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[Bioethical issues and principles in cancer treatment].

Bioethics was established as a new area of interdisciplinary studies focusing on human conduct in the field of the life sciences and health care in the light of moral values and principles in the 1960's and the beginning of the 1970's. Physicians abiding by classical medical ethics based upon the Oath of Hippocrates became subject to criticism because they behaved paternalistically in relation to their patients and provided medical treatment dogmatically without adequate explanation concerning conditions and diagnoses of patients' diseases, what kinds of treatments they were to receive and the possible benefits and risks thereof, along with their prognoses. During the patients' rights' movement, law suits against paternalistic physicians increased in number and the courts tried to establish ethical and legal principles for judgments in law suits using the Ethical Code of Neurenberg (1947) as an excellent model. The legal principles established as "informed consent" include obligations of physicians to provide their patients with adequate explanation and truth-telling, and the rights of patients to autonomy, choice, self-determination, and to give consent to physicians. Besides these rights, patients also have the right to put their veto on their own rights. In such cases, truth-telling by physicians, who believe in truth-telling, such as the disclosure of the diagnosis of cancer to these patients, can legally result in infringement of the patient's rights. It is important for physicians to respect the wishes and opinions of patients based on their own values and not to insist on personal dogmatic opinions. The disclosure of cancer diagnosis to terminal patients is certainly one of the most difficult procedures in medical practice and requires profound medical experience and bioethical insight.

Bioethics

Infertility and bioethical issues of the new reproductive technologies.

The scientific breakthroughs resulting in the delivery of Louise Brown in 1978 have opened the floodgates for an ongoing bioethical discussion about medically assisted reproduction. The majority in our society has accepted in vitro fertilization as an ethically justifiable procedure for infertile couples. The concern persists, however, that new reproductive technology has started us on the course of a slippery slope with potentially dire consequences for the so-created children, the traditional family, and, indeed, for society as a whole. The moral status of the embryo is the central issue in debates about such reproductive developments as the "spare" embryo, embryo freezing, embryo donation, embryo research and micromanipulation. Conflicts of interests between the adult's desire to become a parent and the welfare of the offspring are at the root of moral objections raised against manipulation of human reproduction. Extracorporal conception with the possibility for various gamete donors has also brought the long-practiced procedure of artificial insemination by donor and the potential consequences for the child into the discussion. Surrogate mothering and surrogate gestational mothering force us to redefine the age old dictum mater certa est and can render the child a helpless pawn in parental, emotional, and legal strife. Over the ages, society has through firmly established values exerted control over reproduction and acceptance of the new member in the community. Sex without reproduction was a severe blow to the highly regarded societal belief in parenting as the epitomy of life goals. Reproduction without sex through various technically feasible collaborative means further jolts fundamental traditional values and mandates their re-evaluation. Ethical belief systems are by nature highly charged and fiercely defended. Thus, in a pluralistic society, a consensus on the question "What ought to be done of all that can be done with new reproductive technologies?" is probably unachievable. Heated controversies between interest groups constitute an additional psychological burden complicating the ethical ambiguities for some infertile couples who have to decide about using noncoital conception. The interdisciplinary group report by the ethics committee of the American Fertility Society published in the "Ethical Considerations of the New Reproductive Technologies" constitutes a wide framework of guidelines for rational consideration. It will, one hopes, help to formulate needed regulations because some segments of our society as well as many scientists and physicians in the field believe that not all that potentially can be done ought to be done.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethics, Medical

Bioethical issues in perinatology--is the future now?

The rapid progress of the science of perinatology has produced a broad range of capabilities in our approach to the fetus. Advances in diagnostic methodology, both invasive and noninvasive, enable early identification and potentially, early correction, of a multitude of disorders. The laboratory correlates of this progress have kept pace, with possibilities in the areas of fetal surgery and genetic manipulation which seemed fantasy only a few years ago. Important moral issues which had been deferred because of our physical limitations must now be addressed. As instigators of the scientific stampede, perinatologists must assume a major role in the ethical inquiry as well.

Bioethics

Contemporary bioethical issues in critical care.

The critical care nurse confronts ethical dilemmas in practice on a regular basis. Problems concerning treatment issues, allocation of resources, and collegial disputes are common. Knowledge of available resources can assist the nurse in dealing with these dilemmas.

Adult

Bioethical issues and the moral matrix of U.S. health care.

Solutions to ethical-moral issues will be influenced by the growth of medical technology, by the escalating cost of medical care, and by the involvement of public entities in health care delivery. The major areas of concern that will be affected by these factors are care of the dying, genetics, euthanasia, sterilization, behavior control, reproductive interventions, abortion, informed consent, and distributive justice.

Abortion, Legal

Medical futility. Committee on Bioethical Issues of the Medical Society of the State of New York.

The term futile is used in many different ways. It is therefore difficult to decide whether a procedure or treatment such as CPR or hemodialysis or blood transfusion would be futile in a given case. The AMA's guidelines on the appropriate use of DNR orders state that DNR decisions should be made openly. Institutions should have policies and physicians should elicit the patient's preferences about CPR. For physicians, the question is no longer whether we should discuss DNR orders with our patients; instead, the issue is how to do so with compassion and caring. Physicians should share with patients their judgment about what medicine can and cannot do. Then physicians must "make decisions about when to withhold or limit resuscitation openly" in honest and trusting conversation between doctor and patient. Often CPR is an exercise in futility. The medical profession should be vested with the authority to make futility decisions if they are the product of open discussion and shared deliberation between physician and patient, family, or surrogate. Rationing, triage, and medical futility in relation to AIDS patients require careful deliberation and consideration. What was considered medically futile five years ago for an AIDS patient may be appropriate care nowadays. The need for appropriate use or non-use of life-sustaining therapy for the elderly, the terminally ill, patients with AIDS and other incurable illnesses is evident to patients, health care providers, policy makers, and the public. CPR should only be administered if it is expected to confer lasting benefit to the patient. However, if 10% of elderly patients benefit from CPR in the case of out-of-hospital cardiac arrest, how can one consider this procedure futile? Although communication between physician and patient about difficult treatment limitation decisions has markedly improved in recent years, it remains a problem, largely because open dialogue with patients and families about futility is a demanding emotional and intellectual task. The medical profession is charged with setting standards for the proper implementation of judgments regarding futility.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary Resuscitation

Australian commissions and committees on issues in bioethics.

We examine the role of Australian state and federal committees and law reform commissions in bioethics. Most have been concerned with in vitro fertilization and embryo research. We find deficiencies in the standards of reasoning about the underlying ethical issues raised by these techniques. We suggest stronger representation of those with a background in ethics.

Advisory Committees

International perspectives on treatment choice in neonatal intensive care units.

Over the past 25 years, neonatal intensive care units (NICUs) have been established throughout the industrialized world and in some Third World nations to provide sophisticated medical interventions for critically ill newborns. This paper discusses the four major factors affecting treatment choices for newborns with disabilities or at risk for disabilities: the availability of resources, societal attitudes toward medical interventions and life with disabilities, the roles of physicians, parents and other decision-makers, and the role of the law. Much has been written on the bioethical issues surrounding such treatment as it is practiced in the United States, including analysis by social scientists; however, little has been written on how those issues are perceived and dealt with in most other nations, and very little comparative research has been conducted. The author provides an international perspective on the bioethical issues involved by comparing U.S. practice, which has received much attention, with a generalized commentary on practices in other parts of the world, which have received less examination. The nations surveyed include Australia, Brazil, Britain, Canada, China, France, India, Israel, Japan, the Netherlands, Poland, Sweden, and West Germany. The value of further comparative research is discussed in order to encourage others to do such research.

Attitude to Health

Oocyte and embryo donation.

Oocyte and embryo donation, first reported in humans in 1983 has helped patients who do not possess functional ovarian tissues or whose oocyte cannot be used for fertilisation, to conceive. Though it is the female counterpart as the donor insemination in the male, it imposes quite different bioethical issues. The article is a review of the oocyte and embryo donation programme in general, with special discussion on regimes of Cyclic Steroid Replacement Therapy, the recruitment of oocyte donors, bioethical issues, and future applications of oocyte donation in medicine.

Embryo Transfer

Bioethics: occupational therapy attitudes toward the prolongation of life.

A comprehensive array of bioethical issues have emerged from advances in biological technology. This report assesses the views of individuals at three occupational therapy levels concerning one such issue: The option of painless death for the incurable. A battery of measures used to study beliefs in occupational therapy students included an item dealing with euthanasia. Item analysis revealed that the mean response to the euthanasia item by groups of occupational therapy juniors, seniors, and supervising clinicians from two schools indicated approval of voluntary painless death for the incurably ill. The article concludes with a discussion of the inclusion of bioethical issues in occupational therapy educational programs.

Adult

Nursing code of ethics: an international comparison.

In her worldwide search for a code of ethics to provide guidelines for professional practice, Linda Sawyer found that the codes of health care professionals were disappointing, mainly because they did not provide thoughtful and provocative discussion of the bioethical issues faced by the practitioner. Many organizations deal with controversial issues through the informal mechanism of policy statements, rather than through the more formal, rigid, public and political process needed to amend a code of ethics. While other professional organizations focus on commercial aspects of practice or are silent on ethical issues. Below, an analysis of the codes of selected national nurses' associations.

Bioethical Issues