Notes from an ethics fellowship.
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Modern developments in science, technology and medicine have resulted in an unprecedented interest in ethical and moral issues in the practice of medicine. Changes threaten to erode the traditional ethos of practice and to transform medicine into a marketable commodity. The challenge of a new medical ethic and suggestions for a future course are discussed.
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The constitutionality of criminal prohibitions on physician-assisted death has become one of the most fascinating issues. The Supreme Court viewed a judicial injunction enforcing access to an abortion clinic as "content neutral" and not subject to heightened scrutiny under the First Amendment.
An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion.
This article defines nursing ethics and its place within the disciplines of ethics and nursing. The current endeavours of nursing ethics are identified as: revising codes, assisting nurses to reason ethically, and establishing the nurse's role in ethical decision-making regarding ethical issues, particular clients, and society's definition of health and illness. The authors then propose the further development of nursing ethics to examine critically the ethical dimensions of nursing practice with regards to its theories, diagnostic categories, diagnostic procedures, treatment goals and treatment procedures.
The advent of moral pluralism in the post-modern age leads to a set of issues about how pluralistic societies can function. The questions of biomedical ethics frequently highlight the larger issues of moral pluralism and social cooperation. Reflection on these issues has focused on the decision making roles of the health care professionals, the patient, and the patient's family. One species of actor that has been neglected has been those institutions which are part of the public, secular realm and which have a particular moral heritage.
Whereas previous discussions on ownership of biological material have been much informed by the natural rights tradition, insufficient attention has been paid to the strand in liberal political theory represented by Felix Cohen, Tony Honoré, and others, which treats property relations as socially constructed bundles of rights. In accordance with that tradition, we propose that the primary normative issue is what combination of rights a person should have to a particular item of biological material. Whether that bundle qualifies to be called "property" or "ownership" is a secondary, terminological issue. We suggest five principles of bodily rights and show how they can be applied to the construction of ethically appropriate bundles of rights to biological material.
Many physicians find clinical ethics unhelpful in managing real-life patient care conflicts. In part, this is because different ethical theories often analyze situations in different ways. I review several clinical ethics methods that I have found useful in different patient care situations and discuss how this eclectic approach to ethical problems is consistent with primary care in general.
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