Infertility Accepted treatment is replete with bioethical dilemmas regarding the limits of available medical therapies. Poland has no legal acts regulating the ethical problems associated with infertility treatment and work on such legislation has been in progress for a long time, arousing very intense emotions in Polish society. The purpose of the present study was to find out what Polish women undergoing infertility treatment think about the most disputable and controversial bioethical problems of assisted reproduction. An Attitudes (...) towards Bioethical Problems of Infertility Scale was constructed specifically for this study. Items were taken from the Bioethics Bills currently under discussion in Polish Parliament (Seym). 312 women were enrolled in the study. Women experiencing infertility favoured more liberal legislation. Participants disagreed, for example, with the following regulations: prohibition of embryo freezing, prohibition of preimplantation genetic diagnosis of embryos, age limits for women using in vitro fertilisation and prohibition of in vitro fertilisation for single women. The opinions of patients undergoing infertility treatment are an important voice in the Polish debate on the Bioethics Bills. (shrink)

The rapidly changing field of genetics affects society through advances in health-care and through implications of genetic research. This study addresses the impacts of new genetic discoveries and technologies on different segments of today's society. The book begins with a chapter on genetic complexity, and subsequent chapters discuss moral and ethical questions arising from today's genetics from the perspectives of health care professionals, the media, the general public, special interest groups and commercial interests.

BackgroundWhile healthcare professionals’ right to invoke the conscience clause has been recognised as a fundamental human right, it continues to provoke a heated debate in Polish society. Although public discourse is filled with ethical and legal considerations on the conscience clause, much less is known about the attitudes of healthcare professionals regarding that matter. The aim of this study was therefore to describe the attitudes of Polish physicians, nurses and pharmacists towards the ethical and legal aspects of (...) the conscience clause.MethodsWe analysed a group of three hundred healthcare professionals: physicians, nurses and pharmacists in Poznan, Poland, using a standard questionnaire comprising of 29 questions about various ethical and legal aspects of the conscience clause and participants’ personal experiences with the conscience clause. The study was conducted between January and March 2020.ResultsThis research shows that although most Polish healthcare workers support the right to invoke the conscience clause they differ significantly in their opinions on to whom and to what medical procedures the conscience clause should apply to. It also demonstrated that while the conscience clause is rarely invoked in Poland, most healthcare professionals declare that the current legal regulations in that sphere are unclear and inaccurate.ConclusionsWhile there is an urgent need to raise the awareness regarding the conscience clause among medical students and healthcare professionals and educate them about such issues, it is even more important to improve the legal system in regard to the CC so that it protects both HCPs’ right to the CC and safeguards patients’ rights to medical services. (shrink)

Bioethics is a fairly new, but very popular, discipline broadly present in the public debate of the Western Societies. It deals with difficult tasks and challenges faced by scientists to find ethical, social or political solutions to various problems created by modern science and technological growth. An impressive exploration of several bioethical issues can be found in the works of the Polish Jesuit, philosopher and, now a retired professor, Tadeusz Ślipko. For decades, his scientific attention, apart from theoretical (...) topics, was focused on the issues important to everyday human life. He placed a lot of emphasis on finding ethical solutions to the difficult issues discussed in the postwar Poland. He authored the first Polish ethical monograph devoted exclusively to modern problems of medical and technological development and titled Limits of Life. Dilemmas of the Modern Bioethics, first published in 1988 and reprinted in 1994. (shrink)

Bioethics is a fairly new, but very popular, discipline broadly present in the public debate of the Western Societies. It deals with difficult tasks and challenges faced by scientists to find ethical, social or political solutions to various problems created by modern science and technological growth. An impressive exploration of several bioethical issues can be found in the works of the Polish Jesuit, philosopher and, now a retired professor, Tadeusz Ślipko. For decades, his scientific attention, apart from theoretical (...) topics, was focused on the issues important to everyday human life. He placed a lot of emphasis on finding ethical solutions to the difficult issues discussed in the postwar Poland. He authored the first Polish ethical monograph devoted exclusively to modern problems of medical and technological development and titled Limits of Life. Dilemmas of the Modern Bioethics, first published in 1988 and reprinted in 1994. (shrink)

Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, (...) Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities. (shrink)

W artykule rozważam opinię mówiącą o rezygnacji z terminu „uporczywa terapia” i o potrzebie zastąpienia go terminem „terapia medycznie daremna”. Ponadto zastanawiam się nad przydatnością podziału środków medycznych na zwyczajne i nadzwyczajne. Opowiadam się przeciwko odrzuceniu terminu „uporczywa terapia”, jak również staram się pokazać, że klasyfikacja środków medycznych, która łączy pary pojęć „proporcjonalne/nieproporcjonalne” i „zwyczajne/nadzwyczajne”, może stanowić skuteczną pomoc w podejmowaniu decyzji o rezygnacji z uporczywej terapii zarówno dla lekarza, jak i dla pacjenta. Przedmiotem refleksji czynię wypracowaną przez Polską Grupę (...) Roboczą ds. Etyki Końca Życia definicję uporczywej terapii oraz jej zmodyfikowaną wersję. Zasadniczym kontekstem prowadzonych analiz są opinie niektórych autorów biorących udział w debatach zorganizowanych przez Polskie Towarzystwo Bioetyczne na temat uporczywej terapii oraz terapii medycznie daremnej. (shrink)

W tekście omawiam tę część internetowej dyskusji, przeprowadzonej w listopadzie 2012 r. na stronie Polskiego Towarzystwa Bioetycznego, która dotyczyła niepewności na temat moralnego statusu embrionów ludzkich. W trakcie dyskusji PTB na temat Stanowiska Komitetu Bioetyki przy Prezydium PAN w sprawie preimplantacyjnej diagnostyki genetycznej (PDG) pojawił się następujący argument: skoro spór o moralny status embrionu jest nierozstrzygalny, to powinniśmy opowiedzieć się przeciwko moralnej dopuszczalności wykonywania PDG na embrionach, a także przeciwko prawnej dopuszczalności tego rodzaju diagnostyki. W tekście omawiam tezy Stanowiska i (...) zdań odrębnych, które wywołały tę część dyskusji, a potem koncentruję się na następujących problemach: (I) dopuszczalność stosowania narzędzi teorii decyzji w debatach etycznych; (II) procedura podejmowania decyzji przez ciała doradcze w sytuacji niepewności moralnej; (III) znaczenie osiągnięć nauk biologicznych przy ustaleniu statusu moralnego embrionu; (IV) możliwość kompromisu w sytuacji pluralizmu wartości; (V) znaczenie statusu moralnego embrionów dla oceny moralnej i prawnej dopuszczalności PDG. (shrink)

In response to De Proost and Segers, we provide further reflections on how technologies induce moral change. We discuss moral changes at the societal level as distinguished from changes in bioethical principles or ethical concepts, impacts on theories of justice, and whether the transformations are negative or positive.

Contemporary liberal democracies contain multiple cultural, religious, and philosophical traditions. Within these societies, different interpretive communities provide divergent models for understanding health, illness, and moral obligations. Bioethicists commonly draw upon models of moral reasoning that presume the existence of shared moral intuitions. Principlist bioethics, case-based models of moral deliberation, intuitionist frameworks, and cost-benefit analyses all emphasise the uniformity of moral reasoning. However, religious and cultural differences challenge assumptions about common modes of moral deliberation. Too often, bioethicists minimize or ignore (...) the existence of multiple traditions of moral inquiry. Careful consideration of the presence of multiple horizons for moral deliberation generates challenging questions about the capacity of bioethicists to effectively resolve complex cases and social policy disputes. (shrink)

Issues concerning patients' rights are at the center of bioethics, but the political basis for these rights has rarely been examined. In Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making , Thomas May offers a compelling analysis of how the political context of liberal constitutional democracy shapes the rights and obligations of both patients and health care professionals. May focuses on how a key feature of liberal society -- namely, an individual's (...) right to make independent decisions -- has an impact on the most important relational facets of health care, such as patients' autonomy and professionals' rights of conscience. Although a liberal political framework protects individual judgments, May asserts that this right is based on the assumption of an individual's competency to make sound decisions. May uses case studies to examine society's approach to medical decision making when, for reasons ranging from age to severe mental disorder, a person lacks sufficient competency to make independent and fully informed choices. To protect the autonomy of these vulnerable patients, May emphasizes the need for health care ethics committees and ethics consultants to help guide the decision-making process in clinical settings. Bioethics in a Liberal Society is essential reading for all those interested in understanding how bioethics is practiced within our society. (shrink)

We live in a liberal, democratic, multicultural society where ideally the values of personal liberty and autonomy are paramount. In such a society the state, through the law, should not be concerned with telling people how they should live their lives. In spite of this, many of the ethical stances taken in liberal societies are paternalistic and authoritarian. This readable and balanced book is an original discussion of contemporary issues in bioethics. Max Charlesworth argues that as there (...) can be no public consensus on a set of core values – liberal societies accept a variety of religious, non-religious, political and moral stances - there should be a plurality of ethical stances as well. On this basis he discusses issues such as the ending of human life, the new reproductive technologies and ethical distribution of limited health-care resources, particularly hospital care. (shrink)

Bioethics evolved from traditional physician ethics and theological ethics. It has become important in contemporary discussions of Medicine and ethics. But in contemporary secular societies the foundations of bioethics are minimal in their content and often rely on procedural ethics. The bioethics of particular communities, particularly religious communities, are richer than the procedural ethics of a secular society. Religious bioethics, situated within religious communities, are richer in content in general and in the lived reality.

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical (...) considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices. (shrink)

In an attempt to promote in-depth dialogue amongst bioethicists coming from distinct disciplinary and religious backgrounds this essay offers a critical analysis of a number of the leading methods of addressing pluralism in bioethics and. Exploring the critiques and methodological proposals coming from the social sciences, the contract theorists, and the pragmatists, this study describes the problems which arise when confronting moral diversity in a bioethical context and examines the ability of these various methodologies to adequately resolve these matters. (...) Finally, the foundations of a new conceptual framework for bioethical methodology will be developed. It will be argued that these new methodological insights are able to overcome the problems facing other methodologies and may provide a viable means for adequately addressing issues of pluralism in bioethics. (shrink)

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. (shrink)

: This paper provides an analysis of the first decade of bioethics development in Slovakia (1990-1999), together with an overview of the most important bioethical issues entering the scene of public debate and scholarly ethical analysis.

This article critically re-examines the application of the principle of patient autonomy within bioethics. In complex societies such as those found in North America and Europe health care professionals are increasingly confronted by patients from diverse ethnic, cultural, and religious backgrounds. This affects the relationship between clinicians and patients to the extent that patients' deliberations upon the proposed courses of treatment can, in various ways and to varying extents, be influenced by their ethnic, cultural, and religious commitments. The principle (...) of patient autonomy is the main normative constraint imposed upon medical treatment. Bioethicists typically appeal to the principle of patient autonomy as a means for generally attempting to resolve conflict between patients and clinicians. In recent years a number of bioethicists have responded to the condition of multiculturalism by arguing that the autonomy principle provides the basis for a common moral discourse capable of regulating the relationship between clinicians and patients in those situations where patients' beliefs and commitments do or may contradict the ethos of biomedicine. This article challenges that claim. I argue that the precise manner in which the autonomy principle is philosophically formulated within such accounts prohibits bioethicists' deployment of autonomy as a core ideal for a common moral discourse within multicultural societies. The formulation of autonomy underlying such accounts cannot be extended to simply assimilate individuals' most fundamental religious and cultural commitments and affiliations per se. I challenge the assumption that respecting prospective patients' fundamental religious and cultural commitments is necessarily always compatible with respecting their autonomy. I argue that the character of some peoples' relationship with their cultural or religious community acts to significantly constrain the possibilities for acting autonomously. The implication is clear. The autonomy principle may be presently invalidly applied in certain circumstances because the conditions for the exercise of autonomy have not been fully or even adequately satisfied. This is a controversial claim. The precise terms of my argument, while addressing the specific application of the autonomy principle within bioethics, will resonate beyond this sphere and raises questions for attempts to establish a common moral discourse upon the ideal of personal autonomy within multicultural societies generally. (shrink)

This book examines the relevance of modern medicine and healthcare in shaping the lives of elderly persons and ageing societies. Combining individual and social dimensions, Planning Later Life discusses the ethical, social, and political consequences of increasing life expectancies and demographic change in the context of biomedicine and public health. By focusing on the field of biomedicine and healthcare, the authors engage readers in a dialogue on the ethical and social implications of recent trends in dementia research and care, advance (...) healthcare planning, or the rise of anti-ageing medicine and prevention. Bringing together the largely separated debates of individualist bioethics on the one hand, and public health ethics on the other, the volume deliberately considers the entanglements of envisioning, evaluating, and controlling individual and societal futures. The process of devising and exploring the various positive and negative visions and strategies related to later life is rarely reflected systematically from a philosophical, sociological, and ethical point of view. As such, this book will be crucial to those working and studying in the life sciences, the humanities, and the social sciences, particularly in the areas of bioethics, social work, gerontology and aging studies, healthcare and social service, sociology, social policy, and geography and population studies. (shrink)

The Polish equivalents of Research Ethics Committees are Bioethics Committees (BCs). A questionnaire study has been undertaken to determine their situation. The BC is usually comprised of 13 members. Nine of these are doctors and four are non-doctors. In 2006 BCs assessed an average of 27.3 ± 31.7 (range: 0–131) projects of clinical trials and 71.1 ± 139.8 (range: 0–638) projects of other types of medical research. During one BC meeting an average of 10.3 ± 14.7 (range: 0–71) (...) projects of medical research were assessed (2006). The amendment of Polish laws according with Directive 2001/20/EC caused a percentage increase in BCs which assessed less than 20 projects per year (16% vs. 33% or 42% in 2003 vs. 2005 or 2006 respectively, p < 0,05). The results confirm the usefulness of the current practice of creating BCs by medical universities, medical institutes and regional chambers of physicians and dentists but rationalization of the workload for individual BCs is necessary. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report (...) was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in (...) the United States, has initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)