Ethics Today Research Articles

Medical Ethics Today: Its Practice and Philosophy: The BMA's Handbook of Ethics and Law, 2nd edition

Medical Ethics Today: Its Practice and Philosophy: The BMA's Handbook of Ethics and Law, 2nd edition

Medical Ethics Today: Its Practice and Philosophy: The BMA's Handbook of Ethics and Law, 2nd edition

The avowed aim of this book is to help doctors function in the modern world where ‘patients, other health care workers, media, regulators and the courts’ all expect more explication and justification of the medical decision. These interactions have to be viewed within the context of multiple ethical issues faced by practitioners. Society's interaction with medical science and practice is often represented by professional codes or legislation, meaning that we must be aware of all aspects of this social contract. Thus this handbook aims not only to ‘bridge the gap between theory and practice’ but also to be a source of relevant law and jurisprudence in diverse specialized spheres such as assisted reproduction, genetics and end-of-life issues. The book, with an accompanying CDRom easy to search by subject, succeeds well in its aim, thanks to a structured approach ranging from the basics of practice relevant to all (the patient-doctor relationship, consent and refusal in all ages, confidentiality and health records), to other concerns such as research, public health and custodial settings. These may be specialized areas, but the practitioner who is also a citizen cannot ignore them. Indeed this reflects an ethical stance itself, in the spirit of Aristotle and the practice of ethics as a citizen ‘in the city’ (or in the society where one belongs). In each chapter, general principles are outlined and practical issues then detailed: these are the questions faced by many in everyday practice, such as who has the responsibility for prescribing, how to deal with explicit rationing within the NHS, and how to respond to guidance issued by NICE. The text is also well presented and readable, avoiding the philosophical jargon much loved by the specialist in ethics but obscure to those who passed through the medical curriculum before the subject became compulsory. Vignettes illustrate complex issues: for instance, a chapter on euthanasia refers both to national debates (‘assisted suicide—a human right?’ explains the Dianne Pretty case) and relevant other European models (legislation in the Netherlands). Important points are highlighted in the text; summaries of all the pros and cons are provided—a clear approach to the dialectic tools of philosophical discussion. This is also well exemplified by the chapter on genetics, which furthermore stresses that all individuals have responsibilities, including ‘a general moral duty to take account of the impact of their decisions on others’. This chapter contains also a plea for case-by-case decision making within a framework rather than inflexible rules, and ‘concern for others’ both in general and in the field of genetics where there is an interdependence of interests amongst individuals, family and society at large. Last but not least, the ‘limits of rights’ are outlined in clear terms. This, combined with the introduction to UK human rights legislation in early chapters, is only one of the important points made in this book, of use to all who wish to go further than the letter of the law. Human rights have been discussed in commentaries of mixed quality in various fields (as with the words ‘reproductive rights’ which means many different things to different people); here the concept is well clarified as an important tool in the modern approach to ethical arguments. Twice the size and eleven years after the first edition, the book was well worth waiting for. Clinicians, students and teachers will find it a valuable synthesis of what they should know about the ever more complex field of medical ethics.

Environmental Ethics Today

Environmental Ethics Today

The dynamics of business ethics: a function of time and culture – cases and models

Examines the construct of ethics in general and of business ethics in particular. Provides a conceptual discussion of the dynamics of ethics in society and the dynamics of business ethics in the marketplace. Ethics and business ethics constructs are dependent upon two principal parameters – time and culture. Eventually, ethics and business ethics are about what is perceived as acceptable or unacceptable at a specific time and in a specific cultural setting. What was ethical yesterday may not be ethical today, and what is ethical today may not be ethical tomorrow. Furthermore, both the company’s view and the views of others may determine what is acceptable or unacceptable in business ethics. This is a social construction that may differ between the parties involved in a specific context. The discussion is supported by two brief and different cases from the automobile industry. This research contributes a set of generic models that examine business ethics dynamics.

Being Brought to Light

There is a certain urgency about the ethical today. Amid reports of the misery and injustice that seem to accompany all our human undertakings, and with increasing demand that it prove itself useful to an expanding range of unprecedented crises, the ethical is found to occupy a crucial place in contemporary thought. It stands at the point of a change, as our desire for a better world seeks the transformation of the one in which we find ourselves, and so it is to become the means by which we may be carried over from one situation to another, by which we are to make a difference. The ethical is to save us, and so the urgency of our salvation comes to rest in a particular and intense way on the salvation of ethics itself, saved and preserved for our sake, so that we might also be rescued and kept in safety and brought into the fulness of life that is to be ours. The enormity of this expectation of the ethical has become a kind of running theme through all sorts of contemporary discourses, assuming in many cases a force that would compel agreement without question, and at times erupting in expressions of disgust or even censure at those who would defy this logic. What else are we to do or think?There is a sense in which this ethical has become the last sounding of the thinking of being in the western tradition, taking on the now empty form of its hegemony, while that thinking of being itself is already known to be fraught with difficulty, and so pronouncing itself as the final grand narrative by which nonetheless our redemption is to be secured.

Environmental Ethics Today

Environmental Ethics Today

Heritage And Discovery: A Framework for Moral Theology

[In an effort to clarify foundational categories for moral theology, the author explores several polarities that have often been woven into discussions of moral formation. The first issue she addresses concerns the roles of socialization and autonomy, tradition and innovation, “heritage” and “discovery” in moral development. These principles of change are seen to be complementary rather than contradictory. She then engages the question of the distortion of development through sin, exploring the dialectic of authenticity and inauthenticity. Finally, she applies these categories and relations to the unfolding of moral theology with the Christian tradition, elucidating implications for Christian ethics today.]

Treatment of Suicidal Patients in Managed Care

Back to table of contents Previous article Next article Book ReviewsFull AccessTreatment of Suicidal Patients in Managed CareAndrew Edmund Slaby, M.D., Ph.D.Andrew Edmund SlabySearch for more papers by this author, M.D., Ph.D.Published Online:1 Jan 2002https://doi.org/10.1176/appi.ps.53.1.107AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Management of the suicidal patient brings to the fore problems with managed care more than that of patients with any other psychiatric condition. Failure to provide needed care in a timely manner can lead to unnecessary death and much pain for those who survive. Suicide ranks ninth among causes of death in the United States, and third for adolescents. Provision of psychopharmacotherapy and psychotherapy, in a protected environment if necessary, at the time of suicidal crisis allows the patient in pain to develop new ways of coping to reduce the immediate risk. In many instances it also serves to reduce the impact of future crises so that self-inflicted death is not perceived as an option.This interesting and timely volume addresses the difficulties clinicians encounter as a result of managed care restrictions, and it discusses strategies for working effectively within such restrictions. As the volume editor explains, caregivers often perceive managed care as an attack on the autonomy of their decision making, on the confidentiality of the treatment process, and on their anticipated reimbursement for services rendered.In contrast to the earlier fee-for-service culture, which some feared would stimulate the provision of unneeded care to generate greater hospital and caregiver revenue, the ethical concern today is over the financial gain employers and insurers can reap by limiting the care given to subscribers. Suicidal patients are at risk of being undertreated, being discharged too early, and not being provided care at the level required for their safety. A study cited by contributors to *this volume found that the suicide rate was 7 percent higher in a capitated system than in a fee-for-service system (1). Another study cited found that the premature assignment of patients to outpatient settings had a role in the more than twofold increase in the number of deaths by accidental poisonings and medication errors in the United States between 1983 and 1993 (2).This book, richly illustrated with examples, addresses the impact of managed care on crisis care and brief hospitalization of suicidal patients, with specific discussions of the unique concerns involved in treating the populations at greatest risk—adolescents, substance abusers, and the elderly. The risk that an attempt will lead to completed suicide is estimated to be seven times greater among persons with alcohol use disorders than among those without (3). The book's appendixes on risk evaluation and on navigating managed care should be read by all who provide care for suicidal patients.Strategies elaborated in this volume will help clinicians negotiate passage through the managed care landscape, which at first glance appears inimical and threatening to the values of clinicians. To provide effective care, caregivers must capitalize on the advantages of managed care, such as coordination of available alternatives, and minimize the disadvantages, such as potential undertreatment and the dilution of the clinician's responsibility. Limited access to care has paradoxically spawned creative programs that are intermediate between inpatient and outpatient care and has enhanced the need for clinicians who are skilled in the evaluation of suicide risk and in appropriate emergency triage.The fact that at the close of the 20th century more than 60 percent of Americans were enrolled in managed care (4) indicates both the need for a book like Treatment of Suicidal Patients in Managed Care and the need for clinicians with the skills it discusses.Dr. Slaby is clinical professor of psychiatry at New York University and New York Medical College.edited by James M. Ellison, M.D., M.P.H.; Washington, D.C., American Psychiatric Press, Inc., 2000, 218 pages, $39 softcover

Reconciling Environmental Ethics and Political Values

Book reviewed in this article:Peter S. Wenz, Environmental Ethics Today

The Promotion of a Secular Work Ethic

The Promotion of a Secular Work Ethic

An Ethical Dilemma

The Florida Dental Association’s Code of Ethics, like those of most states, notes that “dentists shall be obliged to report to the appropriate reviewing agencies instances of gross and/or continual faulty treatment or violation of the Florida Dental Practice Act by another dentist. If there is evidence of such treatment the patient should be informed.” 1 Florida Dental Association Code of Ethics Today’s FDA Sourcebook. 1997-98; 9: 192 Google Scholar The same paragraph contains what some commentators have considered to be a contradictory statement: “dentists shall be obliged to refrain from commenting disparagingly without justification about the services of other dentists.” 1 Florida Dental Association Code of Ethics Today’s FDA Sourcebook. 1997-98; 9: 192 Google Scholar The potential contradiction is that making a comment to a patient or agency concerning a colleague’s treatment of a patient may appear to fulfill an obligation to report; the contrary interpretation of such verbiage may, in reality, be a disparaging remark that could subject the reporting dentist to administrative and legal consequences. 2 Weinstein BD Dental Ethics. in: Lea & Febiger, Philadelphia1993: 105 Google Scholar How should dentists balance the ethical responsibilities to the public, the profession, and to colleagues, without improperly violating the code of ethics? Therein lies the dilemma.

Ethics today

Ethics today

Ethical Issues in the Postoperative Intensive Care Unit

Ethical principles are the foundation of the practice of medicine. The intensive care unit (ICU) has always been a fertile ground for ethical dilemmas and today is further impacted by many conflicting forces, including the emphasis on patient autonomy, the medical eco nomic climate and the rise of managed care, and the wide availability of life-extending technologies. This article will address three specific ethical concerns that are particularly seen in the ICU to help physicians clarify the ethical issues present in their day-to-day practice. Advance directives were developed in an attempt to make the area of end-of-life decision-making less com plex and more responsive to patient autonomy, but the uses and limitations of these documents must be under stood to use them most effectively. Futility is a signifi cant concern as lives are extended by recent medical advances and technology. The question then becomes, when is it appropriate to withdraw these therapies, and how then to proceed in a caring and ethical manner. Finally, as patients begin to use advance directives more frequently, there will be more cases of patients with preexisting Do Not Resuscitate (DNR) orders com ing to the operating room for surgery for an unrelated disease or palliative procedures. The conduct of care in these cases needs to be based on a well-understood ethical framework.

The Modernity of Aristotle’s Ethics

Aristotle understood ethics to be a practical rather than a theoretical science. It is a pragmatics, if you will, concerned with bringing about a good life . But the problem and the question from which Aristotle’s ethics begins arid to which it constantly returns concerns the relation of the theoretical to the practical: his concern is for the type or mode of discourse one could use in providing an account of the good life (Eudaimonia). Is this a propositional, apophantic discourse, a discourse claiming to represent the truth and what is true and from which one could then go on to prescribe a course of action, or, and this may be closer to Aristotle, is the philosophical discourse on ethics rather a descriptive one which takes humankind for what it is, not what it ought to be? This relation between theory and practice, between description and prescription, between science and action, is a question and a problem for Aristotle. It is my purpose to take up this question in connection with Aristotle’s texts on Eudaimonia. Another question shall be raised here: What is the relevance of Aristotle’s treatment of Eudaimonia to our contemporary, “modern” concern for ethics and the good life? I would assume, naively perhaps, that even today we are not indifferent to this question of what is a good life, and that we are not indifferent to the many ways in which the “good life” has been described. It would seem, then, that Aristotle’s texts have a particularly striking importance for us today insofar as we prolong the philosophical questioning of the possibilities for ethical and political discourse today and continue to ask who and what we are as human beings.

Introduction: Doing Health Care Ethics Today

Introduction: Doing Health Care Ethics Today

SHORT NOTICES

Solar Ethics, Don CupittIs There a God?, Richard SwinburneBirth of a Worldview: Early Christianity in Its Jewish and Pagan Context, Robert DoranTeaching and Learning Religion: A Phenomenological Approach, Terence LovatCross and Crescenk Responding to the Challenge of Islam, Colin ChapmanChristian Values. Theory and Practice in Christian Ethics Today, J. Ian H. McDonald, T. & T. ClarkLearning for Life: A Handbook of Adult Religious Education, Yvonne CraigA Sense of the Divine. The Natural Environment from a Theocentric Perspective, James M. Gustafson, T. & T. ClarkA Dignified Dying, Hans Kung and Walter JensAquinas and the Jews, John Y. B. HoodOn Earth as It is in Heaven: Temple Symbolism in the New Testament, Margaret Barker, T. & T. ClarkWorship in the Primary School, Elaine McCreery, David FultonClassic Texts in Mission and World Christianity, Norman E. Thomas (ed.)Kant's Idealism, Philip J. NeujahrReligion in Modem Britain, Steve BruceOrdered Universes: Approaches to the Anthropology of Religion, Morton Klass

Ethics today

Ethics today

Ethics today

Ethics today

Ethics today

Ethics today

Ethics today

Ethics today