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Biomedical subjects

J V Welie

Publications and source records attributed to J V Welie.

At least 19 recordsLinked to original sources
PubMed2001

Patient decision making competence: outlines of a conceptual analysis.

In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence.

Choice Behavior↗
PubMed2001

Living wills and substituted judgments: a critical analysis.

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the "power of attorney"), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The ever more common aversion of best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit.

Decision Making↗
PubMed2001

Requirement-driven dental education and the patient's right to informed consent.

In dental education, students spend much of their time treating patients' oral health care needs. Many dental schools still require students to complete a specified number of treatments of various kinds before they can graduate. It often happens that students need to do a particular treatment in order to complete school requirements, when this treatment is not what the patient truly needs, or is not the only treatment indicated for the patient's condition. Consequently, students will be tempted to talk the patient into accepting the procedure. Likewise, educational requirements may tempt the student to postpone certain treatments or forgo non-credit-bearing interventions altogether. We argue that this conflict of interest is inevitable (even though the educational system adopted by the school may mitigate the problem) and analogous to that found in therapeutical experimentation. Hence, we advocate the same ethical solution as has long been adopted for conflicts arising in biomedical experimentation: informed consent.

Attitude of Health Personnel↗
PubMed1999

Towards an ethics of immediacy. A defense of a noncontractual foundation of the care giver-patient relationship.

In this article, I argue that the relationship between patients and their health care providers need not be construed as a contract between moral strangers. Contrary to the (American) legal presumption that health care providers are not obligated to assist others in need unless the latter are already contracted patients of record, I submit that the presence of a suffering human being constitutes an immediate moral commandment to try to relieve such suffering. This thesis is developed in reference to the French philosopher Levinas and the Dutch theologian Schillebeeckx. An expanded version of the biblical parable of the Good Samaritan serves as test case.

Contracts↗
PubMed1999

"Do you have a healthy smile?".

This article examines whether cosmetic interventions by dentists and plastic surgeons are medically indicated and, hence, qualify as medical interventions proper. Cosmetic interventions (and the business strategies used to market them) are often frowned upon by dentists and physicians. However, if those interventions do not qualify as medical interventions proper, they should not be evaluated using medical-ethical norms. On the other hand, if they are to be considered medical practice proper, the medical-ethical principles of nonmaleficence, beneficence, justice and others hold true for cosmetic interventions as much as they do for other medical and dental interventions. It is concluded that most cosmetic interventions do not qualify as medical interventions proper because they do not restore or maintain the patient's health (defined as the patient's integrity) by any objective standards. Rather, cosmetic interventions are intended to enhance a person's physical appearance; more specifically, they intend to fulfill the client's subjective perception of an enhanced appearance.

Altruism↗
PubMed1998

Why should medicine consider a theory of practice? Introduction to the issue.

In reference to historical developments, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the relationship(s) between theory and practice. The authors emphasize the need for scientific research in this neglected area for the sake of both clinical practice and medical education.

Ethics, Medical↗
PubMed1998

Clinical ethics: theory or practice?

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information.

Cultural Diversity↗
PubMed1998

Role of codes of ethics in oral health care.

This group dealt with the role of codes through developing a draft of a code that could be used as a framework of common values in an "Alliance of Dental Organizations." Such an alliance might be an umbrella organization of all groups interested in promoting oral health care by advancing ethical discussion. A set of potential core values, based on traditional ethical principles, is presented.

Conflict of Interest↗
PubMed1997

The status of genetic material and genetic information in The Netherlands.

The moral status of genetic material and information, and the ethics of controlling and manipulating them, is a topic of hot debate in many European countries, including The Netherlands. That heat is due partly to the complexity of the topic, and partly to researchers' fear that their investigations will be hampered by restrictions on the use of personal data or body material. But there is little doubt that manifold diverging interpretations about the status of the human body, body materials, and personal information in Dutch law, written and unwritten, contribute to the intensity of the debates. This article intends to structure the debate by creating more clarity at the conceptual level. By carefully examining relevant articles of the Constitution and Civil Codes, as well as policy documents and authoritative publications, notably in reference to prominent legal concepts such as property, ownership and privacy, and answer should be provided to the following crucial question: is the status of genetic material and information in any sense special in comparison with other body parts and other kinds of information about a person? This paper first discusses the status of human body materials and personal information in general, and then continues with a more specific discussion about the status of genetic material and information. It concludes that the Dutch legislature had carefully avoided (or not felt the need to employ) the concept of ownership in regulating biomedical research; rather, privacy is found to be the prime regulatory concept.

Confidentiality↗
PubMed1996

Euthanasia in the Netherlands.

A review of two decades of euthanasia advocacy reveals that the arguments in favor of euthanasia are not consistent. Although the Dutch debate on euthanasia started as a protest against contemporary medicine's power over death and dying, the general acceptance of euthanasia and recent litigation may have increased medical power by shifting the balance further in the direction of physicians. This article argues that the anxieties of some of the opponents of a euthanasia bill were justified.

Attitude to Death↗
PubMed1995

Viktor Emil von Gebsattel on the doctor-patient relationship.

This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883-1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel's warning against a dehumanization of medicine when the "person" of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.

Anthropology↗