This paper examines the potential role of metaphors in helping healthcare professionals to communicate honestly with patients and in helping patients gain a richer and more nuanced understanding of what is being explained. One of the ways in which doctors and nurses may intentionally, or unintentionally, avoid telling the truth to patients is either by using metaphors that obscure the truth or by failing to deploy appropriately powerful and revealing metaphors in their discussions. This failure to tell the truth may (...) partly account for the observation by clinicians that patients sometimes make decisions that, from the perspective of their clinician, and given all that the clinician knows, seem unwise. For example, patients with advanced cancer may choose to undergo further, aggressive, treatment despite the fact that they are likely to accrue little or no benefit as a result. While acknowledging that the immediate task of telling patients the truth can be difficult for all those concerned, I argue that the long-term consequences of denying patients autonomy at the end of life can be harmful to patients and can leave doctors and nurses distressed and confused. (shrink)

In this paper several reasons as to why framing issues should be of greater interest to both medical ethicists and healthcare professionals are suggested: firstly, framing can help in explaining health behaviours that can, from the medical perspective, appear perverse; secondly, framing provides a way of describing the internal structure of ethical arguments; and thirdly, an understanding of framing issues can help in identifying clinical practices, such as non-directive counselling, which may, inadvertently, be failing to meet their own stated ethical (...) aims. The effect of framing on how individuals interpret information and how healthcare choices are influenced by framing are described. Next, the role of framing in ethical discourse is discussed with specific reference to Judith Jarvis Thomson’s philosophical mind experiment about abortion and the violinist. Finally, the implications of this analysis are examined for the practice of non-directive counselling, which aims at communicating information in a neutral, value-free way and thereby protecting patient autonomy. (shrink)

In an attempt to be rational and objective, and, possibly, to avoid the charge of moral relativism, ethicists seek to categorise and characterise ethical dilemmas. This approach is intended to minimise the effect of the confusing individuality of the context within which ethically challenging problems exist. Despite and I argue partly as a result of this attempt to be rational and objective, even when the logic of the argument is accepted—for example, by healthcare professionals—those same professionals might well respond by (...) stating that the conclusions are unacceptable to them. In this paper, I argue that an interpretative approach to ethical analysis, involving an examination of the ways in which ethical arguments are constructed and shared, can help ethicists to understand the origins of this gap between logic and intuition. I suggest that an argument will be persuasive either if the values underpinning the proposed argument accord with the reader’s values and worldview, or if the argument succeeds in persuading the reader to alter these. A failure either to appreciate or to acknowledge those things that give meaning to the lives of all the interested parties will make this objective far harder, if not impossible, to achieve. If, as a consequence, the narratives ethicists use to make their arguments seem to be about people living in different circumstances, and faced with different choices and challenges, from those the readers or listeners consider important or have to face in their own lives, then the argument is unlikely to seem either relevant or applicable to those people. The conclusion offered by the ethicist will be, for that individual, counterintuitive. Abortion, euthanasia and cadaveric organ donation are used as examples to support my argument. (shrink)

Deborah Kirklin discusses the role of medical imaging in the abortion debateThe latest developments in fetal ultrasound technology, made public by a group called Create,1 and first introduced to the wider UK public by the Evening Standard newspaper reporter Isabel Oakeshott in September 2003 and again in July 2004, have evoked a flood of responses from the public, pro-life and pro-choice campaigners, and politicians, re-igniting the debate about abortion in the UK and elsewhere. The focus of the Evening Standard articles, (...) on the smiling, walking, and waving babies that the images purport to show, was echoed throughout the worldwide media coverage that followed. In July 2004, Sir David Steel, sponsor of the 1967 Abortion Act, publicly stated that the Create images led him to believe it was time to review the legal time limit for abortions. Prime Minister Tony Blair said he considered calls for such a review reasonable.What interests me here is the powerful role that biomedical imaging, and the human artifice it involves, can play in influencing the nature, timing, and tone …. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm (...) in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

There are a number of obstacles to increasing the supply of cadaveric organs for transplantation. These include reluctance on the part of relatives to agree to the so called harvesting of organs from their deceased relative, and the unwillingness of some doctors to approach grieving families and ask consent for this harvesting to take place. In this paper I will focus on the altruistic act of asking that the latter entails, and will argue that failure to acknowledge the personal cost (...) of this act to physicians is having an adverse impact on the supply of organs. I will draw analogies with the almost equally neglected altruistic act of undertaking anatomy dissection and all of the related breaking of societal taboos. I will examine the language used in discussions about increasing organ supply and conclude that the terms cadaveric and harvest are unhelpful in gaining public confidence. A process and vocabulary that openly acknowledges and validates the altruistic acts demanded of all the human beings involved—donors, recipients, their respective relatives, and the health professionals who mediate between them—is needed if the supply of organs is to be increased. (shrink)