bluuebunny/crossref_metadata_2025 huggingface dataset:
Washington State Initiative 119: The First Public Vote on Legalizing Physician-Assisted Death
Authors: McGough Peter M.
Published: July 2009

In the fall of 1991, voters in Washington state were asked to consider a public initiative that sought to legalize physician-assisted death: Initiative 119. Drafted by Washington Citizens for Death with Dignity, the initiative was intended to amend the existing state natural death act in several ways:

1) expand the definition of “terminal condition” to include patients in irrevers ible coma or persistent vegetative state;

2) specifically name “artificial nutrition and hydration” as life-sustaining medical procedures that could be refused or withdrawn;

3) legally allow mentally competent patients with certifiably terminal conditions to request and receive “aid-in-dying” from their physician as a medical service.

The first two proposed amendments were widely acknowledged as timely and appropriate; a coalition of medical, religious, and community organizations had been actively working on such additions for several years. It was the proposal to legalize “aid-in-dying,” however, that represented a radical shift in the conduct of physicians towards their patients and a dramatic shift in social policy.
Chinese Medical Ethics and Euthanasia
Authors: Qiu Ren-Zong
Published: July 2009

Chinese medicine has a history of at least 2,000 years. The first explicit literature on medical ethics did not appear until the seventh century when a physician named Sun Simiao wrote a famous treatise titled “On the Absolute Sincerity of Great Physicians” in his workThe Important Prescriptions Worth a Thousand Pieces of Gold. In this treatise, later called The Chinese Hippocratic Oath, Sun Simiao required the physician to develop first a sense of compassion and piety, and then to make a commitment to try to save every living creature, to treat every patient on equal grounds, and to avoid seeking wealth because of his expertise.
Pastoral Care: Finding a Niche in Ethical Decision Making
Authors: Phillips Donald F.
Published: July 2009

The last three articles within this section of Cambridge Quarterly have focused on organizations or disciplines outside the mainstream of bioethics that are making inroads within the field. This issue's article may be viewed as a departure, but it is not-my thesis is that despite the active presence of the clergy in the ethics field, individuals involved in pastoral care are often thought by health professionals, as well as by a sizeable number of pastors themselves, to not be within the mainstream of ethical decision-making for patients.
Must Good Causes Compete?
Authors: Midgley Mary
Published: July 2009

Rather than discussing the economic side of competition, the actual shortage of resources, I want to discuss competitiveness itself, the competitive attitude. Certainly good causes must in a sense be in competition; that is, they must share resources. The question is should they actively compete? Should they see themselves as competing?

I want to look at a range of difficulties that seem endemic to controversy as such. Some of the difficulties are psychological, but that does not mean that they are accidental, neurotic oddities of particular disputants. They afflict almost everybody who must argue about something important. Other difficulties are in-trinsic in the nature of human life–clashes between rival values, needs, and ideals, places where no fully satisfactory resolution seems attainable.
Helga Wanglie Revisited: Medical Futility and the Limits of Autonomy
Authors: Johnson David H.
Published: July 2009

There is little to indicate from, her circumstances that events would propel Helga Wanglie, an 86-year-old Minneapolis woman, into the center of public controversy. We know little of her life prior to the events that removed her from the world of conscious, sentient beings. By the time of her death on 4 July 1991, Mrs. Wanglie had become the focus of a nationwide public and professional debate on the rights of a patient in a persistent vegetative state (PVS) to receive aggressive medical treatment when such treatment is felt by the patient's doctors not to be in the patient's best interests.
The Wanglie Case from an Uruguayan Perspective
Authors: Franca Omar
Published: July 2009

My experience concerning cases similar to the Wanglie case indicates that there was virtually no possibility of a solution for the conflict between the different expectations of the Wanglie family and those of the physicians caring for Helga Wanglie. A persistent vegetative state precludes a return to consciousness unless an extraordinary phenomenon takes place. Therefore, the physicians expected to be relieved of the duty of continuing to give Mrs. Wanglie respiratory care. However, her family thought it their duty to provide their loved one with the best possible treatment. The family based their position on the claim that life is God's gift and that only He has the right to terminate it. Such spiritual convictions are perceived as reflective of a higher “truth” and are not predisposed to negotiation or change according to the situation.
Ethical Implications of Risk Stratification in the Acute Care Setting
Authors: Knaus William
Published: July 2009

The increasing complexity of modern hospital care and the decisions that must be made were the reasons we began our research on the Acute Physiology, Age and Chronic Health Evaluation (APACHE) project. As a clinician in an intensive care unit (ICU), I felt very uncomfortable making the sorts of decisions that are common today without any source of information or any reference points. These decisions are not avoidable, they are not discretionary, and they are going to become more frequent in the future because we are treating people at later stages of disease.
Acting or Letting Go: Medical Decision Making in Neonatology in The Netherlands
Authors: van Leeuwen E. , Kimsma G. K.
Published: July 2009

The development of neonatology and the establishment of neonatal intensive care units has led to a vast array of new medical ethical problems and dilemmas centered around discontinuing treatment or nontreatment decisions. Neonatology has become one of the fields that has made clear that medical success is only rarely nonproblematic. The new technology can be a blessing for some, but it may also become a sad experience to others, with life-long repercussions.

The ethical problems of neonatology transcend national boundaries. Nevertheless, there are differences in approach among various countries. In The Netherlands, the ethical deliberations have been a matter of public debate, but most of the decision making is left to the medical profession; these decisions are considered too harsh for the general public. Recently, two developments have emerged. The Royal Dutch Medical Association (RDMA) and the Dutch Pediatrics Society have published reports with guidelines and ethical reflections. Over the same period of time, cases have been brought to court for legal analysis and the development of case precedence.
A Paradigm for Making Difficult Choices in the Intensive Care Nursery
Authors: Benitz William E.
Published: July 2009

In the 10 years since the birth of “Baby Doe,” the decisions confronted daily by neonatologists and parents of sick or premature infants have been the focus of a great deal of attention. Issues raised by these decisions have been vigorously debated and discussed in the popular media in political and governmental forums, and in the professional literatures of a variety of academic disciplines. These discourses have illuminated a number of moral and ethical principles that may govern these decisions and have contributed to the development of regulatory and procedural constraints upon this process, including requirements for establishment of infant care review committees at all hospitals that provide neonatal intensive care services. However, the philosophical concepts espoused by theoreticians, although often helpful as abstractions, are rarely invoked at the bedside as decisions are sought for individual patients. No clear consensus has emerged on how these ideas should be incorporated into clinical practice or on the role of mandated ethics committees or discretionary ethics consultants. Consequently, there are wide disparities in decision-making processes both within and among institutions. Failures of these systems to protect neonatal patients or their families remain distressingly common and have attracted considerable attention in the lay press. Although there can be no universal decision tree that can dictate the course of this complex process in all cases, a clearly articulated operative paradigm that defines essential features of an effective and equitable decision-making process is essential to identify the causes of failures and conflicts that arise when the process is dysfunctional and to prevent such problems by providing a framework for training practitioners to deal with these issues.
Legal Issues in Treating Critically Ill Newborn Infants
Authors: Skene Loane
Published: July 2009

Say an infant is born with high lesion spina bifida. She is paralyzed from the waist down and has severe wasting of all areas below the waist. She will always be doubly incontinent and will have no normal sexual function. She has hydrocephalus and a brain stem, abnormality (Arnold Chiari malformation) that is likely to significantly shorten her life. She will probably be retarded and epileptic. She has severe leg deformities — dislocated hips, dislocated knees, and club feet. Her hips are held in a constant position over her chest and her knees cannot be bent in the right direction. She has an 80% chance of developing kyphoscoliosis (curvature of the spine) which may ultimately prevent her from, sitting in a wheelchair and may restrict her lungs, causing respiratory failure and death. She has little spontaneous movement and little response to simple stimuli. She has shallow breathing and difficulty in swallowing and sucking. Whatever treatment this infant is offered, she may not survive. If she does survive, her quality of life is likely to be so poor that one might question whether she would want to live such a life.
The Outpatient Management of a Brain Dead Child
Authors: Stidham Gregory L. , Goldworth Amnon , Joralemon Gail , Bennahum David A. , Ivanjushkin Alexander
Published: July 2009

The patient, a 27-month-old girl, presented to Hospital B by ambulance in acute respiratory failure due to bilateral pneumothoraces.

At 41 weeks, the patient had been delivered by Cesarean section for failure to progress at Hospital A in the same city. Three days after birth she suffered a respiratory arrest. Resuscitation and ventilator support were initiated promptly but the child did poorly, and shortly after this first arrest, the parents were told by the child's physician that she had no chance of recovery. Nevertheless, the mother continued to insist that the child be kept on a respirator and aggressive support be maintained.
Prolegomena to Any Future Code of Ethics for Bioethicists
Authors: Yeo Michael
Published: July 2009

A major facet of the bioethics phenomenon in North America has been the emergence of a new profession on the healthcare turf: a growing number of people calling themselves or being called “bioethicists.” Bioethicists are plying their trade mainly as ethics consultants in hospital settings and as researchers and educators with university affiliations. Other more questionable affiliations can easily be imagined: Bioethicist for a controversial transplant program? For a lobby or advocacy group? For a pharmaceutical company?
A Description of Humanist Scholars Functioning as Ethicists in the Clinical Setting
Authors: Skeel Joy D. , Self Donnie J. , Skeel Roland T.
Published: July 2009

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway.
An Inquiry into Ethics Committees' Understanding: How Does One Educate the Educators?
Authors: Loewy Erich H.
Published: July 2009

This paper inaugurates a new section on education, the focus of which is on education in a broader sense. The purpose is to stimulate discussion not only about techniques of education (even though such papers are certainly welcome) but also to initiate a dialogue concerninig more fundamental questions and issues. What are the goals of education generally and of and for ethics committees specifically? What, for an ethics committee, is “education”? What do we mean by education in this field? To function efficiently on an ethics committee, does a member need specific training? Should the educational efforts of an ethics committee extend beyond the medical and nursing staff? If so (and I think these efforts not only should but must), should they extend beyond the hospital and into the community? Is educating patients a legitimate function of an ethics committee? These are but a few of the questions that I hope will be debated over the years in the pages of this journal.
Models of the Doctor-Patient Relationship and the Ethics Committee: Part Two
Authors: Thomasma David C.
Published: July 2009

Past ages of medical care are condemned in modern philosophical and medical literature as being too paternalistic. The normal account of good medicine in the past was, indeed, paternalistic in an offensive way to modern persons. Imagine a Jean Paul Sartre going to the doctor and being treated without his consent or even his knowledge of what will transpire during treatment! From Hippocratic times until shortly after World War II, medicine operated in a closed, clubby manner. The knowledge learned in medicine was not shared with the patients, who were in general poorly educated and for the most part completely ignorant of the craft of medicine and the physicians (but not, perhaps, of folk medicine). Physicians were cautioned against telling patients too much about their Illness and/or their recovery, perhaps because physicians themselves did not have an enormous armamentarium to confront disease.
The Private Health Insurance Industry: The Real Barrier to Healthcare Access?
Authors: Yarborough Mark
Published: July 2009

Any humane society needs a just and compassionate way to care for those who are sick, and should be vigilant in identifying and eliminating barriers that frustrate efforts to adequately care for the sick. Some current insurance underwriting practices constitute effective barriers to access to healthcare and serve to diminish the place of freedom and justice in our healthcare system.
Saint Martin of Tours in a New World of Medical Ethics
Authors: Lamm Richard D.
Published: July 2009

I end with another parable, but it is also a true story. Harvey Gushing, the famous surgeon after whom the Gushing Lectures are named, made an international reputation in his allegiance to quality. He badgered his profession to a higher standard of self-effacement and railed against the debasement of clinical skills and overemphasis on research and pursuit of personal gain. We honor him to this day because those were, and remain, important points. Yet, Harvey Gushing served as a surgeon during World War I and at Ypres. Although the Allied mortality was as much as 50,000 soldiers a day, not counting the wounded, Gushing refused to operate on any more than two patients each day, arguing that to do so would have lowered his standard of care for his patients a – standard that made sense in one time but that became strikingly insensitive, and I suggest even unethical, in another when confronted with a different reality.
Healthcare: Reform, Yes; But Not à la Lamm
Authors: Pellegrino Edmund D.
Published: July 2009

Richard Lamm is an eloquent and insistent advocate for healthcare reform. In his paper, he argues that if reform is to be effective, a radical metamorphosis in the values underlying our present system must take place. “New realities” have made the “old values” unsustainable. Unless they are replaced by “new values,” we face a future of disastrous overspending, gross inequities in accessibility, poorer health for many, and more expensive dying.
Limiting But Not Abandoning Treatment in Severely Mentally Impaired Patients: A Troubling Issue for Ethics Consultants and Ethics Committees
Authors: Loewy Erich H.
Published: July 2009

On many occasions, care givers are faced with problems in which “drastic” types of treatment seem clearly inappropriate but “lesser” interventions still appear to be advisable, if not indeed mandatory. In the hospital setting, examples are frequent: the demented elderly patient, still very much capable of brief social interactions and still able to enjoy at least limited life, who although clearly not a candidate for coronary bypass surgery is, nevertheless, a patient in whom an intercurrent pneumonia deserves treatment; the severely retarded youngster in whom appendectomy seems clearly warranted but for whom long-term dialysis seems ill-advised. The examples are legion, and their variety defies an easy, stereotypical solution. Why, one may ask, is the treatment of intercurrent pneumonia or operating on an acute appendix “clearly indicated” while coronary bypass and long-term dialysis “clearly” are not? The reactions of care givers in the past have often consisted of attempts to give half-hearted treatment or to treat fully even against their better judgment. The lack of conceptual guidelines that might help sort out such problems has inevitably led either to an inflexible absolutism in which all possible treatment to sustain life or no treatment at all is given or has resulted in a pathetic attempt to act but act minimally (the “slow code” or to give what seems to be an ineffective dose of antimicrobials) with the hope that such actions will be ineffective.
Expanding Opportunities for Ethics Committees: Residential Centers for the Mentally Retarded and Developmentally Disabled
Authors: Edinger Walter
Published: July 2009

Over the past 15 years, ethics committees have become common within the acute care hospital setting. Their development within long-term care settings has evolved more slowly and has been confined primarily to nursing homes. In this paper, I describe the development of an ethics committee in a residential center for the mentally retarded and developmentally disabled (MR/DD). I describe how the committee has progressed and some of the ethical issues in this setting.
Ethics Committees at Work
Authors: Schwartz Robert L. , Luedtke Marcy
Published: July 2009

Lillian T. is a 22-year-old woman with Down Syndrome. Cared for by her mother, she has lived all her life in the same small town and is a quiet, cooperative, and happy individual. Her main pleasures revolve around a steady routine that includes sewing in a sheltered workshop 5 days each week. She performs her own washing and dressing, makes simple meals for herself, and enjoys television.
Teaching Medical Ethics: Is It a Waste of Time?
Authors: Loewy Erich H.
Published: July 2009

The paper by Dr. Myles Sheehan “Why Doctors Hate Medical Ethics” (which would, I think, perhaps have been better entitled “Why Doctors in Training Hate Medical Ethics”) highlights some of the problems of teaching ethics to an extremely weary group of house officers who may look at ethics as a waste of time, as a requirement that must be overcome, or as “a lot of crap” Although Dr. Shee-han's paper offers a number of interesting and valuable insights, it really fails to say why residents hate the teaching of medical ethics any more than they may hate any other conference which, inevitably, intrudes on their time. In this response, I do not so much want to take issue with Sheehan's paper as to comment and to offer some of my own experiences teaching ethics. To do so, I am fully aware, may be regarded as matching anecdote with anecdote, a tiresome and ultimately futile process.
Outside the Garden of Eden: Rural Values and Healthcare Reform
Authors: Brown Kate H.
Published: July 2009

It should surprise no one familiar with the problems in rural healthcare that 87% of a randomly selected sample of Nebraskans recently called for either fundamental or complete change of the healthcare system. Rural communities in the United, States have been hard hit by the rising cost of healthcare at a time of economic and demographic decline. Unable to sustain operating costs and personnel needs, rural hospitals and medical, practices have been forced to close their doors at an, alarming rate.

Furthermore, rural patients are decreasingly able to afford what services are available to them. Most must purchase insurance privately because they are unlikely to be insured through employment. Therefore, they pay dearly because they are not eligible for corporate rates and because insurance companies use experience instead of community rating to assess risk.
Cultural Aspects of Nondisclosure
Authors: Orona Celia J. , Koenig Barbara A. , Davis Anne J.
Published: July 2009

A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.

Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals.
Conflicts between Chinese Traditional Ethics and Bioethics
Authors: Wu Zhaohua
Published: July 2009

Philosophy, including moral philosophy, is the distillation of the spirit of an era. As society and science develop, sooner or later a given philosophy will gradually change form so that the resulting metamorphosis will better meet the needs of the society at that time. Traditional Chinese ethical thought is an outcome of the Chinese closed natural economy and ancient low-level science and is suitable for traditional Chinese medicine. Its superstable structure and character, which have evolved over more than 2,000 years, are rooted deeply in the minds of the Chinese people; hence, it is difficult for them to accept new bioethical views and to adapt to the developments of modern medicine and the changes in society. In China, owing to the strongly rooted values of the old tradition, the consequences of modern medicine have produced an alienating phenomenon that deviates from the goals of modern medicine and leads to conflicts between ethics and science, between old medical ethics and new medical ethics.
Multiculturalism, Medicine, and the Limits of Autonomy: The Practice of Female Circumcision
Authors: Schwartz Robert L. , Johnson David , Burke Nan
Published: July 2009

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma.
Global Bioethics
Authors: Jameton Andrew
Published: July 2009

At the September 1992 Birth of Bioethics conference observing the 30th anniversary of the Seattle kidney dialysis program, Warren Reich discussed the “bilocated” birth of the term bioethics. He showed that the term bioethics was coined in Michigan by Van Rensselaer Potter and that the term was also apparently conceived of independently at about the same time in 1970–1971 in Washington, D.C., by Andre Hellegers and Sargent Shriver. Potter's work, like many similar works in the early 1970s, was concerned with the growing global biological crisis of human overpopulation, the destruction of species, and how to respond to these. He prefaced his bookBioethicswith a “Bioethical Creed for Individuals,” outlining duties to respond to this crisis in a meaningful and scientific way. Hellegers and Shriver used the neologism to name the new Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics. The Center was to study concerns somewhat different from Potter's: the technological revolution in healthcare and its impact on reproduction, investigator-patient relations, and medical ethics.
Reflection of an IRB Chair
Authors: Micetich Kenneth Craig
Published: July 2009

I have been a member of the Loyola University of Chicago, Medical Center Institutional Review Board (IRB) for 12 years and Chair for the last 4 years. The Medical Center Campus is a full-service academic medical center, providing tertiary and primary care to Chicago and its western suburbs. The campus houses a 520bed hospital, outpatient facilities, a cancer center, the graduate medical sciences, a nursing school, and the Loyola University Stritch School of Medicine.
Conflicts of Interest in Research on Children
Authors: Evans Martyn
Published: July 2009

In a research proposal recently submitted to one of the research ethics committees in Wales, children suffering from otitis media, or ‘glue ear’ as it is more familiarly known, were to be tested for allergic reactions to a number of substances using skin-prick tests. Small lancets would be used to pierce the skin of the forearm, allowing the penetration of traces of the allergenic reagent. The size of the subsequent inflamed area of skin would be measured. To demonstrate the expected correlation between glue ear and an allergic reaction, it would be necessary to see whether other children who did not suffer from glue ear also had the same reactions. If they did not, of course, then some causal association between the reaction and the disease condition could be inferred and investigated, with the hope of improving the treatment of the disease itself.
Institutional Morality, Authority, and Ethics Committees: How Far Should Respect for Institutional Morality Go?
Authors: Loewy Erich H.
Published: July 2009

Virtually all persons who have had a hand in shaping the concept of ethics committees in this country accept the principle that the individuals making up the ethics committee should represent different interests, backgrounds, and viewpoints. In other words, ethics committees are intended mainly to represent the interests of the communities they serve. However, ethics committees often also serve hospitals that are religiously based and who, not unreasonably, may insist on affirming their own institutional morality and their own peculiar way of looking at some problems. Deep-seated ethical quandaries, especially in shaping policy, are often unavoidable.
Universal Access on the American Commons
Authors: d'Oronzio Joseph C.
Published: July 2009

As the concept of universal access to healthcare comes to America, an ethical paradox emerges. “Access” is the code word for being assured that sick people without financial resources get appropriate medical care. There is an ethical imperative to provide care for the sick – whether paying or not – and this value ought to give direction to any reformed system.
Rights, Duties, and Limits of Autonomy
Authors: Emson H.E.
Published: July 2009

In the language of secular bioethics, autonomy is always accorded first place in the hierarchy of values that has come to be referred to as the “Georgetown mantra” A dictionary definition of mantra is “a verbal spell, ritualistic incantation, or mystic formula used devotionally,” and the value placed upon autonomy is largely of this nature: uncritical and uncriticised. That there should be and are limits to autonomy is obvious, but these boundaries are undefined, little discussed, and mostly unexplored. To use another metaphor, our emphasis on autonomy is an index of how far the pendulum has swung in an understandable and partly justifiable reaction from, earlier paternalism; has this swing approached its proper limit, and should we be seeking a less extreme and more balanced assessment of autonomy as a bioethical value?
Beyond Autonomy to the Person Coping With Illness
Authors: Thomasma David C.
Published: July 2009

Let us look at autonomy in a new way. Autonomy has a richly deserved place of honor in bioethlcs. It has led the set of principles that formed the basis of the discipline since the beginning. It is the leading principle In what is now regularly called “the Georgetown Mantra,” a phrase suggested by one of the first philosophers ever to be hired In a medical school, K. Danner Clouser. The phrase applies to the principled approach of autonomy, beneficence, nonmaleficence, and justice. This kind of bioethics was developed by scholars like Beauchamp and Childress, Veatch, and Engelhardt, during their association with Georgetown University.
The Individual and Healthcare in the New Russia
Authors: Tichtchenko Pavel
Published: July 2009

The healthcare system in the new Russia is in an agonizing flux of political, economic, and ideological turmoil. The individual in this system, comfortable with the long-established policies of the former Soviet system, is now confronted with instability, rapid change, and an uncertain future.
Ethics Committees: Group Process Concerns and the Need for Research
Authors: Hayes Gregory J.
Published: July 2009

Few ethics committees were in place when the New Jersey Supreme Court announced its ruling on the Quinlan case in 1976. Today, the vast majority of hospitals have formed ethics committees and their use in nursing homes and other healthcare facilities is growing. Given the increasing commitment to the use of ethics committees and their increasing influence on healthcare decision making, the careful evaluation of committee performance should be a high priority. Yet to date ethics committees appear to have undergone relatively little scrutiny. While professional articles on ethics committees do appear and at least one journal (CQ) sets aside a regular section for the discussion of “Ethics Committees at Work” articles to date have primarily been limited to essays, philosophical inquiries, reports, case studies, and, occasionally, surveys. The use of more structured research methodologies has been lacking. As a result, it is not yet clear, for example, what characteristics describe the best functioning ethics committee. Indeed, what constitutes best functioning lacks careful definition as well. Committee impact on medical decision making and patient outcomes, while discussed, has not been systematically measured and analyzed.
The Good Death, Virtue, and Physician-Assisted Death: An Examination of the Hospice Way of Death
Authors: Miller Franklin G.
Published: July 2009

The problem of physician-assisted death (PAD), assisted suicide and active euthanasia, has been debated predominantly in the ethically familiar vocabulary of rights, duties, and consequences. Patient autonomy and the right to die with dignity vie with the duty of physicians to heal, but not to kill, and the specter of “the slippery slope” from voluntary euthanasia as a last resort for patients suffering from terminal illness to PAD on demand and mercy killing of “hopeless” incompetent patients. Another dimension of the debate over PAD concerns the evaluative question of what constitutes a good death. At stake are Issues of character and virtue in the face of death and dying and their Implications for legitimizing the practice of PAD. Critics of PAD argue that “natural” death in the context of comfort care, as provided by hospice programs, isthegood death. In contrast, PAD amounts to an easy way out, an evasion of the ultimate human challenge and task of dying. Because hospice care is clearly preferable to PAD, the former should be encouraged and the latter remain prohibited.
A Buddhist Reflection on the Task of Elders
Authors: Nakasone Ronald Y.
Published: July 2009

Many Japanese American Buddhist families in the San Jose, California area observe a series of late life celebrations in honor of their elders. The sixty-first, the seven-tieth, the seventy-seventh, and eighty-eighth birthdays are celebrated with special flourish. These celebrations mark milestones in life and underscore the respect and gratitude elders are accorded by the family and community. At these gatherings the talk among family and guests invariably turns to the life of the elder and they wonder how the elder was able to survive and even flourish amid the hard- ships and setbacks during his or her long life. Indeed, long-lived elders do seem to have a presence of being that can only come from many years of living. The idea of kyogai, “one's station in life,” is especially revered in the elder. Ordinarily, kyogai refers to one's place in society. Kyogai also suggests the spiritual maturity of being able to live with equanimity and ease in a transient and interdependent world. For Shiryu Morita (1912– ), a leading Japanese sho-artist or calligrapher and student of Buddhist thought and practice, kyogai is both a spiritual and an aesthetic quality. I reflect on Morita's notion of kyogai within the context of the Buddha's attitude toward aging and elders. I offer my reflections as a Buddholo- gist interested in elder ethics and as a Buddhist priest concerned with caring for and empowering elders. I begin with a description of the Buddha's attitude toward aging and elders outlined in the Sutta-Nipata, an early Buddhist document. The “Salla Sutta” in the Sutta-Nipata outlines the Buddha's attitude toward old age, elders and elder tasks. Old age is linked to the question of death and the unease of living in a transient world, in the passages cited below (p. 68).1
An Ethics Consult Team in Geriatric Long-Term Care
Authors: Chichin Eileen R. , Olson Ellen
Published: July 2009

The increasing incidence of ethical dilemmas in long-term care settings, in concert with recommendations from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, has prompted long-term care institutions to develop mechanisms to address these concerns. Some facilities have chosen to set up an ethics committee, although estimates obtained in the past few years indicate that only between 2 and 27% of institutional long-term care settings have such committees. Ethics committees are responsible for assisting staff, residents, and families with the resolution of ethi- cal concerns, and typically engage in policy review and development, case review, and education. Such committees usually count among their membership representatives from a variety of disciplines, with family members, patients, and representatives from patient advocacy groups supplementing the professional component of the committee.
The Gulf Between; Surrogate Choices Physician Instructions, and Informal Network Respones
Authors: Koch Tom
Published: July 2009

Healthcare Providers advising patient surrogates on the appropriateness of continued care for comatose patients have often been sharply criticized for coercive behavior toward patient surrogates; with failing to provide them with adequate information; and for a general failure to adequately cinsider the cimplex needs and hopes of patients, their surrogates, and caregivers. Because decisions on the continuation or withdrawal of care (for example where tube feeding or respiratory assistance are required for nonresponsive patients) often need the legal approval of surrogates the failure of both medical personnel and patient families to understand each other's priorities may lead to ethical and interpersonal conflict.
The Day-to-Day Realities: Commentary on The New Eugenics and Medicalized Reproduction
Authors: Sher Geoffrey , Feinman Michael A.
Published: July 2009

Physicians have a sacred commitment to dedicate themselves through their art and through science to the improvement of the human condition. They have the solemn responsibility to focus on both the prevention and the cure of disease. The human genome project, a 15-year effort to draw the first detailed map in human DNA, will inevitably lead to the widespread implementation of human-gene therapy for the treatment and prevention of disease. We are on the verge of nothing less than a biomedical revolution, the likes of which have not been encountered before. The human genome project will lead to profound changes in the ability to manipulate genes. It will change the way we are born, how we live, how we die, and how we view ourselves in relation to our destiny. Before us lies a difficult transition.
Abortion and the Ethics of Genetic Sexual Orientation Research
Authors: Murphy Timothy F.
Published: July 2009

Reports about possible genetic bases of homoerotic sexual orientation in adults have received a kind of schizophrenic social reception. On the one hand, these reports have been welcomed by some gay men and lesbians as biological confirmation of the commonly held view that sexual orientation is an involuntary trait, that sexual orientation is not in any meaningful sense chosen. Simon LeVay has received mail from thankful correspondents who welcomed his 1991 report about the possible neuroanatomical basis for male homoerotic sexual orientation, and some legal analysts see important implications of biological studies for the ways in which civil rights are recognized, especially those that depend on an immutable characteristic like race or gender.
Social and Ethical Implications ofIn VitroFertilization in Contemporary China
Authors: Handwerker Lisa
Published: July 2009

In March 1988 the People's Republic of China announced the birth of the first test-tube baby born to a 39-year-old infertile peasant woman. This surprise announcement appeared in strong contradiction to China's population reduction goals amidst a population crisis. Yet, the media attention given to this medical achievement would seem to be consistent with the political, social, and economic changes taking place in the last decade, including technological innovation as the key to a modern socialist nation. In short, this announcement highlights tensions facing China as it simultaneously attempts to modernize within a trans-national economy, control population, and maintain traditional Confucian family values within a rapidly changing context.
Report From Hong Kong
Authors: Lau Shelley
Published: July 2009

Hong Kong is a territory of only 400 square miles in size, but with a large population of six million people. We have excellent medical facilities in both the public and private sector and the general health indices of the population are good, with low infant mortality rates (5 per 1000) and long life expectancies (75 years for men and 80 for women).
Gene Therapy in Japan: Current Trends
Authors: Hoshino Kazumasa
Published: July 2009

The Japanese government took significant steps in making decisions about a newly developing clinical application of gene therapy when, on April 15, 1993, the Government officially accepted the Guidelines for Clinical Research on Gene Therapy submitted by the Health Science Council of the Ministry of Health and Welfare of Japan to the Minister.
A Dialogue on Compassion and Supererogation in Medicine
Authors: Thomasma David C. , Kushner Thomasine
Published: July 2009

According to Frankena, “the moral point of view is what Alison Wilde and Heather Badcock did not have.” Most of us, however, are not such extreme examples. We are capable of the moral point of view, but we fail to take the necessary time or make the required efforts. We resist pulling ourselves from other distractions to focus on the plight of others and what we might do to ameliorate their suffering. Perhaps compassion is rooted in understanding what it is that connects us with others rather than what separates us, and rests on developing sufficient awareness, to internalize what our actions, or lack of them, mean in the lives of others.
Physicians' Duty of Compassion
Authors: Dougherty Charles J. , Purtilo Ruth
Published: July 2009

This is a time of change in American healthcare. Market forces are restructuring local delivery systems around competing managed care networks. Many leading proposals for healthcare reform intend a reshaping of the national healthcare marketplace itself. Periods of change create an opportunity to reassess traditional values and practices. Such reassessments can be used to help insure that current innovations and proposed reforms preserve and strengthen the best in the traditions of medicine. A legitimate focus of concern in the medical and medical ethics community has been the effect of these delivery system changes on the physician-patient relationship. For example, will the future American healthcare system support and encourage compassion by physicians? Suppose it does not. Would something of significant moral value have been lost? More pointedly, would a system that undervalued or frustrated physician compassion be incompatible with the moral obligations of physicians? In order to address these questions, we examine the meaning of compassion and the role it should play in the physician-patient relationship. We argue that compassion is a duty of all physicians. Because this is so, we believe that changes in the healthcare system must be judged, in part, by how well they protect and encourage compassionate conduct by physicians.
Love Thy Patient: Justice, Caring, and the Doctor–Patient Relationship
Authors: Rhodes Rosamond
Published: July 2009

Traditional moral theories of rights and principles have dominated medical ethics discussions for decades. Appeals to utilitarian consequences, as well as the principles of respect for autonomy, beneficence, and justice, have provided the standard vocabulary and filled the literature of the field.

Recently on the bioethics scene, however, there has been some discussion of virtue, and, particularly within the nursing ethics literature, appeals are being made to the feminist ethics of care. This intimation of a shift in the wind may have to do with postmodern doubt, or it may be attributable to the claim that virtue theory and the ethics of care (which focus on the character or feelings of the agent, respectively) are more appropriate to private interaction; theories of rights and justice (which focus on the act rather than the agent) are best applied to the political domain of public policy.
The Relationship of Empathy to Moral Reasoning in First-Year Medical Students
Authors: Self Donnie J. , Gopalakrishnan Geetha , Kiser William Robert , Olivarez Margie
Published: July 2009

The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated the father for hypertension, and brought an unborn child into this world is now almost nonexistent. Since the time of the Rockwell portrait, a highly technical medical industry has evolved. Now two-thirds of physicians are board certified in subspecialties, and patients visit an average of 3–4 different physicians per year. Today's physicians see themselves less as “benevolent and wise counselors overseeing the patient's welfare and more as objective scientists applying the latest technical methods to bring about the desired end.” The intimate patient-physician relationship that was once the norm in our society is rapidly disappearing.
Why It Was Hard for Me to Learn Compassion as a Third-Year Medical Student
Authors: Lu Michael Chunchi
Published: July 2009

Ms. B. was a 70-year-old woman who presented with a chief complaint of “my belly got puffy.” She noted that her waistband got progressively tighter as her abdomen swelled up on the month prior to her admission. Although not painful, the swelling caused considerable discomfort and anorexia.

Ms. B. had come to the university hospital by referral from her primary care doctor. She was my first patient on my junior clerkship in internal medicine, a specialty I was particularly interested in going into. It is a rare opportunity for a medical student to pick up a mystery case. Ms. B. had come to us without a diagnosis.
Letting Compassion Open the Door: Battered Women's Disclosure to Medical Providers
Authors: Bauer Heidi M. , Rodriguez Michael A.
Published: July 2009

Domestic violence is an important social problem that strongly impacts the healthcare system. It is estimated that two to four million women are physically abused each year by their husbands, ex-husbands, or boyfriends. Many of these abused women enter the medical system as patients with physical injuries, somatic symptoms, or psychiatric problems. These patients represent a large proportion of women patients in a variety of clinical settings: 22–35% of women presenting to emergency departments, up to 37% of obstetric patients, and over 25% of women seeking primary care. Despite the significant health implications of marital abuse, healthcare providers often fail to identify and treat this problem when signs are present.
Health Policy Watch: “Unexpected” Death and Other Report Cards on Access and Ethics
Authors: d'Oronzio Joseph C.
Published: July 2009

The era of managed care has arrived with portents of a new calculus to integrate cost and quality in health services. These devises such as “report cards” and “outcome measures” place performance against expectations and thus are expected to gauge the value of specific elements of healthcare delivery. From such measures and comparisons, the public will be able to better judge the appropriate, effective, and attractive place to seek their medical services. What is now widely used by utilization review, guiding reimbursement decisions and allowances for the length of hospital stays, will soon have a more prosperous future as general guidelines built into the very framework of managed care agreements.
Setting Limits on Death: A View From the United States
Authors: Johnson Sandra H.
Published: July 2009

Assisted suicide is a tragic issue, one of those for which the tools of mere logic are inadequate and in which the power of the individual case is compelling and seductive but not necessarily clarifying. Meaningful dialogue is difficult. Persuasion is limited because the resolution of the issue, on a moral level, must be founded upon fundamental notions of what it means to be human, especially in the midst of suffering or disability or at the point of death.
Should Physicians Assist the Reaper?
Authors: Haber Joram Graf
Published: July 2009

Physician-assisted suicide is a novel idea having affinities with both suicide and euthanasia. It has affinities with suicide because it involves a self-inflicted death, and it has affinities with euthanasia because the physician is instrumental in the death. It is, however, not exactly either, making it the subject of an exciting debate.