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PubMed2002

Medical facilities as moral worlds.

Bioethics is dominated by an emphasis on rule making and quandary solving. Teaching and research in ethics often focuses upon dramatic, controversial issues at the margins of life and death. Much less attention is given to the relationship between moral reflection and the ethos of place. Medical facilities, however, are moral worlds. To discuss the ethos of place is to focus on the character or atmosphere of particular dwellings. Architecture, interior design, and the interior creation of built environments have moral, spiritual, and aesthetic dimensions. Discussions of "ethics" need to be less oriented to rules and dilemmas, and more attuned to practical matters of everyday social experience. Instead of developing all-encompassing critiques of medical facilities as impersonal, alienating institutions, scholars from various fields need to explore the incremental steps that can make particular settings more decent, humane, and caring.

Architecture↗
PubMed2004

Moral argumentation in talk about health and old age.

This study examines the ways in which people aged 90 or over construct and negotiate meanings of health in research interviews. Detailed analyses of two interview cases illustrate the flow of these negotiations within interviews, and how the interviewees balance different moral arguments. First, the interviewees try to manage the face-threat posed by the questioning about health. Second, their health accounts move on the axis of advocating good health and activity and conceding impaired health and diminished activity. They apply various rhetorical devices to challenge the traditional discourse of old age as decline. On the other hand, aligning oneself with the category of 'old' makes ill-health and inactivity legitimate, but brings along other kinds of moral obligations. Finally, the results are discussed in relation to cultural discourses of old age and health, and their moral implications.

Aged↗
PubMed1997

Clinical pragmatism: a method of moral problem solving.

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.

Catholicism↗
PubMed2001

Is there a unique moral status of human DNA that prevents patenting?

The gene patenting debate, which proved to be a focal point for divergent moral concerns about recent developments in genome research and biotechnology, has revealed that the moral status of DNA is not clear. One of the arguments used to stop undesirable developments was that DNA possesses a unique status, which renders it unfit for patenting. This paper investigates the allegedly unique (moral) status of genetic material and the information it holds from different perspectives. Several properties of DNA prove to be unique. We examine the relevance of these for patentability of genes and conclude that only the unique symbolic meaning of DNA is a relevant factor, which should be taken into account but weighed against other interests involved.

DNA↗
PubMed1997

Moral tensions and obligations of occupational therapy practitioners providing home care.

Home care has been valued as a relevant context for the provision of occupational therapy since the inception of the field. The setting provides rich opportunities to restore meaningfulness in living for clients whose lives have been disrupted by illness or untoward events. Additionally the home care setting allows practitioners to exercise professional commitments and to meet ethical obligations congruent with the field of occupational therapy. Nevertheless, the home care arena is not exempt from the pressures that pervade the health care industry. To thrive in the provision of home care, occupational therapy practitioners must prepare themselves to deal with the philosophic, economic, and moral challenges inherent in the setting. This article explores the moral obligations of occupational therapy practitioners who provide home care. More specifically, it addresses obligations to self, to patients, to caregivers, to society, to the profession, to fellow health care providers, and to agencies and payers. Ethical principles associated with each are highlighted, and issues are raised. Home care practitioners who are attuned to the moral commitments imbedded in occupational therapy philosophy will most likely incorporate these tenets into their clinical decisions.

Ethics, Professional↗
PubMed2005

Earning points for moral behavior: organ allocation based on reciprocity.

Anticipating the reevaluation of the Dutch organ procurement system, in late 2003 the Rathenau Institute published a study entitled 'Gift or Contribution?' In this study, the author, Govert den Hartogh, carries out a thorough moral analysis of the problem of organ shortage and fair allocation of organs. He suggests there should be a change in mentality whereby organ donation is no longer viewed in terms of charity and the volunteer spirit, but rather in terms of duty and reciprocity. The procurement and allocation of donor organs should be seen as a system of mutually assured help. Fair allocation would imply to give priority to those who recognize and comply with their duty: the registered donors. The idea of viewing organ donation as an undertaking involving mutual benefit rather than as a matter of charity, however, is not new. Notwithstanding the fact that reference to charity and altruism is not required in order for the organ donation to be of moral significance, we will argue against the reciprocity-based scenario. Steering organ allocation towards those who are themselves willing to donate organs is both an ineffective and morally questionable means of attempting to counter organ shortage.

Altruism↗
PubMed1984

Created equal? The moral challenge of prenatal diagnosis.

Prenatal diagnosis, as currently practiced in close linkage with selective abortion, poses a moral challenge of many dimensions. The challenge is moral because it brings into question values that have long served as the normative basis for human reproductive behavior. A moral policy is needed to match this challenge, a policy that will promote the development of effective therapy and the emancipation of the early emerging human spirit.

Canada↗
PubMed2002

Germline engineering: the moral challenges.

Not only is the use of germline genetic engineering likely in the long run to be inevitable, there are also no convincing secular moral grounds to forbid this technology in principle. Instead, the general secular moral constraints on the use of germline genetic engineering are either procedural or without predetermined content. Nor can one develop a coherent distinction between eliminating disease and enhancing human abilities. At best, in secular morality one can establish the principle to proceed with care, though the invocation of the precautionary principle argues as much in favor of the development of germline genetic engineering as against its use. Because germline genetic engineering, by eliminating certain genetic defects, offers the prospect of decreasing human suffering and decreasing the use of prenatal diagnosis and abortion, there is an obligation, all else being equal, to change the human genome. In a post-modern world, humans face the challenge of directing their own evolution, although they share no common understanding of human destiny and purpose. Such understandings, though available within religious contexts, are not available to secular bioethics.

Bioethics↗
PubMed2002

Chinese moral perspectives on abortion and foetal life: an historical account.

It is accepted wisdom that, at the present time as well as historically, the typical Chinese attitude toward abortion is very permissive or 'liberal'. It has been widely perceived that Chinese people usually do not consider abortion morally problematic and that they think a human life starts at birth. As part of a bigger research project on Chinese views and experiences of abortion, this article represents a revisionist historical account of Chinese moral perspectives on abortion and foetal life. By presenting Buddhist and Confucian views of abortion, traditional Chinese medical understandings of foetal life, the possible moral foundation of a 'conservative' Confucian position, and some historical features of abortion laws and policies in twentieth-century China, this paper shows that blanket assumptions that the Chinese view of abortion has always been permissive are historically unfounded. As in the present, there existed different and opposing views about abortion in history, and many Chinese, not only Buddhists but also Confucians, believed that deliberately terminating pregnancy is to destroy a human life which starts far earlier than at birth. The current dominant and official line on the subject does not necessarily accord with historical Chinese values and practices.

Abortion, Induced↗
PubMed1989

Moral theory and neurology.

This article presents an outline of a general moral theory and shows its relationship to the concepts of paternalism and that of valid consent and refusal. The authors then show how this theory and these concepts can be usefully applied to the moral problems that neurologists often face in determining how to act when they have distressing information for their patients. Finally, a procedure is provided for determining when it is morally justified to deceive patients by withholding information about their diagnoses, prognoses, or about their prospective treatments.

Comprehension↗
PubMed1983

Moral and humane: patients' libraries in early nineteenth-century American mental hospitals.

"Moral treatment" designates a period in American psychiatry in the first half of the nineteenth century when retreats and asylums, following the example of the York Retreat in England, began to offer humane care to the mentally ill. Patients had a close and personal relationship with the hospital superintendent or the resident physician; positive behavior was rewarded and patients were expected to exercise self-control. Moral treatment was marked by a well-ordered daily routine in which patients followed a therapeutic regimen of work and leisure activities. Reading was regarded as both therapeutic and recreational, and was highly recommended. For this reason, retreats and asylums maintained book collections and considered library services an important aspect of the patients' therapeutic program. This paper examines patients' library activities in eight early nineteenth-century mental hospitals where moral treatment was practiced.

Books↗
PubMed1995

Commentary: moral growth in medical students.

Knight has shown how the moral growth of medical students involves a spiritual journey. He may, however, present too sanguine a portrayal of the extent to which the medical education environment promotes this moral and spiritual growth. Medical school may indeed be more abusive than supportive. Admitting more women to medical school and teaching more humanities courses, while worthwhile, will not necessarily promote the goals that Knight appropriately advocates.

Bioethics↗
PubMedDate not supplied

Physicians and patients: moral agency in a pluralistic world.

This paper examines the role of the physician in a pluralistic community. A personal and communal sense of identity must resolve a vast array of often conflicting backgrounds and contexts in order to function smoothly. Physicians are neither entitled to impose their own moral views on their patients nor expected to surrender their own moral agency. Several illustrative cases are given. The solution of inevitable conflicts is embodied within the context of the situation, but since irreconcilable differences remain, a resolution is not always possible. Tolerance for such differences and ways of dealing with them allows the integrity of both parties to remain intact.

Cultural Diversity↗
PubMed1990

Letting and making death happen, withholding and withdrawing life-support: morally irrelevant distinctions.

The author argues that there is no morally relevant distinction between letting and making death happen, and between withholding and withdrawing life-support. There is a discussion of possible adverse consequences in believing that there are moral distinctions. And then he shows that acknowledging the absence of such a distinction does not necessarily imply any endorsement of active euthanasia.

Ethical Analysis↗
PubMed1984

Moral absurdities in critical-care medicine: commentary on a parable.

A dominant characteristic of critical-care medicine today is the emergence of powerful institutions functioning within a framework of a noncoherent set of values and philosophical perspectives. Anyone who would assign a significant role to the philosophy of medicine for today's era must not simply account for the quandaries of critical-care medicine, but also attend to the antecedent values, conflicts, and absurdities that form the ethical issues, as well as the models of ethical response (market ethos, professional ethos, etc.) that indicate which moral principles might be relevant. These considerations form the new agenda for the philosophy of critical-care medicine. This broad philosophical task is an urgent one, for critical-care medicine is rapidly molding the moral dimensions of all of medicine.

Ambulances↗
PubMed1998

Moral and social issues regarding pregnant women who use and abuse drugs.

Pregnant women who abuse drugs, such as alcohol, cocaine, and marihuana may face a variety of legal and social responses, including involuntary commitment, forced treatment, and criminal sanctions. These programs are intended to remedy apparent maternal-fetal conflicts but paradoxically may encourage some women to avoid beneficial medical and social services or to seek abortion. Although pregnant women have ethical duties to give due consideration to their offspring, these moral obligations fail to justify coercive and punitive programs regarding substance abuse. Coercive fetal protection policies may undermine pregnant women's trust and cooperation, violate their autonomy, weaken our civil liberties, and raise a host of ethical problems relating to race, gender, and class prejudice. Education and drug treatment programs, rather than punitive and coercive measures, may better help pregnant women fulfill their moral duties to refrain from abusing substances.

Child Welfare↗
PubMed1997

Holiness, virtue, and social justice: contrasting understandings of the moral life.

Being a Christian involves metaphysical, epistemological, and social commitments that set Christians at variance with the dominant secular culture. Because Christianity is not syncretical, but proclaims the unique truth of its revelations, Christians will inevitably be placed in some degree of conflict with secular health care institutions. Because being Christian involves a life of holiness, not merely living justly or morally, Christians will also be in conflict with the ethos of many contemporary Christian health care institutions which have abandoned a commitment to Christian spirituality. In this regard, managed care raises the special question of how Christian institutions can act morally under financial constraints and maintain their character while under the control of secular managers. This question itself raises the further question as to why health care institutions need even pose this query when there are Christian physicians and nurses who could work for less, or Christian men and women who could become sisters and brothers and work for nothing. Contemporary challenges to Christians to maintain their integrity in a post-Christian world have much of their force because Christians have failed to maintain traditional Christian sprituality. In the face of that failure, Christian physicans and nurses will find themselves in greater conflict with health care institutions, because few will any longer understand the requirements of traditional Christianity. In its place, they will have put a generic spirituality, a value-neutral understanding of the role of the health professional, and an anonymous commitment to social justice.

Abortion, Induced↗
PubMed1996

Navigating the wards: teaching medical students to use their moral compasses.

The upsurge in formal medical ethics training stems from the desire for more compassionate, less "dehumanized" physicians who can competently face the ethical dilemmas posed by technologic advances and resource constraints. How best to encourage ethical thinking and behavior among medical students remains an open question. However, the authors argue that medical ethics education suffers from an overreliance on strategies that target ethical thinking, with relative inattention to students as ethical actors in specific clinical contexts. In order to produce ethically competent physicians, medical educators must not only teach students to understand and learn from the dilemmas that shape their moral world but also train them to respond to those dilemmas appropriately. The authors discuss current practices in ethics education and how traditional approaches may not equip students with the types of moral "navigating skills" they need to become ethical physicians. They illustrate how medical students can and do learn norms of ethical behavior on the wards and argue why medical education ought to focus more explicitly on this aspect of clinical training. They conclude by recommending ways medical educators can encourage ethical thinking and behavior throughout the entire course of medical training.

Clinical Clerkship↗