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Biomedical subjects

Erich H Loewy

Publications and source records attributed to Erich H Loewy.

16 recordsLinked to original sources
PubMed2005

Use and abuse of bioethics: integrity and professional standing.

This paper sets out to examine the integrity and professional standing of "Bioethics." It argues that professions have certain responsibilities that start with setting criteria for and credentialing those that have met the criteria and goes on to ultimately have social responsibilities to the community. As it now stands we claim that Bioethics--while it certainly has achieved some progress in the way medicine has developed--has failed to become a profession and has to a large extent failed in its social responsibility. We feel that Bioethics has to define itself, set criteria for membership in the profession, police itself and--above all--meet its social responsibility to become a profession meriting that name.

Attitude of Health Personnel↗
PubMed2005

Age discrimination at its best: should chronological age be a prime factour in medical decision making?

This paper briefly reviews the papers in this special section of HCA and makes the point--a point which should be obvious--that statistics are useful only as guidelines but tell one nothing about the individual patient in front of you. Chronological age merely shows what is true of most but decidedly not of all patients in a particular age group. To ration on the basis of age alone is unfair to the individual denied treatment and damaging to the community because it disturbs the solidarity which comes about because most members of the community feel that the community has obligations beyond those of not directly harming them; indeed, what produces solidarity is the feeling that members of a community will do their best to come to each others help. Rationing on the basis of age alone denies people of equal treatment under the law and--when it comes to the elderly--is a type of age discrimination. It is pointed out that what matters is a patient's disease and not his/her age. A permanently vegetative person 8 years of age is a much sadder occurrence than it would be at age 90--but the critical fact is that both are permanently vegetative. Age cuts both ways--it is irrational to spend hundreds of thousands of dollars, untold amounts of time, energy and devotion to the 520 gm infant with a gr IV diffuse haemorrhage whose chance of leading a sentient life is close to zero and to hesitate before using a diagnostic MRI on a patient who is 90 but fully alert and enjoying life. It is concluded that age as an independent variable in the allocation of resources is ethically highly problematic.

Age Factors↗
PubMed2005

In defense of paternalism.

This paper argues that we have wrongly and not for the patient's benefit made a form of stark autonomy our highest value which allows physicians to slip out from under their basic duty which has always been to pursue a particular patient's good. In general - I shall argue - it is the patient's right to select his or her own goals and the physician's duty to inform the patient of the feasibility of that goal and of the means needed to attain it. If the goal is not one that is possible, the patient, with the physician and family, must select a feasible goal and then discuss the costs/benefits of various approaches. The physician should take a leading role in helping the patient select the goal. I argue that to simply present a laundry list of means and insist that patients choose for themselves is not only abandoning patients to their autonomy but is, in fact, a crass form of violating the patient's autonomy. Freely choosing not to choose is a choice a patient with decisional capacity is entitled to make and one that needs to be respected.

Beneficence↗
PubMed2004

Advance directives. Good, bad or indifferent.

The author writes about various alternatives once decisional capacity is lost. So-called advance directives come in two forms: the living will and an appointed proxy for health care. The US--were these have been legally binding for over 20 years in all states--is a useful laboratory for studying the effect. Advantages and disadvantages are discussed. In some civilizations decisions about all such matters are made in different ways--these are not superior or inferior but simply different. In the US with its shameful social conditions for a large part of the population more important problems need to be addressed. In civilizations which have at least basic medical care for all, discussing such documents becomes far more important. The EU is likely to make some form of advance directive have legal standing. The last 20 or more years that they have been utilized in the US may provide experience important for the time when the EU also makes such documents legally binding.

Advance Directives↗
PubMed2004

Euthanasia, physician assisted suicide and other methods of helping along death.

This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paper--and really the lead in idea--stresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) is killing another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended.

Ethics, Medical↗
PubMed2003

Principalism at the bed-side.

Using an actual case, this paper examines a number of ways in which physicians deal with such a case and with the various "principles" and ethical theories to which they are apt to appeal. It goes on to suggest that using Dewey's method of solving problems is most applicable at the bed-side.

Aged↗
PubMed2003

Education, practice and bioethics: growing barriers to ethical practice.

While Bioethics is now taught at all medical colleges in the United States as well as in other nations, and while discussions about Bioethics have become frequent in most medical journals there are increasing barriers to teaching and incorporating what has been taught into daily practice. I shall discuss some of these barriers and suggest that integrating the teaching of Bioethics throughout the curriculum after presenting some of the basic theory and methodology is the most effective way of teaching this vital subject. Furthermore, courses in health care ethics are often taught as something distinct and distinguishable from one's medical practice. I shall emphasize what I consider to be the failure of Bioethics to participate effectively in creating a context whereby what has been taught can be put into praxis. In this brief article I will discuss such barriers and suggest several approaches and remedies.

Bioethics↗
PubMed2002

Bioethics: past, present, and an open future.

The development of bioethics, spurred by the Nazi era and initiated in recent times largely in the United States, appears to be taking hold across at least the Western world. To date it lacks the necessary trappings of a true profession: that is, it lacks self-definition, criteria, and a method of assuring that those who call themselves bioethicists not only have appropriate training but function appropriately. Partly this is because the very term "appropriate" has not been defined! These are tasks that the new guard, with perhaps the advice and help of those of us from the old guard, will have to address. The development of bioethics has been mainly focused on those who had good access to healthcare. Those with a lack of access have been given short shrift. Basic healthcare provided to all within a given society has been the case in virtually all industrialized countries except for the United States since at least World War II, and even longer in most cultures. Here in the United States, our main bioethics societies, and bioethicists as individuals, have tended to concentrate on individualistic ethics and its problems (euthanasia, abortion, termination of care, IVF, etc.) and have, to a large measure, practiced "rich man's ethics." The lack of access to healthcare as well as many other faults have been labeled "system errors" and are in general considered to be beyond the responsibility of the bioethical profession. They tend to be shrugged off. We have been inclined to "join the establishment" and in so doing have often forgotten our own mission. We have spent a good deal of time discussing the ownership of a dead man's sperm and have made relatively little contribution to an equitable distribution of healthcare. In many respects, we have sold out. In my view, this is an evasion of social responsibility--social responsibility being one of the hallmarks of an honest profession. Until we come to terms with our mission--a mission that cannot merely be self-serving--we shall not be regarded as a profession. And that is a shame.

Bioethics↗
PubMed1991

Families, communities, and making medical decisions.

In his carefully crafted article, which, it is hoped, will stimulate further dialogue about this issue, David J. Doukas reviews some of the literature on this subject. He does not seem to differentiate between the family's role in decision making for competent or incompetent patients. His interest is prior to that: it is in working out a general agreement prior to the time that such an agreement may be needed. He favors a family covenant, one in which trust accumulates over time, and he offers a model of such a covenant. At first blush, the notion of covenant rather than the notion of contract seems far more suited to the medical milieu. I have no problem with the idea of covenant and trust, but I have serious reservations about its implementation....

Altruism↗
PubMedDate not supplied

The uncertainty of certainty in clinical ethics.

Physicians accept fallibility in technical matters as a condition of medical practice. When it comes to moral considerations, physicians are often loathe to act without a good deal more certitude and seem less willing to accept error. This article argues that ethics is intrinsic to medical decision making, that error is the inevitable risk of any action and that inaction (clearly action by default) carries even greater risk of error. Whether in the moral or the technical sphere, error must be accepted by physicians as part of the learning process which informs and enriches future decisions. Moral virtue, it is concluded, resides more in the making of a decision and in the agony of making it than it does in the potentially fallible decision itself.

Decision Making↗
PubMedDate not supplied

Oh death, where is thy sting? Reflections on dealing with dying patients.

This paper examines the reactions of physicians and other health professionals when they become involved in decisions about the death of their patients... Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.

Attitude to Death↗