Decision-making capacity (DMC) is, in many ways, a central organizing concept of modern health care ethics. Patients with DMC have the moral—if not always the legal—authority to make all manner of...

Moral conflicts over medical treatment that are the result of differences in fundamental moral commitments of the stakeholders, including religiously grounded commitments, can present difficult challenges for clinical ethics consultants. This article begins with a case example that poses such a conflict, then examines how consultants might use different approaches to clinical ethics consultation in an effort to facilitate the resolution of conflicts of this kind. Among the approaches considered are the authoritarian approach, the pure consensus approach, and the ethics (...) facilitation approach described in the Core Competencies for Healthcare Ethics Consultation report of the American Society for Bioethics and Humanities, as well as a patient advocate approach, a clinician advocate approach, and an institutional advocate approach. The article identifies clear limitations to each of these approaches. An analysis of the introductory case illustrates those limitations, and the article concludes that deep-seated conflicts of this kind may reveal inescapable limits of current approaches to clinical ethics consultation. (shrink)

This paper considers whether Rawls' theory of justice as fairness may be used to justify a human right to health care. Though Rawls himself does not discuss health care, other writers have applied Rawls' theory to the provision of health care. Ronald Green argues that contractors in the original position would establish a basic right to health care. Green's proposal, however, requires considerable relaxation of the constraints Rawls places on the original position and thus jeopardizes Rawls' arguments for the two (...) principles of justice. Norman Daniels claims that health care is best understood as a means for helping to achieve Rawls' goal of equality of fair opportunity. Daniels acknowledges, however, that his interpretation cannot justify a basic right to health care; rather, it would at best require that certain kinds of care be made available to certain kinds of individuals. Finally, in place of the notion of health care is a human right, it is suggested that the provision of health care is a social ideal which may inspire the creation of specific legal rights. On this view, social provision of health care may properly vary significantly from culture to culture. Despite this variability, social systems may still be criticized on moral grounds. Keywords: justice, right to health care, equality, fair opportunity. (shrink)

This article discusses the nature and significance of the holistic health movement in four ways. First, a general characterization of the movement is proposed, based on shared commitment to five assumptions: (1) a positive view of health as well-being, (2) individual responsibility for health, (3) the importance of health education, (4) control of social and environmental determinants of health, and (5) low technology or “natural” therapeutic techniques. Second, a basic difference among advocates of holistic health/medicine is proposed in terms of (...) the presence or absence of commitment to scientific method. Third, holistic health/medicine is briefly compared with concepts of holism in biology and in the social sciences. Finally, criticisms of each of the basic tenets of the holistic health movement are offered. (shrink)

Current federal policy, as reflected in the final Baby Doe rule, will have a chilling effect on the ability of doctors to care appropriately for severely disabled infants. The policy threatens to prolong life unjustifiably for such infants. It will force physicians to violate a duty to do no harm without compensating benefit. And it raises serious problems for the just distribution of health care.

This commentary, while sympathetic to Thomasma and Pellegrino [15], raises three sets of questions concerning the adequacy of their view of medicine as a foundation for medical ethical decision-making. The first set of questions concerns the account of the nature of medicine presented by Thomasma and Pellegrino. It is argued that the account is not clearly univocal and that even the most important description offered requires further clarification. Questioned, secondly, is the reasoning used by Thomasma and Pellegrino to propel their (...) movement from establishing an evaluative component in medicine to asserting an ethical dimension to medical judgment. It is argued that the authors equivocate in their presentation between the medical and moral uses of value terms. Finally, the role of the living body as a foundation for medical ethics is questioned, both in terms of the normative force such a ground can generate, and in terms of the range of duties to which this foundation must commit the profession. (shrink)

Who should have access to assisted reproductive technologies? Which one of many seriously ill patients should be offered the next available transplant organ? When may a surrogate decision maker decide to withdraw life-prolonging measures from an unconscious patient? Questions like these feature prominently in the field of health care ethics and in the education of health care professionals. This book provides a concise introduction to the major concepts, principles and issues in health care ethics, using case studies throughout to illustrate (...) and analyse challenging ethical issues in contemporary health care. Topics range widely, from confidentiality and truthfulness to end-of-life care and research on human subjects. Ethics and Health Care will be a vital resource for students of applied ethics, bioethics, professional ethics, health law and medical sociology, as well as students of medicine, nursing and other health care professions. (shrink)

Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct and disciplinary procedures. The article (...) concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach. (shrink)

Basic disagreements about what makes human life valuable hinder use of the concept of futility to decide whether it is appropriate to continue life support for one in a permanent state of unconsciousness, or to provide intensive medical care to one in the last stages of a terminal illness (the “paradigm cases”). Triage planning (the process of establishing criteria for health care prioritization) is an attractive alternative framework for addressing the paradigm cases. Triage planning permits society to see the cases (...) in the context of diverse moral perspectives, limited resources, and competing health care demands. Furthermore, at least one essential question posed by the paradigm cases is whether treatment is wasteful, and triage planning is a useful model for identifying and eliminating wasteful medical care. The authors describe how triage planning can be implemented to address the paradigm cases, and conclude that it offers one way of moving debate about these cases beyond futility. (shrink)

How should the hospital’s ethics consultation service respond to this request from the Emergency Department for advice about “how to proceed” in caring for ED patient Benjamin? In order to off...

This article examines two currently disputed issues regarding public policy for mentally retarded people. First, questions are raised about the legal tradition of viewing mental competence as an all-or-nothing attribute. It is argued that recently developed limited competence and limited guardianship laws can provide greater freedom for retarded people without sacrificing needed protection. Second, the question of who should act paternalistically for retarded people incapable of acting for themselves is examined. Rothman's claim that special formal advocates are the best representatives (...) for retarded people is discussed and criticized. It is argued that parents, professionals and legal advocates should share decision-making authority on behalf of those who are incompetent. (shrink)

In his book Engineered Death: Abortion, Suicide, Euthanasia and Senecide, John Woods uses an argument from analogy to establish the following conclusion: even if one grants that foetuses are not persons but only potential persons, killing foetuses is murder. Murder, according to Woods, is the defeasibly wrongful violation of the right to life ascribed to persons. If this argument is successful, it would of course have profound consequences for the ongoing philosophical debate over the morality of abortion. Whether or not (...) they hold that foetuses are persons, philosophers would be forced to adopt the same moral attitude toward foeticide as they would adopt toward the killing of persons. That is, the killing of foetuses and the killing of persons would be defeasibly wrong in the same way; their wrongfulness could be defeated only in special and limited circumstances, perhaps like those suggested by Judith Thomson in her “Defense of Abortion”. (shrink)

Although voluntarily stopping eating and drinking as a way to hasten one’s death is not yet a widely recognized practice in the United States, it has received increasing attention in the medical and bioethics literature in recent years. After a brief review of the broader context of human death and dying, this article poses and examines 11 conceptual, personal, and public policy questions about VSED. The article identifies essential features of VSED and discusses whether VSED is a type of suicide. (...) It identifies reasons why people may or may not choose VSED, and it considers responses by family members and professional caregivers to people who have chosen VSED. It also considers how public policies may permit and regulate or restrict the practice of VSED. Examination of these questions is designed to increase understanding of VSED and to inform moral evaluation of this practice. (shrink)

Book reviewed in this article: Ethics and Critical Care Medicine. John C. Moskop and Loretta Kopelman, eds. Dordrecht: D. Reidel “Ethical Moments in Critical Care Medicine,” symposium issue of Critical Care Clinics. James P. Orlowski and George A. Kanoti, eds.