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The morality of induced delivery of the anencephalic fetus prior to viability.

In situations where anencephaly is diagnosed and where the mother's life or health is threatened Roman Catholic hospitals are faced with the dilemma of waiting until viability before inducing the fetus, thus potentially putting the mother at further risk. According to most Roman Catholic ethicists, induced delivery before viability is contrary to the Church's prohibition of direct killing of the innocent. The authors propose for discussion a reconsideration of this position in the case of the anencephalic fetus and conclude that taking the life of such a fetus does not constitute an attack on its personal dignity and therefore is morally permissible.

Anencephaly↗

The morality of human gene patents.

This paper discusses the morality of patenting human genes and genetic technologies. After examining arguments on different sides of the issue, the paper concludes that there are, at present, no compelling reasons to prohibit the extension of current patent laws to the realm of human genetics. However, since advances in genetics are likely to have profound social implications, the most prudent course of action demands a continual reexamination of genetics laws and policies in light of ongoing developments in science and technology.

Commodification↗

Nursing considered as moral practice: a philosophical-ethical interpretation of nursing.

Discussions of ethical approaches in nursing have been much enlivened in recent years, for instance by new developments in the theory of care. Nevertheless, many ethical concepts in nursing still need to be clarified. The purpose of this contribution is to develop a fundamental ethical view on nursing care considered as moral practice. Three main components are analyzed more deeply -- i.e., the caring relationship, caring behavior as the integration of virtue and expert activity, and "good care" as the ultimate goal of nursing practice. For the development of this philosophical-ethical interpretation of nursing, we have mainly drawn on the pioneering work of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. We will also show that the European philosophical background offers some original ideas for this endeavor.

Altruism↗

Moral reasoning and the review of research involving human subjects.

The model of moral reasoning used in Institutional Review Board review fails to uphold ethical ideals for research participants for it does not adequately acknowledge the particular context of research or of subjects, including their gender, their socioeconomic status, and the communities in which they lead their lives. The ethical review of research needs to take seriously the particularities of the research context as well as the situations of potential participants. A variety of conclusions are drawn for changes to the system for ethical review. Most significant is a call for effective consultation with the various communities affected by research and greater reliance on subject representatives. Also proposed is national review for selected research.

Community Participation↗

Long-term evaluation of orofacial function in children with Down syndrome after treatment with a stimulating plate according to Castillo Morales.

The aim of this investigation was to evaluate the long-term orofacial development of Down children who received plate therapy according to Castillo Morales in their early childhood. The orofacial development of 27 Down children was documented before and after plate therapy and at a follow-up examination 13 years +/- 6 months after initiation of therapy. The orofacial appearance significantly improved during therapy (p = 0.00). During the follow-up, mouth posture remained stable (p = 0.259), whereas tongue position further improved (p = 0.034). A better long-term development was documented in children with initial severe orofacial dysfunctions.

Adolescent↗

The person-affecting restriction, comparativism, and the moral status of potential people.

Traditional ethical theories have paradoxical implications in regards to questions concerning procreation and our moral duties to future people. It has been suggested that the crux of the problem resides in an all too 'impersonal' axiology and that the problems of population axiology can be solved by adopting a 'Person Affecting Restriction' which in its slogan form states that an outcome can only be better than another if it is better for people. This move has been especially popular in the context of medical ethics where many of the problems of population axiology are actualized. Examples are embryo or egg selection, pre-implantation genetic testing, assisted reproduction programmes, abortion, just to mention a few. I discuss a number of different interpretations of the Restriction and in particular one interpretation which I call Comparativism. According to this view, we should draw a distinction between uniquely and non-uniquely realizable people. The former people only exist in one out of two possible outcomes, whereas the latter exist in both of the compared outcomes. The idea is that we should give more weight to the well-being of non-uniquely realizable people or take it into account in a different way as compared to the well-being of uniquely realizable people. I argue that the different versions of the Person Affecting Restriction and Comparativism either have counterintuitive implications of their own or are compatible with traditional theories such as Utilitarianism.

Bioethical Issues↗

Moral imagination in long-term care workers.

Our study focused on the cultural construction of dying and death in long-term care facilities. This article centers on direct care workers' perspective of residents' deaths. The data on which this article is based were gathered in a multi-year, multi-site study through formal ethnographic interviews, informal conversations, and on-site observations of residents and staff members. During fieldwork, we noticed an aptitude of direct care workers to deal with residents' deaths, which we named "moral imagination." The term is borrowed from other disciplines to describe a "way of seeing" residents. The case studies presented--that of three direct care workers: a dietary aide, a nurse aide, and an assistant activities director--are suggestive of workers in each category. Our study offers implications for future research concerning direct care workers' value to residents' quality of life. We also propose questions for long-term care facilities about standards of formal caregiving at the end of life.

Aged↗

How empathy, egocentrism, Kohlberg's moral development, and Erikson's psychosocial development are related to attitudes toward war.

In this exploratory study 91 students took a questionnaire which measured their feelings of oneness with all humanity, their egocentrism, level of moral development according to Kohlberg, psychosocial development according to Erikson, and their attitude toward war, diplomacy, the Gulf war, civilians and soldiers in the Gulf area, etc. The hypothesis that empathy with humankind leads to concern about those involved and opposition to war was supported. These individuals were more likely to endorse values expressed in Kohlberg's Level 6. Students endorsing Level 4, law-and-order mortality, especially if they had no friends overseas and used no news source other than the usual U.S. mass media, were more likely to be pro-war, believe President Bush and the military briefings, and opposite reliance on diplomacy. If people had experienced war, they were more frequently against it. However, hardship experienced, lack of egocentrism, believing in a greater good for a greater number of people (Kohlberg's Level 5), and Erikson's psychosocial development were not associated with students' orientation toward war. Further research is suggested.

Adult↗

Newborn infants and the moral significance of intellectual disabilities.

This article presents moral philosophical arguments regarding life-saving medical treatment that may be more available to infants without disabilities than to infants with intellectual disabilities. The ideas are that children with disabilities are a burden to their families and to society and that a happy life may not be attainable for these children and their families. I argue that human well-being is not based merely on individual characteristics, but is a result of the individual's relation to other people. Further, children with disabilities are not inevitably a burden to their families or society. Accordingly, intellectual disability is not a sufficient reason for withholding life-saving treatment.

Children with Disabilities↗

[Bioethics and psychotherapy: which moral assumptions sustain psychotherapeutical acts?].

BACKGROUND: Since about 1970 biomedical ethics crystallized into a full-fledged discipline. The so called "ethical turn" is a fundamental conceptual challenge for the field of medicine and has generated heated controversy. Today, the ancient psychotherapeutic framework is under the severest strain in its long history. AIM: To review the relationship between psychotherapy and the conceptual shift in moral theory. MATERIAL AND METHOD: To forge a new model for the patient-physician relationship, speech acts and nature of man derived from a "pragmatic turn" of bioethics. RESULTS: Research findings suggest that behavior, cognitive and psychodynamic psychotherapies are speech-acts constituted by a hierarchy of subordinate acts distributed on three levels: the level of the locutionary act, the act of saying; the level of the illocutionary act (or force), what we do in saying and the level of the perlocutionary act, what we provoke by the fact that we speak. CONCLUSIONS: Advances in linguistic research have led to a more sophisticated understanding of how psychotherapy affects ethical issues. These developments point towards a new era of psychotherapeutical theory and practice in which specific modes of psychotherapy can be designed to target specific dilemmas of medical ethics.

Bioethics↗

Bioethics, medicine, and the moral ground.

"Bioethics" and "biomedical ethics" are new expressions, conveying new ideas and new concerns. They entered the language in the 1960s. "Ethics," of course, is an ancient word meaning the study of applied moral philosophy. Bioethics is an interdisciplinary field of study that considers ethical issues in wellness and illness. Some would strongly argue that it even embraces our entire natural ecology. It certainly concerns the profession of medicine. Bioethics, like ethics itself, seeks to know and understand "goodness."

Decision Making, Organizational↗

[Without shame, no moral. How physicians could commit murder].

The German doctors and their almost unanimous participation in the atrocious murderies of psychiatric patients, retarded or handicapped people as well as their medical experiments on prisoners are viewed in a historical context. Hence, their acts and violation of human dignity are seen as part of a development that was inaugurated in the Enlightenment by the glorification and wholesale cultivation of rationality as the supreme criterion of humanity. Consequently, the faculty of moral perception was seriously impaired because the emotions and above all, the feeling of shame--a civilizing assert of Western man, were largely suppressed in the pursuit of scientific acknowledgement and awards.

Ethics, Medical↗

Living wills--moral directive can cause legal dilemma.

When recognized by law, the living will, a concept that is growing in popularity, alleviates many difficulties involved in discontinuing the use of life-support equipment for the terminally ill patient. However, without statutory backup, a living will is a mere moral directive that poses liability problems for physicians and hospitals whether they honor it or not.

Life Support Care↗

Bioethics guides medical-moral decisions that affect families.

Advanced medical technology has complicated moral decisions affecting health care by increasing costs and by holding out heroic measures that may be contrary to an individual's self-actualization. Bioethics guides the family, society's principal institution for nurturing, as it grapples with issues of life generation, prolongation, and termination.

Bioethics↗

Some moral dimensions in genetic counseling.

Diagnostic techniques such as fetoscopy and amniocentesis raise moral questions about the propriety of genetic testing and the content of genetic counseling. A Christian genetic counselor must make ethical decisions about what information to convey to clients.

Catholicism↗

Do-not-resuscitate patients in critical care: moral and ethical considerations.

In this article the author describes moral and ethical dilemmas presented by the "do-not-resuscitate" (DNR) patient in the critical care unit. The author defines the term DNR, and discovers implementation of the concept is not universally consistent among health care facilities. From the literature review, the author identifies characteristics, care requirements, economic cost, suitability of treatment, patient/family preferences, and health care professionals' values and beliefs as six important factors encompassing care and treatment of DNR patients in critical care. Recommendations for critical care professional practice, emphasizing the importance of communication, education, research, the development of specialized care units, and advance personal directives, is presented.

Critical Care↗

Nurses with blood-borne pathogens and the moral responsibilities of nurse regulating authorities.

This paper examines, for consideration by nurses and nurse regulating authorities (NRA), certain ethical and practice issues concerning registered/enrolled nurses with blood-borne pathogens (BBPs), such as Human Immunodeficiency Virus and Hepatitis Viruses. Under existing legislation, the identity and infectious status of a nurse with a BBP may be notified to a NRA by either a medical practitioner or another person. In the event of a notification being made, NRAs need to consider the question of how best to achieve a workable balance between protecting the significant moral interests of both the public and the nurse concerned. This paper clarifies how such a balance may be achieved, and provides recommendations on how the issue can be addressed in practice.

Acquired Immunodeficiency Syndrome↗

Teaching medical ethics to medical students: moral, legal, psychological and philosophical aspects.

Teaching medical ethics to medical students requires a mixture of the moral, legal, psychological and philosophical aspects of the subject. The experiences of a teaching programme at Hannover Medical School will be described. The didactic concepts derived from these experiences are given under five headings: Ethics education should take place continuously from the first year of medical school onward. Ethics teaching should progress from concrete cases to more abstract and theoretical considerations. Real cases are preferable to paper cases. Practising skills is as important as teaching knowledge. Participation is guaranteed by small-group-teaching. The concept is supported by data from the evaluation of the Hannover courses.

Clinical Competence↗