Continuing or discontinuing treatment: ethical criteria.
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This paper discusses the provocative views of Skene and Parker as to the role of religious or other ideologically based interest groups in law and policy making. We draw distinctions between doctrine and prejudice and between argument and ideology which we trust take the debate further. Finally we recommend an ethereal, democratic, and populist partial solution.
Medical technology has created dilemmas for those who make decisions regarding whether to prolong life in the face of severe, irreversible illness. Two questions usually arise: who should decide, and what standards should the decision makers use? These questions can be particularly difficult for members of religious institutes. The basic legal standard for such decisions is the patient's autonomy or self-determination; the patient's wishes are paramount. If the patient has been determined incompetent, a person who has the patient's best interests at heart should make the treatment decisions. Sometimes it may be necessary for the court to appoint a conservator. In California a recent law enables a person to create a Durable Power of Attorney--that is, to designate someone to make all health care decisions if the designator becomes incompetent. The surrogate can base decisions on either of two basic legal standards: substituted judgment or best interests. The substituted-judgment standard holds that the decision should be the one that the patient would have made if competent. The decision should be based on any available information about the patient's values and preferences. If these are not sufficiently known, the decision maker may have to resort to the best-interest standard, evaluating all options to determine what is "best" for the patient. In the case of a religious who becomes incompetent and has no family members, the physician probably will accept a member of the institute as a surrogate. If the incompetent religious has family, they and the institute should discuss who should be responsible for communicating with medical personnel. In California, a competent member of an institute should designate a surrogate in advance to avoid any confusion or conflict later.
In vitro fertilization (IVF) and embryo transfer (ET) have recently become an accepted treatment modality for patients with mechanically caused infertility. The first series admitted to our program comprised 42 patients with confirmed mechanical infertility. The method of patient selection and the techniques of laparoscopy, follicular aspiration and oocyte recovery are described. From 26 laparoscopies, a total of 39 oocytes was recovered. Normal cleavage of 10 oocytes was obtained; they were transferred into the uterus at the 4- to 16-cell stage. One pregnancy was obtained. An IVF and ET program involves certain ethical, legal and religious questions, which have special implications in Israel: foster mothers and the use of donor sperm are forbidden. Only married couples may enter the program. Indications, methods, success rates and method failure are discussed.
Since 1973 the practice of infanticide for some severely handicapped newborns has been receiving more open discussion and defence in the literature on medical ethics. A recent and important argument for the permissibility of infanticide relies crucially on a particular concept of personhood that excludes the theological. This paper attempts to show that the dispute between the proponents of infanticide and their religious opponents cannot be resolved because one side's perspective on the infant is shaped by a metaphysics that is emphatically rejected by the other. In such a situation philosophical argument is powerless to bring about a resolution because there can be no refutation of one side by the other.
Science and technology in the field of human reproduction present new legal, ethical and religious questions which do not always have immediate answers. The first step in the rapidly developed field of reproductive technology was the use of sperm donation (artificial insemination by donor, AID) and the establishment of sperm banks. The state of Israel faced these problems when the regulations for sperm donation were discussed. The fact that the main holy places for the three monotheistic religions are in Israel directly influences the make-up of the population constituents. Therefore, besides a majority of secular people, a high percentage of the population of Israel is very religious: Jews, Moslems and Christians. Thus any resolution relating to AID should take this demographic combination into account. The practice of AID is opposed by the different monotheistic religions. To avoid the conflict between secular and religious people, and between the different religions' perspectives, the legal problem of AID in Israel was solved not by laws but by regulations which were published by the Ministry of Health. The main idea behind this attitude is that the state and its authorities should not and do not deal with ethical or religious questions. Thus, the decision was left to the couples and to the donors. The regulations address technical requirements, health problems and confidential issues concerning the couple, the donor and the child. In this paper we present the different views relating to these problems as perceived by the different religions, and describe the solution that was accepted by the Israeli Ministry of Health.
Recent advances in the field of reproduction have made it possible to obtain preembryos and to use them in many research applications. These include research into improving methods of IVF treatment, contraceptive research, preimplantation diagnosis, gene therapy, the study of malignant disease, and others. The benefits, academic and scientific, are enormous. Apart from these benefits are many moral, legal, religious and ethical problems and reservations. Potential sources from which the preembryos may originate may also lead to controversy. Pressure groups in various societies seek to hasten governments into legislation or other means of control. We conducted a Medline search of all pertinent literature since 1980, and the findings are reviewed following. Regulated use of preembryo research is ethically acceptable by most groups in society. Suggestions for regulation are provided.
Attitudes towards active voluntary euthanasia (AVE) and physician-assisted suicide (PAS) among 1,238 doctors on the medical register of New South Wales varied significantly with self-identified religious affiliation. More doctors without formal religious affiliation ('non-theists') were sympathetic to AVE, and acknowledged that they had practised AVE, than were doctors who gave any religious affiliation ('theists'). Of those identifying with a religion, those who reported a Protestant affiliation were intermediate in their attitudes and practices between the agnostic/atheist and the Catholic groups. Catholics recorded attitudes most opposed to AVE, but even so, 18 per cent of Catholic medical respondents who had been so requested, recorded that they had taken active steps to bring about the death of patients.
The church and other community organisations have a legitimate role to play in influencing public policy. However, intervention by the church and other religious bodies in recent litigation in Australia and the United Kingdom raises questions about the appropriateness of such bodies being permitted to intervene directly in the court process as amici curiae. We argue that there are dangers in such bodies insinuating their doctrine under the guise of legal argument in civil proceedings, but find it difficult to enunciate a principled distinction between doctrine and legal argument. We advise that judges should exercise caution in dealing with amicus submissions.
A previous essay (Erde, 1988) tracked the influence of the major Western historical paradigm of the great chain of being through various positions taken about abortion. This essay shows the paradigm's influence on our language--especially in animating the use of "god" and phrases like "playing god". This is important given the prevalence of religious values in bioethics debates and the pervasiveness of the language. I hunt unsuccessfully for a meaning that could serve as a moral principle, and I show how these phrases are rooted in the paradigm. I conclude that all that such language can do is offer the pretense that there is a specific absolute ground for forbidding something which could otherwise be morally acceptable. But such language is nearly senseless, and worse still, it is immoral in that it cuts off reflection and debate.
There are religious and philosophical versions of the thesis that AIDS is a punishment for homosexual behaviour. It is argued here that the religious version is seriously incomplete. Because of this incompleteness and because of the indeterminacies that ordinarily attend religious argumentation, it is concluded that the claim may be set aside as unconvincing. Homosexual behaviour is then judged for its morality against utilitarian, deontological, and natural law theories of ethics. It is argued that such behaviour involves no impediment to important moral goals and is not therefore immoral. Where natural law might be used to condemn homosexual behaviour, it is argued that the theory itself is not well established. Consequently there is a prima facie reason for rejecting the philosophical version of the punishment thesis. This conclusion is further supported by noting the lack of proportion between the purported immorality of homosexuality and a punishment as devastating as AIDS.
388 Japanese religious groups--143 Shinto, 157 Buddhist, 58 Christian and 30 others--were asked to answer questions regarding several forms of euthanasia and extraordinary treatment during the dying process. Passive euthanasia and indirect euthanasia were accepted by around 70% of the respondents. Active euthanasia was favored by less than 20% of them. Christians were less supportive of euthanasia than practitioners of other religions. Shinto and Buddhist corporations advocated "being natural," when medical treatment became futile at the terminal stage. Religionists' views may deepen the discussion of end-of-life issues.
In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion.
Most religious traditions hold that what makes one a person is the possession of a soul and that this gives one moral status. This status in turn gives persons interests and rights that delimit the set of actions that are permitted to be done to them. In this paper, I identify the soul with the capacity for consciousness and mental life and examine the ethical aspects of medical decision-making at the beginning and end of life in cases of patients who either never have had or have lost this capacity. I argue that, although these patients may lack moral status, they nonetheless have moral value as human organisms and forms of God-given biological life. In particular, I explore what this value entails about the permissibility of withholding or withdrawing life-sustaining treatment and of harvesting viable organs from patients with no higher-brain function.
BACKGROUND: Knowledge of physician attitudes and preferences regarding religion and spirituality in the medical encounter is limited by the nonspecific questions asked in previous studies and by the omission of specialties other than family practice. This study was designed to determine the willingness of internists and family physicians to be involved with varying degrees of spiritual behaviors in varied clinical settings. METHODS: The study was a multicenter, cross-sectional, nonrandomized design recruiting physicians from 6 teaching hospitals with sites in North Carolina, Vermont, and Florida. A self-administered survey was used to explore physicians' willingness to address religion and spirituality in the medical encounter. Data were gathered on the physicians' religiosity and spirituality and sociodemographic characteristics. RESULTS: Four hundred seventy-six physicians responded, for a response rate of 62.0%. While 84.5% of physicians thought they should be aware of patients' spirituality, most would not ask about spiritual issues unless a patient were dying. Fewer than one third of physicians would pray with patients even if they were dying. This number increased to 77.1% if a patient requested physician prayer. Family practitioners were more likely to take a spiritual history than general internists. CONCLUSIONS: Most primary care physicians surveyed would not initiate any involvement with patients' spirituality in the medical encounter except for the clinical setting of dying. If a patient requests involvement, however, most physicians express a willingness to comply, even if the request involves prayer.
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This is a retrospective study of the outcome of surgical procedures in patients who were Jehovah's Witnesses. Over a 75-month period, 58 Jehovah's Witness patients had 78 surgical procedures at the Vancouver General Hospital. Three patients had preexisting anaemia of less than 100 g.L-1 haemoglobin. Postoperative haemoglobin concentration decreased below 50 g.L-1 in three patients. One patient had a postoperative haemoglobin of 34 g.L-1 (haematocrit 10.1 per cent) and survived. One patient died from uncontrollable postoperative haemorrhage. Perioperative morbidity was not uncommon, including significant hypotension (eight cases), cardiac arrhythmias (six), myocardial ischaemia (three), excessive bleeding (four), postoperative nausea or syncope (four), and wound or urinary tract infection (four).
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