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The concealed and the revealed: bioethical issues in Europe at the end of the second millenium.

Bioethical debate in Europe is partly a reaction to political endeavors and events. In line with the political goal of a united Europe, a European regulation is being sought for medical research and medical ethics ('Convention on Human Rights and Biomedicine'). A certain degree of ambivalence has come to the fore: whilst it does seem possible to reach a consensus (albeit a merely 'diplomatic' consensus) about complicated bioethical issues at an international level when certain controversial matters are excluded or a certain vagueness maintained, new principles are also required at a national level, for example when the medical profession of one state feels obliged to assume a 'local' stance, such as in the sensitive issue of termination of treatment. The individual contributions to this publication, together with various other current fields of bioethical conflict in Europe--especially Germany--are introduced below against a common background, namely that the original dividing line between the concealed and the revealed has shifted.

Abortifacient Agents, Steroidal↗

[Ethical and bioethical issues disturbing nursing: REBEn's publications from 1970 to 2000].

UNLABELLED: It was studied the ethical and/or bioethical issues published in the Revista Brasileira de Enfermagem (Brazilian Nursing Journal-REBEn) that disturbed the nursing in the period between 1970 and 2000. Tha aim was to identify in articles published in the REBEn, during the mentioned period, subjects related to the ethics/bioethics. To discuss the theoretical perspectives in which the authors base their arguments. The study was quantitative and qualitative, documentary or bibliographical type. RESULTS: in the last 30 years it had gradual increase in the number of the articles that debates ethical questionings. After 1984 appear the first study, with bioethics connotation, in which the author discourses on the interventions of nursing before the patient in imminent death, with the purpose to verify the relations between the personal and professional values of the nurse. Was Valdria Lunardi who used the bioethics term for the first time in 1998.

Bibliometrics↗

[Bioethical issues and principles in cancer treatment].

Bioethics was established as a new area of interdisciplinary studies focusing on human conduct in the field of the life sciences and health care in the light of moral values and principles in the 1960's and the beginning of the 1970's. Physicians abiding by classical medical ethics based upon the Oath of Hippocrates became subject to criticism because they behaved paternalistically in relation to their patients and provided medical treatment dogmatically without adequate explanation concerning conditions and diagnoses of patients' diseases, what kinds of treatments they were to receive and the possible benefits and risks thereof, along with their prognoses. During the patients' rights' movement, law suits against paternalistic physicians increased in number and the courts tried to establish ethical and legal principles for judgments in law suits using the Ethical Code of Neurenberg (1947) as an excellent model. The legal principles established as "informed consent" include obligations of physicians to provide their patients with adequate explanation and truth-telling, and the rights of patients to autonomy, choice, self-determination, and to give consent to physicians. Besides these rights, patients also have the right to put their veto on their own rights. In such cases, truth-telling by physicians, who believe in truth-telling, such as the disclosure of the diagnosis of cancer to these patients, can legally result in infringement of the patient's rights. It is important for physicians to respect the wishes and opinions of patients based on their own values and not to insist on personal dogmatic opinions. The disclosure of cancer diagnosis to terminal patients is certainly one of the most difficult procedures in medical practice and requires profound medical experience and bioethical insight.

Bioethics↗

Bioethical issues concerning death: death, dying, and end-of-life rights.

Ethical issues about death, dying, and a person's right to make end-of-life decisions have become one of the most legally complex and culturally sensitive areas to emerge in our time. Sensitive issues associated with a terminally ill individual's right to make end-of-life decisions and the disposition of those who are unable to make such decisions for themselves will keep healthcare professionals, medical ethicists, counselors, families, lawyers, judges, and legislators busy for years to come. Americans find it difficult to deal with end-of-life issues and would rather focus on what more can be done to save a life.

Advance Directives↗

[Bioethical issues involved in the prescription of levonorgestrel].

The use of levonorgestrel for emergency post coital contraception after rape, has raised strong and recurring discussions during 2004 and 2005 in Chile. The debate has been centered in its presumed post fertilization or anti implantation effect, that some consider an abortive action. There are no scientific evidences supporting this effect, with divergences about the ontological status of the embryo. Therefore, the use of levonorgestrel implies bioethical decisions that, in a democratic and pluralistic society, should be solved considering individual and collective responsibilities, conditions of equity and the informed autonomy of the affected women. Their moral values and their capacity to assume the consequences of an assault on their dignity, honor and self-esteem, in addition to physical and mental injuries, should also be considered.

Bioethical Issues↗

Applying theological developments to bioethical issues such as genetic screening.

Catholic movements within the centre of Roman Catholic doctrine recently have discussed Trinitarian theology as applied to sciences, arts, economics, health and other social areas. We explore the possibilities Trinitarian theology offers to bioethical debate, concentrating particularly on genetic screening and testing. It is important therefore to analyse the philosophical implications of this approach onto the bioethical world, where much disagreement occurs on fundamental issues. It is Catholic basic teaching to recognize and see God's hand in plurality, not merely as a cliche and then doing what we feel is right, but to recognize how to live in a pluralistic world. We recognize, in agreement with these theologians, that in order for a Trinitarian mode of understanding to be used by those doing bioethical debate, there is a need to depart from fundamentalism.

Bioethics↗

Rural bioethical issues of the elderly: how do they differ from urban ones?

Typical ethical issues in health care for the elderly include decision making for elderly patients with and without capacity, advance directives, the use of life-sustaining technologies, and questions of access to services and justice. Obviously the same issues are relevant for elderly patients in rural settings. But the unique features of rural living add another dimension to ethical discourse and the care of patients, namely the primary importance of relationships. Rural bioethics is based on an ethic of familiarity, which alters our attention to such issues as confidentiality, multiple relationships, scope of practice, and access issues. The following article briefly outlines the unique features of rural bioethics and provides a case analysis.

Aged↗