Biomedical subjects
Publications and source records attributed to B J Spielman.
There is great skepticism about the admittance of expert normative ethics testimony into evidence. However, a practical analysis of the way ethics testimony has been used in courts of law reveals that the skeptical position is itself based on assumptions that are controversial. We argue for an alternative way to understand such expert testimony. This alternative understanding is based on the practice of clinical ethics.
Explore the source record for details and available documents.
Those who provide health care for the elderly are being confronted by a variety of ethical problems, including paternalism, withdrawal of life-support systems, and allocation of scarce resources. Discussion surrounding these issues lacks persuasive power because it lacks an appropriate theoretical grounding. This paper grounds geriatric ethics in the theory of the person described by Stanley Hauerwas. It shows that Hauerwas' emphasis on the attributes of temporality, sociality, and limitation is both consistent with the conclusions of gerontologists, and fruitful for developing specific ethical guidelines. Three ethical principles--continuity, interdependence, and normality--provide a framework from which to begin to resolve ethical problems in geriatrics.
This paper calls for a shift away from autonomy as the central value in geriatric ethics. In treatment and experimental settings, differences between older and younger adults are easily attributed to deficiencies on the part of the elderly when autonomy is the central value. Overemphasis on the concept of autonomy skews our understanding of human relationships toward excessively rational models, distracts attention from important physical and social characteristics of aged persons, and results in ethics by default. This paper describes several principles that would be more useful starting points than autonomy in developing a geriatric ethic.
In response to a competitive environment, hospital administrators are pressuring physicians to discharge Medicare patients "sicker and quicker" and to transfer indigent patients from their emergency rooms. This paper compares health administrators' ethics to public expectations regarding financially motivated hospital transfers and discharges. Health administrators use balancing strategies: code morality, survivalism, mission dependency, and tithing. Public expectations, exemplified in P.L. 99-272, P.L. 99-509, and recent case law, are based on norms of potential for patient harm and patient occupancy. These norms are morally preferable to those of health administrators; they reinforce the value of identified lives and the reliability of the health care system.