Biomedical subjects
Publications and source records attributed to B Gert.
To gain patients' confidence, these moral guidelines offer specific consideration in presenting treatment choices, gaining consent, and responding to patients' decisions. When the dentist-patient relationship is one of mutual trust, unusual and difficult situations are easier to solve.
The standard ways of distinguishing between active and passive euthanasia, act versus omission, and removal of ordinary versus removal of extraordinary care, do not have any clear moral significance. We have used particular aspects of the physician-patient relationship to make a morally significant distinction between active and passive euthanasia. Passive euthanasia is defined as the physician's abiding by the rational valid refusal of life-sustaining treatment of a patient or his surrogate decision-maker. Understanding passive euthanasia in this way makes it clear why, everything else being equal, there is no morally significant difference between discontinuing a treatment and not starting it, for example, taking a patient off a respirator versus not putting him on in the first place. It also makes clear why stopping the feeding and hydration of some patients is not merely morally permissible but is morally required. Patients may make a rational valid refusal of food and fluids just as they may of other kinds of life support, and what patients rationally refuse when competent holds its force when they become incompetent. By basing the distinction between active and passive euthanasia on the universally recognized moral force of a rational valid refusal, we have provided a clear foundation for the moral significance of this distinction. Our way of making the distinction preserves for patients the control over their lives that has sometimes been unjustifiably taken from them. It also eases the burden on doctors who no longer are forced to make use of ad hoc and confused distinctions in which they justifiably have little faith.(ABSTRACT TRUNCATED AT 250 WORDS)
We analyze the ethical issues related to the physician's role in informing about, advising, rejecting, or performing a definitive birth control procedure (sterilization). We define a rational request for tubal ligation, the limited delaying (or facilitating) role that guidelines for deciding on ligation should have, the justifiable reasons for rejecting a request, and the physician's obligations and options. We also consider the need to supply adequate information, the implications of recommending a second-best treatment, and the pivotal place of the "likelihood of regret" in medical decision-making.
Explore the source record for details and available documents.
We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but 'involuntary'. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them.
Explore the source record for details and available documents.
The permanent cessation of functioning of the organism as a whole is the definition underlying the traditional understanding of death. We suggest the total and irreversible loss of functioning of the whole brain as the sole criterion of death; this has always been an implicit criterion of death. If artificial ventilation is present, only completely validated brain dysfunction tests should be used to show that this criterion of death is satisfied. In most cases without artificial ventilation, permanent loss of cardiopulmonary function is sufficient. We propose a statutory definition of death based on the criterion of total and irreversible cessation of whole brain functions but allowing physicians to declare death according to their customary practices in most cases.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die.