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PubMed1998

The changing moral landscape of human reproduction: two moments in the history of in vitro fertilization.

Ethical attitudes toward in vitro fertilization (IVF) have varied historically. This paper discusses the changes in views about the morality of human IVF by exploring the response to a pair of critical moments in the history of this reproductive technology: the announcement of the first successful IVF experiment by John Rock and Miriam Menkin in 1944 and the first successful IVF live birth of Louise Brown in 1978. By exploring public and private reactions to these two events in the context of wider social and political developments, this paper demonstrates the degree to which our notions of the morality of medical experimentation and of reproductive technologies are socially constructed and historically contingent.

England↗

PubMedDate not supplied

Where do moral decisions come from?

[Mark] Johnson asks us to take seriously theory as an imaginative construction that offers, not an objective account of the world, but a dynamic, intersubjective construal of it....A common feature [of the four books discussed] is the conviction that moral universals are somehow bound up with dynamic processes that have their origin in the human form, not with disembodied rules or rational arguments per se.

Bioethics↗

PubMed1996

Compliance, coercion, and compassion: moral dimensions of the return of tuberculosis.

Since 1986, we have seen a rise in the occurrence of tuberculosis in the United States. Long considered defeated in this country, the disease is returning with distressing vigor. Outbreaks of MDR-TB, tuberculosis resistant to more than one medication, have been reported around the country. This article analyzes the Centers for Disease Control and Prevention's National Action Plan to Combat Multidrug-Resistant Tuberculosis, with particular focus on the moral dimensions of mandatory directly observed treatment (DOT) and involuntary quarantine. It is proposed that a moral response to the control of tuberculosis must be one which is sustainable and which can effectively curtail the spread of the disease at a minimal cost to individual rights.

Altruism↗

PubMed1997

Effects of the Castillo-Morales stimulating plate on speech development of children with Down's syndrome. A retrospective study.

Within the scope of a follow-up examination, the speech development of 2 different groups of children with trisomy 21 was compared. The patient group (n = 20) was treated with a Castillo-Morales stimulating plate in early childhood (average treatment time = 10.8 months, average age at follow-up examination: 55 months). The control group (average age 47.4 months) comprised 18 children with Down's syndrome who had ceased stimulating plate treatment after one month or had received no treatment because, although treatment proved in retrospect to be indicated, parents were not adequately informed. Two specially developed standardized forms were used, one to document parents' concepts of speech development, and the other to record relevant medical data. Other factors evaluated included motoricitiy and hearing ability, which also have an effect on speech. Follow-up examination revealed that the patient group had better results concerning oral motoricity than the control group. Within the patient group, mouth and tongue position improved in 75% of the patients compared with the first examination. Despite a poorer average general somatic development and hearing ability, the patient group had a faster speech development than the control group with respect to 1-, 2- and multi-word sentences. We therefore believe that treatment with the Castillo-Morales stimulating plate has a positive effect at least on initial speech development due to long-term improvement of peripheral conditions in the orofacial region. Thus, not only improved oral motoricity but also earlier speech development can be interpreted as a positive social factor.

Child, Preschool↗

PubMed2005

Reasonable partiality in professional ethics: the moral division of labour.

Attention is given to a background idea that is often invoked in discussions about reasonable partiality: the idea of a moral division of labour. It is not only a right, but also a duty for professionals to attend (almost) exclusively to the interests of their own clients, because their partial activities are part of an impartial scheme providing for an allocation of professional help to all clients. To clarify that idea, a difference is made between two kinds of division of labour, a technical one and a social one. In order to assess the applicability of the idea of a moral division of labour to professional ethics, journalism is contrasted with other professions.

Confidentiality↗

PubMed2006

Catharsis and moral therapy II: An Aristotelian account.

This article aims at analysing Aristotle's poetic conception of catharsis to assess whether it may be of help in enlightening the particular didactic challenges involved when training medical students to cope morally with complex or tragic situations of medical decision-making. A further aim of this investigation is to show that Aristotle's criteria for distinguishing between history and tragedy may be employed to reshape authentic stories of sickness into tragic stories of sickness. Furthermore, the didactic potentials of tragic stories of sickness will be tried out. The ultimate aim is to investigate whether the possibilities of developing a therapeutic conception of medical ethics researched in a previous article on catharsis and moral therapy in Plato may be strengthened through the hermeneutics of the Aristotelian conception of tragic catharsis.

Catharsis↗

PubMedDate not supplied

Study to assess quality of life (morale and happiness) in two continuing care facilities - a comparative study in the UK and The Netherlands.

The elderly in a nursing home in Nijmegen are less disabled and have higher morale and happiness scores than the elderly in a continuing care facility in London. These scores, however, do not correlate with physical or mental disabilities within each group. In Nijmegen, religion (practising and importance of) is associated with high happiness scores in the elderly, whereas use of sedatives lead to reduced happiness or low morale in both groups of elderly.

Journal Article↗

PubMed1994

The do-not-resuscitate order. Moral responsibilities of the perioperative nurse.

To provide care that is consistent with a patient's view of his or her best interests, the perioperative nurse must be a knowledgeable, informed member of the OR team. This knowledge must include familiarity with and understanding of all policies that relate to the care of the surgical patient--including DNR policies. The nurse must be willing to assert his or her moral agency in developing DNR policies that will eliminate potential conflict among the OR team members regarding patients with DNR designations. Only by being a knowledgeable moral agent can the perioperative nurse function as an effective advocate of the patient as a person.

Conflict, Psychological↗

PubMed1998

The physician's moral obligations to the pregnant woman, the fetus, and the child.

The moral obligations and ethical duties of health care professionals responsible for the care of a pregnant woman, a fetus, and a child are complex and evolve with gestation and birth. Well-intentioned physicians and others concerned with the interests of pregnant women and their fetuses may disagree about the moral status of the fetus and ethical duties owed to both the woman and fetus. This article lays out a framework for thinking about these issues from several perspectives.

Ethics, Medical↗

PubMed2003

Moral hazard and adverse selection in Australian private hospitals: 1989-1990.

The Australian hospital system is characterized by the co-existence of private hospitals, where individuals pay for services and public hospitals, where services are free to all but delivered after a waiting time. The decision to purchase insurance for private hospital treatment depends on the trade-off between the price of treatment, waiting time, and the insurance premium. Clearly, the potential for adverse selection and moral hazard exists. When the endogeneity of the insurance decision is accounted for, the extent of moral hazard can substantially increase the expected length of a hospital stay by a factor of up to 3.

Adult↗

PubMed2003

Self-selection and moral hazard in Chilean health insurance.

We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.

Adolescent↗

PubMed1997

Discontinuing dialysis in persistent vegetative state: the roles of autonomy, community, and professional moral agency.

This report proposes a policy for discontinuing dialysis in persistent vegetative state (PVS) patients and attempts to address autonomy and community-based values while maintaining professional moral agency. It is recommended that the policy be adopted at a regional level (eg, the ESRD Network). The involved physicians and ethicists would communicate with the next-of-kin and surrogate decision-makers, and the local ethics committee would perform a double review of the case to assure the appropriateness of the policy to the case. Given the unique nature of PVS with its permanent loss of consciousness and autonomy, we hold that a community-based consensus can form a guideline that limits futile dialysis while respecting patient and professional moral agency. Prior consent of dialysis patients to the regional policy at a time shortly after initiating dialysis will add to its ethical impetus.

Advance Directives↗

PubMed2006

The moral imperative of designating patient safety and quality care as a national nursing research priority.

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.

Australia↗

PubMed2000

"Happy Meals" in the Starship Enterprise: interpreting a moral geography of health care consumption.

This paper extends earlier explorations of the use of metaphor in the marketing of the Starship Children's Hospital in Auckland, New Zealand, by examining controversy surrounding the opening of an in-hospital McDonalds fast-food outlet. The golden arches have become a key element of many children's urban geographies and a potent symbol of the corporate colonisation of the New Zealand landscape. In 1997 a minor moral panic ensued when a proposal was unveiled to open a McDonald's restaurant within the Starship. Data collected from media coverage, advertising and interviews with hospital management are analysed to interpret competing discourses around the issue of fast food within a health care setting. We contend that the introduction of a McDonald's franchise has become the hospital's ultimate placial icon, adding ambivalence to the moral geography of health care consumption. We conclude that arguments concerning the unhealthy nature of McDonald's food obscure deeper discourses surrounding the unpalatable character of the health reforms, and a perceived 'Americanisation' of health care in New Zealand.

Adult↗

PubMed2001

Generating revenues: fiscal changes in public mental health care and the emergence of moral conflicts among care-givers.

OBJECTIVE: The author examined how the focus on financial accountability in the public mental health sector has affected direct service providers' experience of their work. METHODS: This was a two-year mixed method study conducted throughout one small, state-run system. Data that were collected include field notes taken in the course of participant-observation research, tape-recorded semi-structured ethnographic interviews, as well as responses to an ethnographically-informed survey instrument that was administered to providers throughout the system. RESULTS: Interview materials suggest that care-givers view their jobs as a "calling," work that they perform in the service of something greater than themselves. As the public mental health sector increases its emphasis on fiscal issues, however, these employees are experiencing heightened moral tensions around their work. Jobs that were once conceptualized as being done "for love" now are being done "for money" - a change that represents a moral contamination of the workplace for many individuals. CONCLUSIONS: The goal of enhanced fiscal accountability in the public mental health system is to increase service effectiveness and cost-efficiency, that is, to do better work and to do it for less money. These study results suggest that this strategy could backfire, as some service providers must focus less on the qualities of the services they deliver, and more on the quantities. The study encourages mental health services researchers to incorporate ethnographic methods into study designs so that participants' experiences can be taken into account when evaluating the impact of system changes.

Attitude of Health Personnel↗

PubMed1998

In whose 'best interests'? Ethical issues involved in the moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit.

This study scrutinizes the ethical and moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit. Adolescent victims of sexual abuse exhibit a plethora of psychopathological symptomatology which can lead in many cases to the adolescent resorting to self-injurious behaviours in an attempt to relieve feelings of tension, anxiety and guilt. Because the unit in which the writer is involved is an open, community-based treatment centre with limited staffing levels, a completely secure environment may be compromised. Consequently self-injurious adolescents may become so disturbed that a more secure environment must be sought. The limited resources for disturbed adolescents in Northern Ireland means that occasionally the only option available to health care professionals who find themselves in this situation is to utilize the services of the psychiatric adult, forensic unit in Belfast which is contained within a large psychiatric hospital. Many would agree that such a placement for a disturbed adolescent seems inappropriate but is at the same time unavoidable. This study will examine the ethical and moral minefield that only recently has become a dilemma for health care professionals and particularly for nurses endeavouring to adhere to the code of professional conduct.

Adolescent↗

PubMed2006

The impact of Roman Catholic moral theology on end-of-life care under the Texas Advance Directives Act.

This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered.

Advance Directives↗

PubMedDate not supplied

The moral domain of the medical record: the routine ethics evaluation.

The structure, content, and orientation of the contemporary medical record inadequately reflect the appropriate influence of patients' rights and bioethics on health care. Most tellingly, the medical chart reveals a remarkable absence of attention to medical ethics, except in the case of crisis management. But medical ethics informs both crisis decision-making and virtually all clinical interventions. Indeed, clinical care embodies a complex array of choices influenced by individual and cultural values, themselves reflecting religious beliefs, personal histories, psychologies, and social mores. But the typical medical chart, which records clinical descriptions, analyses, and rationales for treatment, rarely identifies or accounts for this value-laden dimension of care and thus both over-simplifies and distorts the depiction of a patient's illness and its treatment. To better reflect the complex moral domain of clinical care, and assist in organizing its complex structure, a systematic procedure is proposed here to evaluate the ethical status of every patient: As a routine part of the clinical evaluation, in a designated Ethical Concerns section of the medical record, an "ethics work-up' is designed to serve as a moral 'diagnostic' analogous to its scientific counterpart. Adapted to the needs of individual patients, such evaluations should identify ethical problems, coordinate related data, resources, and opinion, and define the rationale for choices made and actions pursued. In establishing improved integration of the 'epistemologies' of care and the 'ethics' of care, the goals of a more humane, patient-centered medicine may be better met.

Boston↗