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Training physicians to care for the dying.

PROBLEM: The education of medical students and house staff regarding management of death and timely discussions of death with patients and families has been deficient, leaving physicians ill-equipped to provide appropriate care to dying patients. METHOD: We propose a five-pronged curriculum in terminal care to be ongoing from medical school through postgraduate training. This program includes: Clinical skills--including pain and symptom management, prognostication and care in various settings; Communication skills--including listening and how to discuss bad news with patient and family; Psychosocial issues; Administrative/management and team interaction, and Bioethical issues, including DNR and living wills. CONCLUSION: It is hoped that such training will teach physicians to accept death as inevitable, to recognize and acknowledge the state of dying and, finally, to understand that appropriate care includes appropriate death, which is one arrived at with minimal suffering, with minimal social and emotional impoverishment, with preservation or restoration of important relationships and with resolution of residual conflicts.

Clinical Competence↗
PubMed1989

Ethics committees for "high tech" innovations in Japan.

Although ethics committees in Japan have been developing in major medical schools and in some hospitals, their members are usually medical professionals from the same institution. The lack of national legislation for setting up ethics committees permits only a voluntary code of standards for doing clinical research work in high tech medical applications. The author argues for the necessity of more open debate on bioethical issues and proposes the participation of the lay public and bioethicists in Ethics Committee in Japan.

Advisory Committees↗
PubMed1990

Current trends in biomedical ethics in the United States.

Enormous growth of medical activities and issues in the 1960s and 1970s stimulated birth of the field of contemporary biomedical ethics. Nevertheless, when one examines recent trends within the field in the United States, one is struck with how many significant transformations and developments have occurred since that time. This presentation examines recent developments in five areas--those of patient rights and autonomy, termination of life, manipulation of Nature, health care resource allocation, and decision-making by the general public. The author also notes that although bioethical issues have become politicized as major interest groups and the general public have become increasingly involved, the quest for consensus remains a central one for health care ethics in the United States.

Bioethical Issues↗
PubMed1989

The President's Commission: the need to be more philosophical.

This paper argues, contrary to what has sometimes been claimed, that public commissions need to be more philosophical than they have been in analyzing crucial bioethical issues. It argues (a) that the failure of the President's Commission to develop and use even simple distinctions between life and personhood led to flaws in both its discussion of death and its discussion of persistent vegetative patients, and (b) that its treatment of access to health care fails to develop a coherent approach precisely because it is based on no serious philosophical reflections about justice in health care.

Advisory Committees↗
PubMed1990

Public philosophy: distinction without authority.

An assumed core of normative ethical principles may constitute a philosophically proper framework within which public policy should be formulated, but it seldom provides any substantive solutions. To generate public policy on bioethical issues, participants still need to confront underlying philosophical controversies. Professional philosophers' proper role in that process is to clarify major philosophical options, to press wider-ranging consistency questions, and to bring more parties into the philosophical debate itself by arguing for particular substantive claims. Though questions of fact that mediate final policy conclusions frequently fall outside philosophical competence, one sort of fact, lack of political support, should seldom cause philosophers to stand aside; philosophers still have an important role as critics of culture, politics, and profession. They have no authority, however, on even the philosophical presuppositions of public policy.

Advisory Committees↗
PubMed1986

Selected bibliography of recent articles in ethics and geriatrics.

The disciplines of bioethics and geriatrics have had parallel development in recent years. From small and relatively esoteric fields 15 or 20 years ago, both have grown enormously. Although the numbers of geriatricians and ethicists in practice or in academic centers have increased substantially, these disciplines represent areas in which better understanding is sorely needed. This bibliography is intended to assist the clinician in locating salient literature concerning bioethical issues in geriatric medicine and research. It is highly selective; it does not attempt to cover all the literature on bioethics. There are several excellent general bioethics bibliographies for clinicians in the recent literature, as well (not limited to clinical journals or clinical topics), some of which are included in section 13 for the reader's further information. The ethical issues that arise in geriatric medicine are similar to those that arise in the care of younger patients, but certain kinds of problems happen with far greater frequency. Dilemmas concerning decisions about care at the end of life are particularly relevant in geriatrics, as persons of extreme old age are often presented with choices about life-sustaining therapy when critical illness occurs. This includes decisions about cardiopulmonary resuscitation and nutritional support. When these clinical decisions arise in the care of patients who cannot decide for themselves, the question arises as to what role the assessment of "quality of life" ought to play in decisions to pursue or to forego life-sustaining therapy. Informed consent to treatment and to participation in research has been an important area of ethical investigation. Dilemmas about consent to treatment are complicated in some elderly populations because of the higher incidence of cognitive impairment and the higher incidence of the clinician's suspicion (or assumption) of cognitive impairment. In consent to research, there are additional issues of voluntariness and equitable selection, especially when subjects are residents of nursing homes. Because of the increasing numbers of elderly persons in our society, and because of the role of social resources (federal, state, and local) in acute and long-term medical major concern in gerontologic bioethics. The topic headings for this bibliography reflect these common issues which arise in the care of the elderly.+2

Bibliographies as Topic↗
PubMed1985

Oregon Health Decisions. An experiment with informed community consent.

Oregon Health Decisions is a citizen-based project intended to develop statewide awareness of severe bioethical dilemmas. The project has set in motion civic means for addressing and resolving problems in Oregon's health provision system associated with personal autonomy, equity of access, prevention of illness, and humane cost containment. The process of civic involvement with consequent results is described together with the implications for future health policy in Oregon and elsewhere.

Advisory Committees↗
PubMed1990

Human gene therapy, the public, and public policy.

The public's involvement in the debate over human gene therapy is used to illustrate two points. First, complex bioethical issues often come to the public's attention because of a scandal, in this case the Cline episode; enlightened discussion and public understanding are difficult to achieve under these conditions. Second, even with unfavorable circumstances at the outset, the debate can become channeled into politically responsible institutions which then can develop effective public policy. For gene therapy, four significant forums emerged: the President's Commission's Report Splicing Life, the 1982 Congressional Hearings, the OTA Report, and the RAC's Points to Consider document.

Advisory Committees↗
PubMed1987

Bioethics as a prescription for civic action: the Japanese interpretation.

This paper reports on recent developments in the rise of bioethics in Japan. Much of the recent interest in bioethics in Japan is seen as a response to various civic movements. The women's liberation movement, access to equal opportunity, and the recognition of patients' rights and the importance of informed consent are among some of the movements influencing the development of bioethics in Japan. The author argues that this movement is to be encouraged and fostered by health care professionals, public policy makers, as well as lay persons in Japan.

Bioethical Issues↗
PubMed1988

Bioethics in Thailand: the struggle for Buddhist solutions.

The Thai concern for bioethics has been stimulated by the departure of Thai medicine from its long tradition through the introduction of Western medical models. Bioethics is now being taught to Thai medical students emphasizing moral insights and principles found within Thai culture. These are to a large extent Buddhist themes. Veracity is always a duty for people in general and medical personnel in particular. Falsehoods and deception cannot be morally justified simply on the grounds that we think it is good for another. Buddhism also prohibits killing. The doctrine of kamma holds that joys and sorrows are the result of one's own past actions. Kamma must run its course or will be manifest in a future life. Mercy-killing also violates the Buddhist psychology. A physician who kills subconsciously transfers his aversion to suffering to the one who embodies the suffering. Buddhist justice is understood in terms of impartiality and equal treatment. Compassion goes beyond justice to self-giving and self-denial. It is central to the path to the attainment of highest human fulfillment.

Advisory Committees↗