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Suicide: ethical and moral issues from a theological perspective.

A historical review of the Jewish, Christian, Islamic, Hindu and Buddist attitudes of suicide. The evolution to the contemporary Christian perspective is discussed citing contributions of Aristotle, Augustine, Aquinas and Donne. Issues raised by life-extension technology are discussed.

Ethics

Attitudes toward genetic testing of Amish, Mennonite, and Hutterite families with cystic fibrosis.

BACKGROUND: We had the unique opportunity to study families with cystic fibrosis (CF) from an interrelated Amish-Mennonite kindred and from an isolated Hutterite kindred. METHODS: While obtaining blood for DNA linkage analysis to help find the CF gene, we asked family members to answer a questionnaire about attitudes and feelings toward genetic testing. The questionnaire was also administered to families receiving care at the University of Rochester. After DNA-based CF carrier testing was developed, we asked the families whether they wanted to know the results. RESULTS: Each cultural group felt differently about many issues. Between 31% and 78% approved of CF-carrier testing and 14% to 78% approved of prenatal diagnosis. The majority (59%) of Hutterite parents and siblings were opposed to carriers marrying carriers and most (82%) of the CF families wanted to know the results of carrier testing. CONCLUSIONS: Cultural differences need to be understood before genetic services are offered. Also, most CF mutations and their clinical correlates (phenotypes) will need to be defined. There are as few as three CF mutations in the Hutterite population. It will be possible to offer them the option to choose accurate genetic counseling. It will be difficult to offer genetic services to other populations with more heterogeneous attitudes and many more identified and yet-to-be-identified CF mutations.

Abortion, Therapeutic

Intercultural differences in the bioethical assessment of abortion: preliminary results and a proposal for further research.

Descriptor terms related to 37 articles dealing with the moral question of abortion and taken from a printed database specializing in Catholic applied ethics were scanned for clusters with respect to the Anglo-American or European origin of the articles. To identify types within the data Configural Frequency Analysis was used. Application indicated a dominant interest in the process of ethical decision-making in Anglo-American Catholic bioethics. The assumption that European Catholic bioethicists discuss the morality of abortion primarily in terms of an anthropological debate focused on the moral status of prenatal life could not be validated statistically.

Abortion, Legal

Suffer the little children: the ancient practice of infanticide as a modern moral dilemma.

Inherent in nursing practice is respect for human life. Traditionally, this respect has been guided by the sanctity-of-life principle as embraced by the Jewish and Christian faiths. However, there appears to be a shift in philosophical thought regarding the inviolability of human life in medical and nursing practice. The very notion of what constitutes human life is the subject of vigorous debate, both within and outside the hospital-institutional setting. The topic of infanticide is examined from traditional Jewish and Christian perspectives and contrasted with current philosophical thinking. Pediatric nurses are challenged to reflect on how this potential shift in values will affect their personal philosophy and professional practice.

Child Advocacy

Ethical considerations in modern human experimentation.

The use of properly controlled clinical trials in medical experimentation has been of vital importance to the progress of medical science. At the same time, the new form of experimentation has also generated some of our most difficult and perplexing moral dilemmas. The solutions to the many complicated ethical problems involved in human experimentation are not straightforward, and despite numerous books, articles, codes, guidelines, and declarations, many specific issues of right and wrong in human experimentation have not yet been definitively resolved. Society today has an obligation greater than ever to control, regulate, and enforce properly balanced codes of human experimentation in order to minimize the unacceptable ethical problems and maximize the desired results of modern human experimentation. These, however, are not sufficient. The patient's greatest safeguard in experimentation is a skillful, intelligent, and conscientious physician and investigator. Thus, the investigator bears great responsibility in balancing between the common good and the individual's rights. In this article the relevant secular and Jewish ethical principles and rules concerning human experimentation are specified and methodologically organized. Particular emphasis is placed on the elucidation and evaluation of the ethical controversies surrounding randomized clinical trials.

Beneficence

Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's Witness.

OBJECTIVE: To present the case of a Jehovah's Witness with severe anemia and to review the religious philosophy of such patients, the ethical and medicolegal aspects of their care, and the therapeutic options available to clinicians. DATA SOURCES: A MEDLINE literature search (1980 to 1992) identified most studies. Other studies were selected from the bibliographies of identified articles. STUDY SELECTION: Selection of articles was limited to the history, philosophy, medicolegal and ethical issues, and clinical management of anemic Jehovah's Witnesses; a recent article on recommendations for red cell transfusion was also reviewed. CONCLUSIONS: A clear understanding of the philosophy of the Jehovah's Witnesses regarding blood transfusion and of the medicolegal and ethical aspects of their care is essential to clinicians who care for such patients. One must also be aware of the many alternative therapeutic options that can maximize oxygen delivery and minimize oxygen consumption. The insights gained from this review are applicable to any severely anemic patient who refuses blood transfusion.

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