The conflict between autonomy and beneficence in medical ethics: proposal for a resolution.
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The author discusses the postmodernist claim that the "grand theories" have lost credibility, even in the field of medical science and practice. Rather than representing a shared reality among physician and patient, illness represents two quite distinct realities - the meaning of one being significantly and distinctively different from the meaning of the other. However, existential clinical narratives can function as important bridges between the world of the patient and the world of the physician. Such narratives provide important information regarding the patient's biographical situation and, particularly, the personal and cultural meanings which are a function of the biographical situation. At the same time, these narratives provide physicians with useful information for the practice of medicine.
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The paper is aimed to show the fruitlessness of the debate on cloning both as regards its theoretical solutions and its practical influence on the final decisions concerning this issue. The author claims that the highly diversified attitudes of the participants of the debate, which issue from their reference to different philosophical approaches and sets of premises, do not allow for development of a commonly accepted theoretical standpoint. However, independently of theoretical controversies, the possibility of cloning human beings and introducing changes in the genotype will probably be accepted due to the similarities between the expected results of genetics and the ideas of contemporary, liberal Western culture.
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During the past decade, there has been a noticeable shift in the philosophical approach to health care. This change in thinking, from problem-focused to goal-oriented and from discipline-specific to team driven, has been apparent in rehabilitation as well. The Spinal Cord Program at G. F. Strong Rehab Centre in Vancouver, Canada, has developed a goal-setting framework to define and meet clients' needs by promoting a partnership between the client and family and the clinical team. Donabedian's paradigm provides the model on which the interdisciplinary goal-setting framework is based. The purpose of the framework is to clearly outline clients' and staffs' expectations of the rehabilitation program, identify responsibilities, ensure accountability of clients and staff, and facilitate measurement of goal achievement. Evaluation of the framework indicates that most staff and clients believe the framework provides more structure and direction to the client's rehabilitation program than the previous approach; others believe the use of a goal checklist imposes too much structure and compromises the specificity of goals. This paper will discuss the design, implementation, and evaluation of the framework and recommendations for improvement.