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PubMed1998

Health-related behaviors, social support, and community morale.

The relation among health behaviors, social support, and community morale--attitudes toward one's community, such as attachment and social participation--was examined in 597 adults living in a Japanese community. Logistic models revealed that strong spousal support was related to reduced alcohol drinking and enhanced family support was related to a reduction in smoking. The support of friends was positively associated with the frequency of alcohol drinking by men. Among women, family support was positively related to the frequency of consuming Japanese-style food. Community morale was positively associated with consuming Japanese-style side dishes and negatively associated with alcohol consumption. The results indicate that there are varied associations between social relationships and health-related behavior and that these associations are gender-related. Knowing the specific associations between an individual's social relationships and his or her health-related behavior will he helpful for community-based intervention.

Journal Article↗
PubMed2003

The self as a moral concept.

A case is made for the epistemological and ontological premises of social constructionism against arguments that it is subjectivist. From this, questions about the 'status' of the self, and its centrality (or not) to experience, emerge. Arguments for the de-centralization and centralization of the self are discussed, with particular attention to the embodied-embedded quality of the self, from which the spatiotemporal metaphors of 'positioning', 'narrative' and 'voicedness' have arisen. It is argued that communication is inherently evaluative and that the self is a 'special case' of evaluation (in terms of moral agency): the self and morality are, therefore, conceptually linked. The concept of a relational self-of-selves is one that, it is argued, emerges from dialogic processes--processes that draw upon these metaphors of embodiment and generate high orders of reflexivity. Thus, social constructionism yields a sophisticated account of self-hood, agency and responsibility.

Attitude↗
PubMed1998

Groups as gatekeepers to genomic research: conceptually confusing, morally hazardous, and practically useless.

Some argue that human groups have a stake in the outcome of population-genomics research and that the decision to participate in such research should therefore be subject to group permission. It is not possible, however, to obtain prior group permission, because the actual human groups under study, human demes, are unidentifiable before research begins. Moreover, they lack moral standing. If identifiable social groups with moral standing are used as proxies for demes, group approval could be sought, but at the expense of unfairly exposing these surrogates to risks from which prior group approval is powerless to protect them. Unless population genomics can proceed without targeting socially defined groups, or can find other ways of protecting them, it may fall to individuals to protect the interests of the groups they care about, and to scientists to warn their subjects of the need to do so.

Cultural Diversity↗
PubMed1999

Bioethics in a liberal society--political, not moral.

This paper argues for the importance of the political context of a society for bioethics. In particular, I argue that in a liberal constitutional society, such as the one we find ourselves in, no particular moral perspective is granted a privileged position. Rather, individuals are allowed to live their lives according to values they adopt for themselves, and the rights granted to protect this ability "trump" social consensus, and place boundaries on the social application of personal moral beliefs and values.

Bioethical Issues↗
PubMed2000

Permitting suicide of competent clients in counseling: legal and moral considerations.

State statutes, case law, and professional codes of ethics in the mental health professions typically stress either a duty or the permissibility of disclosing confidential information in order to prevent clients from seriously harming themselves. These sources are intended to address cases where clients are deemed to be suffering from cognitive dysfunction for which paternalistic intervention, including involuntary hospitalization, is considered necessary to prevent self-destructive behavior. The counselor's moral and legal responsibility is less apparent when mentally competent clients desire suicide as release from irremediable suffering due to severe physical illness, and this desire is defensible within these clients' value systems. This paper will explore moral and legal dimensions of a counselor's decision not to intervene in such cases. The concept of permitted suicide will be introduced and defined, and guidelines for its application developed.

Commitment of Persons with Psychiatric Disorders↗
PubMed2003

What philosophy of mind can tell us about the morality of abortion: personhood, materialism, and the existence of self.

I attempt to show that, under materialist assumptions about the nature of mind, it is a necessary condition for fetal personhood that electrical activity has begun in the brain. First, I argue that it is a necessary condition for a thing to be a moral person that it is (or has) a self--understood as something that is capable of serving as the subject of a mental experience. Second, I argue that it is a necessary condition for a fetus to be (or have) a self that some form of electrical brain activity occurs. Third, I argue that since the beginning of brain activity typically occurs at around 10 weeks of gestational age, most fetuses are not persons during the first 10 weeks of pregnancy and hence that abortion of most fetuses during this period does not rise to the moral level of murder.

Abortion, Induced↗
PubMedDate not supplied

Healthcare reform's moral, spiritual issues. The problems are not just political.

Although President Clinton's proposals were defeated in 1994, healthcare reform is an issue that will not go away. But it is an especially complex issue because it is moral and spiritual as well as political. Catholic social teaching could help free us Americans from our confusion on the topic. For example, the Catholic ideas of justice, subsidiarity, and the common good could help us address the crux of the healthcare reform debate, which questions the fairness of forcing more fortunate people to provide healthcare for those who are sick and poor. Catholic social teaching tells us that our healthcare decisions must be made not only on the basis of what is good for me but what is good for us as a community. By the same token, we might find that several specifically spiritual ideas are helpful. Christianity says, for example, that sickness can be a gift because it is a window on immortality for us; that we should not prize life above all other values; and that friendship--including the civic friendship involved in healthcare--is a way we can enter full friendship with God. These moral and spiritual ideas lead us to certain political conclusions: Healthcare reform should be politically realistic, relatively simple. and inclusive. Because healthcare is a good like no other, it can be a powerful occasion for realizing God's own compassion, healing, and justice.

Attitude to Health↗
PubMed1999

Moral authority, power, and trust in clinical ethics.

Moral concerns about the authority, power, and trustworthiness of physicians have become important topics in clinical ethics during the past three decades. These concerns have come to greater prominence with the increasing involvement of large-scale private institutions in the organization and delivery of medical services, especially managed care organizations, and with the increasing involvement of government in the payment for and organization and delivery of medical services. When physicians act as the agents of large institutions or governments. the power of physicians over their patients increases. The purposes of this article are (1) to reflect briefly on the historical origins of the moral problem of physicians' power in medicine, and (2) to introduce the articles in the 1999 annual number of the Journal of Medicine and Philosophy on topics in clinical ethics.

Delivery of Health Care↗
PubMed1984

Ethics Commission examines moral distinctions in using life supports.

Deciding to Forego Life-Sustaining Treatment, a report of the President's Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioral Research, examines four common medical-ethical distinctions. The report highlights the 1980 Declaration on Euthanasia and closely follows Catholic moral teaching on the following. Death by action versus omitting to act. The commission rejects the idea that a physician who fails to act should not be held responsible for a patient's death. Failing to resuscitate, for example, or to take other steps to prolong life, are just as much causes of death as a lethal injection. The health profession's traditional duty to act on the patient's behalf precludes any distinction between acts and omissions. Withdrawing versus withholding treatment. Acknowledging that initiating treatment may create an obligation to continue treatment, the commission suggests that distinguishing between withholding and withdrawing could encourage undertreatment and overtreatment. Fear of being unable to withdraw unsuccessful treatment could lead to physicians' failing to treat patients who might benefit from the therapy. Ordinary versus extraordinary means. The commission upholds this distinction. It suggests, however, that the phrase "proportionate versus disproportionate" better describes the moral issue involved in selecting treatments that, in relation to their expected benefits, impose no excessive burden on the patient or family. Regarding intended versus unintended consequences, the commission departs from Catholic tradition. It fails to acknowledge the significance of physicians' intentions. What matters instead, according to the commission, is whether physicians act within their authority as defined by society. Thus, the commission suggests, the use of pain medications that may cause death can be socially and legally acceptable.

Ethics, Medical↗
PubMedDate not supplied

New models for decision making in moral theology.

The way that the Christian tradition faces moral issues is being reshaped. Rather than focusing solely on Scripture and tradition as the basis for resolving ethical issues, decision makers should investigate human experience as well, some contemporary theologians recommend. In contrast to a traditional notion of natural law, which analyzes "human nature," the revisionist approach analyzes human experiences to discover what is authentic in them. This process looks not only at the physical structure of an act but also at its intentionality and its effect on the parties involved. Absolute material norms do not exist, according to the revisionist school. Instead one must examine an act's effects on a person's relationship to God, to others, to the physical world, and to oneself to determine whether it is morally right or wrong. Although this theological trend could be disconcerting to those who serve on ethics committees--since it does not rely on clear-cut rules--and may make decision making more difficult, its value lies in its potential to bring Christians closer to a divine understanding of reality.

Bioethical Issues↗
PubMed1997

John Gregory (1724-1773) and his lectures on the duties and qualifications of a physician establishing modern medical ethics on the base of the moral philosophy and the theory of science of the empiric British Enlightenment.

In 1769/70 the Scottish physician and philosopher John Gregory (1724-1773) published Lectures On the Duties and Qualifications of a Physician. Gregory developed a truely ethical - in the sense of (moral) philosophically based - system of conduct in a physician. His concept of practising and teaching ethics in medicine and science is established on a very broad footing: combining Bacon's (1561-1626) general philosophy of nature and science with both, the general, likewise empirically based moral philosophy of his personal friend David Hume (1711-1776), and with the principles upheld by the so-called Common-Sense Philosophy. His Lectures had - particularly via the famous Code of Medical Ethics of Thomas Percival (1740-1804) - a decisive influence on our contemporary concepts of ethics in medicine and science. John Gregory is, without doubt, one of the most important and certainly the most comprehensive among the founders of what is known today as modern Bioethics.

Bioethics↗
PubMed1994

[The issue of "moral" therapies in the treatment the mentally ill as presented in Polish medical writing in the 1830s and 1840s].

The beginning of the 1830s sees the appearance of a specialist approach to psychiatric topics in Polish scientific writing. The author discusses the two first scientific works in the field. The first is the little publicized and underestimated--in Polish historiography--work by the physician Józef Jakubowski of Cracow. The dissertation, entitled O metodzie psychicnej (On the psychic method), appeared in print in 1831. The other work discussed is the hitherto unknown manuscript of the dissertation O porzadku w domu zdrowia (On order in the health-house) written by professor Józef Korzeniowski of Vilna in the 1840s. Both works describe a new direction in Polish medicine, namely the "moral therapy" in the treatment of the mentally ill, which developed against the background of reminiscences of the Enlightenment and the emerging romanticism. The article analyzes the substance of the dissertations, which illustrate the contemporary state of knowledge, and the possibilities and conditions of treatment leading to a recovery of mental health. The two works also give an idea of attempts to define the developing terminology concerned with the concept of mental illness and with diseases recognized at the time. They reflect as well the social status of the mentally ill person. Above all, however, they supply information on the recommended methods and procedures in "moral therapy".

History, 19th Century↗
PubMed2001

Exploring a moral landscape: genetic science and ethics.

This project draws on scholarship of feminist and womanist scholars, and on results of interviews with scientists currently involved in molecular genetics. With reference to Margaret Urban Walker's "practices of moral responsibility," the social practices of molecular geneticists are explored, and strategies identified through which scientists negotiate their moral responsibilities. The implications of this work for scientists and for feminists are discussed.

Bioethics↗
PubMed2001

Cloning: can it be good for us? An overview of cloning technology and its moral implications.

Adequate answers to moral questions about cloning require a working knowledge of the science and technology involved, both present and anticipated. This essay presents an overview of the current state of somatic cell nuclear transfer technology (SCNT), the type of cloning that now permits whole organism reproduction from adult DNA. This essay explains the basic science and technology of SCNT and explores its potential uses. Next, this essay notes remaining scientific obstacles and unanswered moral questions that must be resolved before SCNT can be used for human reproduction. Attention is given to aspects related to cloning for therapeutic and research purposes.

Adult↗
PubMed2003

Unmanaged care: towards moral fairness in health care coverage.

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

Actuarial Analysis↗
PubMed2003

[Hans Neuffer (1892-1968). Medical moral philosopher and politician of profession in personal union].

Hans Neuffer had a well established, civil familiary background. He was raised according to Christian values and remained a practising Christian until the end of his life. Before 1945 he was no person in public life. In spite of the fact that he disapproved the Nazi rule, he did not practise open resistance. After World War Two politically guiltless physicians were needed. Neuffer had this quality and on top of that he had a talent for organisation. In the beginning he was medical functionary in his swabian hometown Stuttgart. In 1949 he took over tasks as medical functionary nationwide. Under his leadership the German physicians succeeded in creating the structures of self administration, that still exist today. Big improvements in income were achieved. The German physicians profited from this until the seventy years of the last century. In addition to this the German doctors managed to become fully accepted members of the World Medical Association (WMA). Besides his work as medical functionary, Neuffer was occupied with ethical questions. The premise of Neuffer's medical ethics were the physician's close ties to God. The responsibility to God was more important than responsibility to conscience, science, the people or the government. One of the foundations of Neuffer's ethics lies in the doctor's personality. Like an artist the "true" physician felt an inner calling. He possessed high mental capacity and had special psychological abilities. Such high moral, mental and psychological demands could only be fulfilled in freedom. Freedom required an adequate income and physicians' self administration. This kind of medical ethics fitted well to the political aims of West Germany's General Medical Council. The freedom of the medical profession and independence from society or government were crucial positions. Hans Neuffer was a politically and morally guiltless medical functionary. At the end of his presidency in 1959, West Germany's physicians had achieved all important aims of their political program.

Ethics, Medical↗
PubMed1987

Moral issues arising from genetics.

Gene therapy, pre-natal diagnosis, genetically altered bacteria, patenting new life forms: these are all outgrowths from the development of genetics. Our focus will be on the moral issues engendered by some of the genetic techniques which are now so well integrated into clinical medicine. The section on genetic counseling is meant to show the most frequent moral problems encountered as they might really occur. Genetic screening is presented as a mix of preventive medicine and aid for genetic counseling. Genetic engineering is discussed in the context of evolution and human needs and desires.

DNA, Recombinant↗
PubMedDate not supplied

[Antionio Morales Perez and thermal etherization].

During the last decades of XIXth century, after a 40-year parenthesis, interest on ether as anesthetic agent is being elicited again in some European countries. In the present paper, we study the personal method of Antonio Morales, the Spanish surgeon. His method, the so-called thermic etherization, is encompassed within the group of techniques that were based on anesthetic vapor heating techniques. We also describe the device designed by Morales and the changes that were introduced later on.

Anesthesia, Inhalation↗