determining that an individual has died. Instead, it is customary medical practice to declare a person dead when three conditions have been met: cessation of heart beat, cessation of respiration, and opening of the pupils. Of the developed nations, only Japan and Israel do not recognize brain death as the death of the human person.
Ethics Committees at Work
Authors: Tichtchenko Pavel , Edmond Jean C. , Nelson Robert M. , Blank Ellen L. , Shapiro Robyn S. , Mackay Charles
Published: July 2009

The Research Center for Surgery (RCS) in Moscow is recognized as one of the largest and most prestigious surgical institutions in Russia. In this 400-bed facility more than 3,000 surgical procedures are performed annually, including heart, liver, and pancreas interventions and the reimplantation of limbs. The main focus of the research program at the RCS is on the transplantation of organs and reconstructive surgery. All procedures are free of charge to the patient.
Judging Medical Futility: An Ethical Analysis of Medical Power and Responsibility
Authors: Jecker Nancy S. , Schneiderman Lawrence J.
Published: July 2009

In situations where experience shows that a particular intervention will not benefit a patient, common sense seems to suggest that the intervention should not be used. Yet it is precisely in these situations that a peculiar ethic begins to operate, an ethic that Eddy calls “the criterion of potential benefit.” According to this ethic, “a treatment is appropriate if itmighthavesomebenefit.” Thus, the various maxims learned in medical school instruct physicians that “‘an error of commission is to be preferred to an error of omission,’ or ‘when in doubt, cut it out’ or ‘if but one patient is helped, then the treatment is worthwhile.’”
Conflict in the Pediatric Setting: Clinical Judgment vs. Parental Autonomy
Authors: Goldworth Amnon
Published: July 2009

Over the past several decades, conflicts between physicians and patients or patient surrogates concerning continued treatment or the withdrawal of treatment have received public and legal attention. In more recent years, there have been several prominent Instances in which physicians have refused to provide treatment requested by patient surrogates because such treatment was judged to be futile. The claim that a treatment is futile has far reaching consequences. It serves to justify the withholding or withdrawal of treatment and thus, perhaps, to also justify the rationing of healthcare. It limits the autonomy of the patient or patient surrogate by reducing their participation in the decision making process.
Care Ethics: A Concept in Search of a Framework
Authors: Loewy Erich H.
Published: July 2009

In this paper, I want to try to put what has been termed the “care ethics” into a different perspective. While I will discuss primarily the use of that ethic or that term as it applies to the healthcare setting in general and to the deliberation of consultants or the function of committees more specifically, what I have to say is meant to be applicable to the problem of using a notion like “caring” as a fundamental precept in ethical decision making. I will set out to examine the relationship between theoretical ethics, justice-based reasoning, and care-based reasoning and conclude by suggesting not only that all are part of a defensible solution when adjudicating individual cases, but that these three are linked and can, in fact, be mutually corrective. I will claim that using what has been called “the care ethic” alone is grossly insufficient for solving individual problems and that the term can (especially when used without a disciplined framework) be extremely dangerous. I will readily admit that while blindly using an approach based solely on theoretically derived principles is perhaps somewhat less dangerous, it is bound to be sterile, unsatisfying, and perhaps even cruel in individual situations. Care ethics, as I understand the concept, is basically a non- or truly an anti-intellectual kind of ethic in that it tries not only to value feeling over thought in deliberating problems of ethics, but indeed, would almost entirely substitute feeling for thought. Feeling when used to underwrite undisciplined and intuitive action without theory has no head and, therefore, no plan and no direction; theory eventuating in sterile rules and eventually resulting in action heedlessly based on such rules lacks humanity and heart. Neither one nor the other is complete in itself. There is no reason why we necessarily should be limited to choosing between these two extremes.
Moving From Autonomy to Responsibility in HIV-Related Healthcare
Authors: Tuohey John F.
Published: July 2009

No healthcare issue has generated as much ethical debate on the relationship between the individual and society as HIV Infection. In this debate, an appeal is most often made to such principles as autonomy and confidentiality to protect individuals who are HIV positive or who have AIDS from an invasion of privacy thought to be justified by society's need for information. In the first years, this emphasis on the protection of the individual was essential. Even today, there are risks in disclosing one's HIV status. However, as more and more persons become Infected, live longer, and move within the healthcare industry for non-HIV related care, as both patients and healthcare workers, the terms of the debate need to be redefined.
Autonomous Decision Making and Japanese Tradition
Authors: Hoshino Kazumasa
Published: July 2009

Crucial problems exist in understanding Japanese traditional customs with regard to autonomous decision making by patients in Japan. These problems are difficult to comprehend because they seem, by western standards, to defy logic. Questions that baffle those outside the Japanese tradition, include: Why do many Japanese patients hesitate to make medical treatment and care decisions for themselves without consulting family, close friends, or someone viewed as being in a superior position? Why do many Japanese physicians fail to disclose the truth directly to the patient, instead customarily conveying information to family members, despite the doctors' awareness of their legal obligation to protect the patient's privacy? Why do many Japanese physicians continue to question whether patients should be told the truth at all? What perpetuates Japan's widespread, but often unnoticed, neglect of the individual's right to self-determination in healthcare decision making?
Ethics Committees at Work: Do Not Resuscitate Orders in the Operating Room: The Birth of a Policy
Authors: Micco Guy , Cohen Neal H.
Published: July 2009

The question of whether Do Not Resuscitate (DNR) orders should be sustained in the operating room was brought to our ethics committee by a pulmonologist and involved one of his patients for whom he serves as a primary care physician. His patient, a woman with chronic obstructive lung disease (COPD) was electing, for comfort purposes, to have a hip pinning following a fracture. At the same time, she wished to have a DNR order covering her entire hospital stay. The anesthesiologist described her direction as “improper” and refused to participate in surgical procedures if DNR orders extended to the operating room. The patient refused to rescind the order during surgery. As a result, the surgery was canceled to the great chagrin of the patient.
Jessica Mitford Discusses Attitudes on Aging
Authors: Kushner Thomasine
Published: July 2009

Our attitudes toward aging change in that “old” depends on where you are. When I was 16, and my sister Nancy was 29, I suddenly realized, to my horror, that one of us was about to be 30. I went around saying to everyone, “Poor Nancy, she's almost 40,” because to me at that time, 30 and 40 were about the same. Later, when Nancy was 40, she said she didn't mind because, according to me, she had been 40 for a decade.
The Ethics of Decision Making for the Critically Ill Elderly
Authors: Iris Madelyn Anne
Published: July 2009

The ethics of decision making for the critically ill elderly is an area of concern for all those involved in the decision-making process. The number of participants involved in decision making around end-of-life issues may be many: treatment and care decisions often bring together not only the patient and the physician, but the family, an extended medical care team, and impartial members of a hospital or institutional ethics committee. In addition, treatment and care decisions made at the end of life occur in a variety of settings, not just the acute care hospital. Elderly patients who are critically ill, or in the final days or weeks of life, are found in intensive care or medical units of hospitals, in hospital and nursing home based hospice programs, in long-term care settings such as skilled nursing facilities, or at home, where they are tended by family caregivers. Differences in patterns of decision making regarding the care and treatment of critically ill older adults can be found across these settings, and decisions often vary according to the roles of the participants.
The Ethical Challenge of Providing Healthcare for the Elderly
Authors: Thomasma David C.
Published: July 2009

Populations around the world are aging at a very fast rate, so much so that care for the elderly will soon rupture even the most carefully planned, enlightened care provisions societies can offer. The demographics in advanced countries demonstrate this dilemma, even without projections based on antiaging medications that may be possible in the near future, and a healthier lifestyle that has preoccupied the yuppies for about 10 years.