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Advanced patient records: some ethical and legal considerations touching medical information space.

The application of advanced computer-based information technology to patient records presents an opportunity for expanding the informational resource base that is available to health-care providers at all levels. Consequently, it has the potential for fundamentally restructuring the ethics of the physician/patient relationship and the ethos of contemporary health-care delivery. At the same time, the technology raises several important ethical problems. This paper explores some of these implications. It suggests that the fundamental ethical issue at stake in these developments is the status of the electronic record which functions as the analog of the health-care consumer in health-care decision making. Matters such as control and patient dignity are implicated. Other important ethical issues requiring solution include data ownership, data liability, informed consent to use and retrieval, security and access. The paper suggests that the ethical problems that arise cannot be solved in piecemeal fashion and on a purely national basis. They should be addressed in a coordinated international fashion and receive appropriate legal expression in the relevant countries and be incorporated into appropriate codes of ethics.

Computer Security↗

Assisted reproductive technology: a dilemma for the nursing profession.

Assisted Reproductive Technology, despite poor outcomes in the treatment of infertility, is poised to take on a new supplementary role to genetic engineering. As an extreme example of medical/reductionist philosophy it is diametrically opposed to the emerging commitment to holism within the nursing profession. Nurses in Australia have been noticeably absent from the debate, research and decision making that has occurred about this technology, yet the implications for professional practice are far-reaching.

Australia↗

Reflections on death and dying.

Americans simultaneously worry about dying and about being tethered to machines that keep them alive beyond a point when life has any meaning. People living with terminal illness often feel isolated from life around them and a burden on those they love; they feel uncertain that their deaths will be relatively free of pain and suffering and that their dignity will be compromised as little as possible. These failings can be remedied. Traditional hospice care and integrating palliative care into the general medical setting are important, but they cannot alone occasion a better dying. The medical community must re-imagine dying and reflect about ways to transform image into reality in practice and in training colleagues and successors. Physicians and others know how to provide care and even improve living when cure is unlikely; the harder task is to respect such care as profoundly as curing. The exigencies of modern medicine, where time is a budgetable commodity, makes caring well for dying patients difficult. Medicine cannot have hegemony over dying and cannot singularly offer people a better death, but it cannot absent itself either. The almost single-minded focus on decision making that has infused conversations about dying and death may divert attention from the attentiveness and loving relationships that are as vital as life's end as at its beginning. Medicine has "colonized" death: It has transformed it into a place where progress in staving it off may appear to be unlimited, and thus it encourages forgetting that death is part of the human condition. The task before medicine, and academic medicine in particular, is to transform death back into a human scale. With all that is available to delay death--but not to make it optional--the most important task is to recover humbleness before an awesome moment and be with the patient, one human being to another, knowing that dying is not always open to solutions.

Advance Directives↗

Prophecy and policy.

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Advisory Committees↗