In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation to its (...) patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

Recognition that it is both possible and important to teach secondary school students about bioethics issues and theory has grown slowly within the field of bioethics. In the late 1970s and 1980s, a few first-generation pioneers recognized the teaching and learning opportunities inherent in bioethics and obtained pilot grants to educate high school teachers about bioethics issues. In the 1990s and 2000s, second-generation efforts explored the possibilities of bioethics in secondary schools using a range of approaches, models, and funding sources. (...) A third generation of programs that are now emerging benefits from more stable funding and offers materials that may be accessed by teachers across a country or around the world; a number of these programs are endorsed by national entities. An historical overview of these efforts to teach bioethics in high schools highlights some essential steps that must be taken to meet the challenge of teaching bioethics in pre-college settings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.3 (2002) 305-323 [Access article in PDF] Scope Note 41 Bioethics and Cloning, Part I Susan Cartier Poland and Laura Jane Bishop This is Part One of a two part Scope Note on Bioethics and Cloning. Part Two will be published in the December 2002 issue of the Kennedy Institute of Ethics Journal and as a separate reprint. Contents For Parts 1 And 2 (...) Part 1Part 2I.History of the ScienceI.Ethical PerspectivesII.Historical CommentaryII.Religious PerspectivesIII.Animal WelfareIII.Fiction and FilmIV.Laws and Legal Literature"Clone" is a collective noun (I, Stewart 1997, p. 771). A collective noun names a group and is composed of individual members, such as "herd" or "flock." Derived from the Greek kl¯on for twig or slip, "clone" was first used in biology to describe the aggregate of asexually produced progeny of an individual, either naturally occurring or man-made; the definition later expanded to mean a group of genetically identical members who originate from a single ancestor. Thus, a clone is a group that results from the process of asexual reproduction.In nature, cloning occurs either by parthenogenesis (reproduction without fertilization) or by fission (embryo splitting). In a pioneering experiment in 1952, Robert Briggs and Thomas J. King (I, 1952), cancer researchers at the Institute for Cancer Research (today part of the Fox Chase Cancer Center) in Philadelphia, demonstrated on frogs another method of cloning by transplanting nuclei into enucleated cells, a technique called "nuclear transplantation," which John B. Gurdon and colleagues (I, 1958, 1975) used to create clones of frogs.Then, in the late 1970s and early 1980s, two back-to-back frauds in cloning occurred. First, the cloning of a human described by American science journalist David Rorvik in the 1978 book In His Image was called a hoax by a court in [End Page 305] 1982. Second, the cloning of three mice, announced by German wunderkind Karl Illmensee to scientific circles in 1979 (and to the public in 1981), could not be proven to be true, according to convincing evidence by McGrath and Solter (I) published in 1984.With their pronouncement that mammalian cloning was impossible, McGrath and Solter essentially stopped cloning research and funding for such biological research. So by the mid-1980s, instead of further investigating cloning, developmental biologists studied embryology related to in vitro fertilization, while molecular biologists studied recombinant DNA under the newly relaxed NIH guidelines. These two strands of scientific investigation came together in the work of Ian Wilmut, who created in vitro embryos using nuclear transplantation to reproduce genetically engineered cattle. Wilmut was seeking a way to increase the successful birth rate when, in the 1990s, he produced identical twin sheep, Megan and Morag, cloned from an embryonic cell, followed by another sheep, Dolly, cloned from an adult cell. The birth of a mammal from an embryo whose genetic material came from an adult cell firmly re-established the possibility of cloning from adults. Prior to Dolly's birth, scientists believed that adult cells lost the ability to dedifferentiate—i.e., to become unspecialized—and so could not direct the development of an embryo through to birth.The 1997 announcement of Dolly's birth initiated the present widespread discussion of cloning. Because of its potentially vast applications across human health, medicine, agriculture, and business/economics, cloning raises a host of issues including those concerning: genetics and genetic engineering, patenting, animal rights and/or animal welfare (especially for transgenic, research, or cloned animals), organ transplantation, reproduction, eugenics, pharmacology (drug production using transgenic animals), research practices, informed consent, stem cell research, women's rights, children's rights, parental rights and responsibilities, and theology and philosophy. It fosters questions about the meaning and purpose of life, the limits of human powers to intervene in research and therapy, and what it means to be human or animal. In addition, environmentalists and organic farmers raise concerns about the effect of novel animals and plants on the environment, while nutritionists and the lay public wonder... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.1 (2001) 91-112 [Access article in PDF] Scope Note 40 Animals in Research and Education: Ethical Issues Laura Jane Bishop and Anita Lonnes Nolen Scientific enquiry is inexorably tied to animal experimentation in the popular imagination and human history. Many, if not most, of the spectacular innovations in the medical understanding and treatment of today's human maladies have been based on research using animals. (...) However, the use of animals in research and experimentation has been debated, defended, and protested by both individuals and organizations at various levels. Responses range from personal lifestyle decisions and fervent philosophical treatises to strident arguments, violent demonstrations, and direct action. The continuum of attitudes about animals and the human relationship with animals spans the range between those who support no regulation of the human use of animals and those who advocate absolute animal liberation from all human use (see II, Orlans 1993, p. 22). History The first recorded experimentation on animals occurred in ancient Rome, but not until the Renaissance did scholars begin serious study of how the body works. Leonardo da Vinci (1452-1519) and other artists and anatomists pursued anatomical investigations of muscle and bone structure. William Harvey (1578-1657) discovered the circulation of the blood via his experiments on live deer. During this period, much live animal experimentation both in England and France was based on the view of French philosopher René Descartes (1596-1650) that animals are incapable of feeling pain. Jeremy Bentham (1748-1832), the English utilitarian philosopher, thought otherwise. In his "Introduction to the Principles of Morals and Legislation" in 1789, Bentham declared, "The question is not, can they reason? Nor, can they talk? But can they suffer? Despite Bentham and others, the belief that animals could not perceive pain persisted in many quarters into the twentieth century. Nineteenth century French physiologist Claude Bernard [End Page 91] (1813-1878)-and his teacher, François Magendie (1783-1855)-conducted wide-ranging animal experiments including surgery, use of drugs, and removal of body parts from many species. Bernard argued that while no amount of benefit could justify any harm to human research subjects, even extreme harm and pain for animal research subjects could be justified by the potential benefit to human beings. Although he did use anesthetics in his work after their discovery in 1847, even Bernard's later work was controversial because of the numbers of animals used and the repetitive nature of his research. The experiments of Magendie and Bernard both laid the foundations for animal experimentation as a practice for scientific advance and contributed in large measure to the emergence of the anti-vivisection movement. Public protests over animal experiments conducted in France and the fear that these might come to England led to the passage of the first law controlling animal experimentation, the "1876 Cruelty to Animals Act" in England. This history and the dynamic tension between scientific inquiry and public concern set the stage for the activism and scholarship of the twentieth century.Since the 1960s, the amount of attention, activism, and scholarship related to animal use has increased at a rapid pace. The modern animal protection movement, led by the Australian philosopher Peter Singer in his book, Animal Liberation (II, 1975), based its advocacy on animals' ability to experience pain and suffering (Bentham's argument). Singer's book and other investigations into animal research, such as LIFE magazine's photojournalism piece on pet theft, animal cruelty, and animal experimentation (Concentration Camps for Dogs. LIFE (4 February 1966), pp. 22-29), brought the use of animals in research, testing, and education to the attention of the general public. Activists, advocates, laypersons, scientists, lawmakers, and animals themselves, have created the interesting, complicated, and complex history of animal rights and animal welfare over the last several decades. Current Statistics Worldwide, approximately 35 million animals are used in research each year; the United States alone uses 12 million animals annually--more than any other country. In 1998, the official number of research animals recorded in the United States was 1... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 16.4 (2006) 379-396MuseSearchJournalsThis JournalContents[Access article in PDF]Pharmacists and Conscientious Objection *In March 2005, a Wisconsin pharmacist's act of conscience garnered headlines across the United States. After a married woman with four children submitted a prescription for the morning-after pill, the pharmacist, Neil Noesen, not only refused to fill it, but also refused to transfer the prescription to another pharmacist or to return the prescription (...) to the customer. As more such incidents occurred, many states "... decided to consider and enact laws setting the bounds of pharmacists' and other health care workers' professional obligations" (III, Grady 2006, p. 327). Discussions of objector legislation, also referred to as "conscience clauses," "refusal clauses," and "abandonment laws" (III, Appel 2005, p. 279), are not limited to professional ethics, but also draw from philosophical, theological, and legal perspectives. The purpose of this Scope Note is to present a wide variety of viewpoints on the health provider's right to conscience.More than 40 years ago the development of "The Pill" as the first reliable method of birth control not only ushered in a feminist revolution, but also provided a new focus for concerns of conscience for those who were part of the anti-abortion movement based on religious belief in the sanctity of life. Similarly, in the past ten years, worldwide, and seven years (1999) since the emergency contraception "morning after" pill first became available as a prescription item, there has been an upsurge in the number of medical personnel who refuse to prescribe or dispense it on grounds of personal conscience, whether for religious reasons or not. Their actions bring into play issues of power and control for health care personnel and for patients—in this case women, which also raises women's rights issues. Ironically, studies in France, Sweden, and the United Kingdom have shown that emergency contraception does not reduce the abortion rate—it is too infrequently used (II, Glasier 2006).It is important to underline the difference between the "morning-after" pill or "Plan B," which is made up of two progestin pills containing levonorgestrel (a synthetic derivative of the female hormone progesterone), and RU-486 (Mifiprex [End Page 379] or mifipristone with misoprostol). Plan B, if taken within 72 hours post-coitus prevents implantation, and therefore pregnancy, by suppressing the output of luteinizing hormone, the hormone that triggers the ovulation process. Scientists have been unable to determine whether this action could destroy already fertilized eggs, but even if it does, it uses the same mechanism as occurs with the birth-control pill, that was developed some 45 years ago. By contrast, RU-486 acts up to 49 days after implantation by blocking the action of progesterone in order to terminate the pregnancy and as such is an abortifacient (II, US FDA 1).On 24 August 2006, the U.S. Food and Drug Administration announced approval of the Plan B pill for over-the-counter (OTC ) sales (II, US FDA 2). Although this action makes the drug more widely available, it remains to be seen whether pharmacists who are conscientious objectors and who refuse to dispense it also will refuse to provide it OTC.A survey article by Rebecca Dresser (II, 2005, p. 9) succinctly sums up the problem for conscientious objectors: "Because emergency contraception can act to block implantation of a fertilized egg, people who believe in protection of human life after conception find it morally objectionable."When conscientious objections are raised over abortion or birth control services performed, prescribed, or dispensed, they affect not only the health professionals—physicians, pharmacists, nurses, and health technicians—who may object, as well as their colleagues and/or managers, but also the consumers: the female patients who are then forced to reconsider or to seek an alternative supplier, as well as their spouses or partners. Alta Charo (II, 2005, p. 2473) makes the point that the patient needs to have access to a system of counseling and referral "so... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part 2Laura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part Two of a two part Scope Note on Religious Perspectives on Bioethics. Part One was published in the June 1994 issue of this Journal. This Scope Note has been arranged in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1I.GeneralVI.HinduismII.African Religious TraditionsVII.IslamIII.Bahá'í FaithVIII.JainismIV.Buddhism and ConfucianismIX.JudaismV.Eastern OrthodoxyPart 2I.Native (...) American ReligiousChristian Scientist TraditionsEpiscopal/AnglicanII.ProtestantismEvangelicalGeneralJehovah's WitnessAnabaptist (Church of theLutheranBrethren, Friends SocietyMethodist/Wesleyan(Quaker), and Mennonite/NazareneAmish/Hutterite)Presbyterian/ReformedAssemblies of GodSeventh-day AdventistBaptistUnitarian UniversalistChurch of Jesus Christ of theUnited Church of Christ Latter-day SaintsIII.Roman CatholicismChristian Church (Disciples of Christ)[End Page 357]IntroductionThe many religions of the world bring diverse, and occasionally divergent attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine for these faith traditions in the United States, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing on bioethics, for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Native North American ShamanismAvery, Charlene. Native American Medicine: Traditional Healing. Journal of the American Medical Association 265 (17): 2271, 2273, 1 May 1991. A brief description of the general principles of Southwestern Native American religions is provided. Most tribes believe that health and religious well-being are interconnected.Day, Thomas W. Cross-Cultural Medicine at Home. Minnesota Medicine 75 (3): 15-17, March 1992. The Ojibwe tribe's view of health incorporates spiritual health and emphasizes a holistic approach to health care that encompasses a harmonious balance between the individual, community, and nature, as well as between body, mind, and spirit.Hirschfelder, Arlene B., and Molin, Paulette. The Encyclopedia of Native American Religions. New York: Facts on File, 1992. 367 p. A survey of Native American religions is provided, including tribal histories, descriptions of religious ceremonies, and biographical sketches.Hultkrantz, Åke. Health, Religion, and Medicine in Native North American Traditions. In Healing [End Page 358] and Restoring: Health and Medicine in the World's Religious Traditions, ed. Lawrence Sullivan, pp. 327-58. New York: Macmillan, 1989. Hultkrantz summarizes the Native American attitude toward medicine and health care, explaining that belief in the supernatural and its powers is one of the most important tenets of life. Ailing persons are aided by those who have been trained to act as mediators between the sick individual and the supernatural powers. Attitudes toward health and disease, and the role of the medicine man are demonstrated through the use of examples taken from many tribes.Hultkrantz, Åke. Shamanic Healing and Ritual Drama: Health and Medicine in Native North American Religious Traditions. New York: Crossroad, 1992. 197 p. Hultkrantz surveys the varied traditions of Native North Americans and their outlook on medical care, health, and religion, and emphasizes that Native American medical beliefs... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part ILaura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part One of a two part Scope Note on Religious Perspectives on Bioethics. Part Two will be published in the December 1994 issue of this Journal. This Scope Note has been organized in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1Part 2I.GeneralI.Native AmericanII.African Religious TraditionsReligious TraditionsIII.Bahá'í FaithII.Protestantism—willIV.Buddhism (...) and Confucianisminclude a general sectionV.Eastern Orthodoxyand sections focused onVI.Hinduismspecific denominations.VII.IslamIII.Roman CatholicismVIII.JainismIX.JudaismIntroductionThe many religions of the world bring diverse, and occasionally divergent, attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and [End Page 155] health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing in bioethics; for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith, but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.Specific citations about a region or country were chosen because of the predominance of a religious tradition within the population. In all cases, variation in spelling represents author usage. This Scope Note treats only the literature published in English, and every attempt has been made to identify English language sources for these faiths.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Dictionaries and EncyclopediasMelton, J. Gordon, ed. Encyclopedia of American Religions. Fourth edition. Detroit: Gale Research, 1993. 1217 p. Basic information about the history, sacred texts, membership, educational facilities, publications, and North American addresses are provided for 1,730 churches, denominations, sects, and cults. Bibliographies for many faiths supplement this extensive resource.Reich, Warren T., ed. Encyclopedia of Bioethics. New York: Free Press, Macmillan, 1978. 4 volumes. Articles on all the major religions as they relate to bioethics are included in this highly-regarded encyclopedia. In addition, many of the topical essays feature a section on the views of various faiths on the topic under discussion. For the best use of the Encyclopedia, see the subject index in volume 4. (Note: a revised, second edition is due to be published by Macmillan in late 1994.)GeneralAmerican Psychiatric Association. Committee on Religion and Psychiatry. Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitment and Psychiatric Practice. American Journal of Psychiatry 147 (4): 542, April 1990. The American Psychiatric Association recommends that psychiatrists respect their patients' religious beliefs and that they not impose their own [End Page 156] beliefs on their patients.Bankowski, Z., and Bryant, J. H. Health Policy, Ethics and Human Values: Proceedings of the XVIIth CIOMS Round Table Conference, Athens Greece. Geneva: Council for International Organizations of Medical Sciences, 1985. 336 p. Many sections of this volume address issues where religion impacts health policymaking. Africa, the Middle East, Europe, Latin America, and Asia are highlighted for the varied ways in which their religions and cultures are integrated into the provision of health care.Batchelor, Edward, ed. Abortion: The Moral Issues. New York: Pilgrim Press, 1982. 246 p. Batchelor compiles a collection of essays by experts on religious ethics as they relate to abortion. Includes... (shrink)