End-of-life decisions: Christian perspectives.

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.     

Surrogate medical decision making on behalf of a never-competent, profoundly intellectually disabled patient who is acutely ill

With the improvements in medical care and resultant increase in life expectancy of the intellectually disabled, it will become more common for healthcare providers to be confronted by ethical dilemmas in the care of this patient population. Many of the dilemmas will focus on what is in the best interest of patients who have never been able to express their wishes with regard to medical and end-of-life care and who should be empowered to exercise surrogate medical decision-making authority on their behalf. A case is presented that exemplifies the ethical and legal tensions surrounding surrogate medical decision making for acutely ill, never-competent, profoundly intellectually disabled patients.     

Abortion in Islamic Ethics,and How it is Perceived in Turkey: A Secular,Muslim Country

Abortion is among the most widely discussed concepts of medical ethics. Since the well-known ethical theories have emerged from Western world, the position of Islamic ethics regarding main issues of medical ethics has been overlooked. Muslims constitute a considerable amount of world population. Turkish Republic is the only Muslim country ruled with secular democracy and one of the three Muslim countries where abortion is legalized. The first aim of this paper is to present discussions on abortion in Islamic ethics in the context of major ethical concepts; the legal status of the fetus, respect for life and the right not to be born. The second aim is to put forth Turkey’s present legislation about abortion in the context of Islamic ethical and religious aspects.     

Legal implications for failure to comply with advance directives: an examination of the incompetent individual's right to refuse life-sustaining medical treatment

Life-sustaining medical technology in the past century has created a growing body of case law and legislation recognizing the incompetent individual's right to make his or her own end-of-life decisions. This article focuses on California's leadership in the area of these specific end-of-life issues: specifically, exploring the right of an incompetent individual to refuse life-sustaining medical treatment. The article examines advance directives along with various judicial decision-making standards for incompetent individuals and explores the sociobehavioral and legal rationale for compliance with incompetent individual's rights to make end-of-life decisions. Finally this article concludes (i) that advance directives allow competent individuals to state the medical treatment they would prefer in the event they should later become incompetent and (ii) that when advance directives are properly executed in a detailed manner, under laws currently in effect in some jurisdictions, the preferences stated in the directive bind health care providers.     

Who is more ethical? Cross‐cultural comparison of consumer ethics between religious and non‐religious consumers

Religion is a significant part of daily life that affects consumers' decisions and behaviors. Religious consumers are predicted to be more ethical than non‐religious consumers. Nonetheless, past research suggests mixed results. Hence, the present study has two main objectives: (1) to examine differences in moral ideologies and ethical beliefs among religious and non‐religious consumers in Indonesia and Australia and (2) to investigate the impact of moral ideologies and religiosity on consumer ethical beliefs. This is one of the first cross‐cultural studies to compare consumer moral ideology (specifically, idealism and relativism) and consumer ethical beliefs between religious and non‐religious consumers. The results show that religious consumers tend more toward idealism than relativism and have stronger ethical beliefs regarding negative consumer ethical behaviors compared with non‐religious consumers. However, for ethical beliefs regarding specific consumer behaviors, namely, recycling and software piracy/buying counterfeit, the effect of religion was overshadowed by cultural differences between the two countries. This study contributes to the debate on the impact of moral ideologies and religiosity on consumer ethical beliefs. The findings may assist managers and public policymakers in their efforts to mitigate unethical consumer activities. Copyright © 2016 John Wiley & Sons, Ltd.     

Legal and Ethical Implications of Refusing to Counsel Homosexual Clients

In 2001, a federal appeals court upheld the job termination of a counselor who requested being excused from counseling a lesbian client on relationship issues because homosexuality conflicted with the counselor's religious beliefs (Bruff v. North Mississippi Health Services, Inc., 2001). This article provides the facts of the case and the legal reasoning of the court. The authors also explore the legal and ethical issues related to this case.     

Exploring the Role of Religiosity and Spirituality in Amniocentesis Decision-Making Among Latinas

Given the complex array of emotional and medical issues that may arise when making a decision about amniocentesis, women may find that their spiritual and/or religious beliefs can comfort and assist their decision-making process. Prior research has suggested that Latinas’ spiritual and/or religious beliefs directly influence their amniocentesis decision. A more intimate look into whether Latinas utilize their beliefs during amniocentesis decision-making may provide an opportunity to better understand their experience. The overall goal of this study was to describe the role structured religion and spirituality plays in Latinas’ daily lives and to evaluate how religiosity and spirituality influences health care decisions, specifically in prenatal diagnosis. Semi-structured interviews were conducted with eleven women who were invited to describe their religious beliefs and thoughts while considering the option of amniocentesis. All participants acknowledged the influence of religious and/or spiritual beliefs in their everyday lives. Although the women sought comfort and found validation in their beliefs and in their faith in God’s will during their amniocentesis decision-making process, results suggest the risk of procedure-related complications played more of a concrete role than their beliefs.     

The role of proxies in treatment decisions: evaluating functional capacity to consent to end-of-life treatments within a family context

Psychology as a profession has entered the arena of palliative and hospice care later in the process than other health care professions. Through the use of Familial Advance Planning Evaluations (FAPEs), however, psychologists can assist individuals and families in facing end-of-life transitions in important ways. Hospice and palliative care philosophy treats the patient and family as the unit of care. End-of-life decision-making is therefore a family matter as well as a normative developmental transition. Yet, little is known about the decision-making process. This paper reviews the literature regarding informed consent, advance care planning, and proxy decision-making and outlines a theoretical model for familial decision-making. Previous models of end-of-life capacity evaluations and family assessments are presented and serve as the basis for a comprehensive assessment of familial decision-making at the end of life. Functional capacity evaluations of individuals at the end of life regarding decisions about life-sustaining medical treatments enable both the individual patient and one identified proxy from his or her family to discuss important issues families may face during medical crises at the end of life. The information gleaned from such evaluations has the potential to assist psychologists and other professionals in designing family-specific interventions to reduce caregiving distress, improve quality of life for dying patients, and ease the transition to bereavement for caregivers.     

Medical ethics in Britain

This paper describes ‘the medical ethics scene’ in Britain. After giving a brief account of the structure of British medical ethics and of the roles of the different groups involved it mentions some of the important medico-moral events and issues of the fairly recent past, and describes in greater detail four important examples of professional, legal, governmental and media concerns with medical ethics, themselves illustrating the wide variety of interests wishing to influence the British medical profession's ethics. The examples offered are the development of research ethics committees, the Sidaway case concerning informed consent, the Warnock Committee's Report on in vitro fertilisation and associated issues, and the 1980 Reith Lectures on ‘Unmasking Medicine’. In the final section a fairly new methodological development in British medical ethics is described in which the medical profession is increasingly recognising the need to add to traditional medical ethics education, with its longstanding history of the inculation and enforcement of ethical norms, an element of philosophical or critical medical ethics, at the heart of which is justification of substantive medico-moral claims in the light of counterarguments.     

Revisiting the problem of Jewish bioethics: the case of terminal care

This paper examines the main Jewish sources relevant to end-of-life ethics, two Talmudic stories, the early modern code of law (Shulhan Aruch), and contemporary Halakhaic (religious law) responsa. Some Orthodox rabbis object to the use of artificial life support that prolongs the life of a dying patient and permit its active discontinuation when the patient is suffering. Other rabbis believe that every medical measure must be taken in order to prolong life. The context of the discussion is the most recent release of the "Steinberg Report," which proposes a law regulating end-of-life issues in Israel. It is argued that the Orthodox rabbis base their views on a strongly positivist concept of religious law. The rabbis deliberate the law as a manifestation of the will of God and try to stretch the law as much as possible in order to benefit the patient, even when it is good for the patient to die. Direct and active actions that kill are prohibited; certain forms of passive euthanasia and contrivances that terminate life support without needing direct human action are accepted.     

Balancing Confidentiality and Collaboration Within Multidisciplinary Health Care Teams

As multidisciplinary perspectives are increasingly integrated into the treatment of health problems, opportunities for clinical psychologists in medical settings are expanding. Although cross-discipline collaboration is at the core of multidisciplinary treatment models, psychologists must be particularly cautious about information sharing due to their profession??s ethical standards regarding patient confidentiality. Psychologists?? ethical obligations require them to achieve a delicate balance between contributing to the treatment team and protecting patient confidentiality. In the current review, relevant ethical standards and federal guidelines are applied to everyday practices of clinical psychologists in medical settings. Additionally, recommendations for individual psychologists, health care organizations, and graduate training programs are presented.     

Legal and Ethical Considerations in Allowing Parental Exemptions From Newborn Critical Congenital Heart Disease (CCHD) Screening

Critical congenital heart disease (CCHD) screening is rapidly becoming the standard of care in the United States after being added to the Recommended Uniform Screening Panel (RUSP) in 2011. Newborn screens typically do not require affirmative parental consent. In fact, most states allow parents to exempt their baby from receiving the required screen on the basis of religious or personally held beliefs. There are many ethical considerations implicated with allowing parents to exempt their child from newborn screening for CCHD. Considerations include the treatment of religious exemptions in our current legal system, as well as medical and ethical principles in relation to the rights of infants. Although there are significant benefits to screening newborns for CCHD, when a parent refuses for religious or personal beliefs, in the case of CCHD screening, the parental decision should stand.     

The Care of the Ultra-Orthodox Jewish Patient

The Ultra-Orthodox Jewish community embraces a system of values and a rigorous behavioral code that are deeply rooted in religious tradition and history. Here we describe some of the unique challenges that stem from the encounter between modern medical practice and the Ultra-Orthodox world. Through examples of clinical and ethical scenarios ranging from prenatal care to end-of-life decisions, we illustrate problems related to observance of age-old practices in a modern hospital setting, balancing acceptance of Divine will with standard risk assessment, reconciliation of patient autonomy with deference to rabbinic authority and fear of stigma associated with mental illness in a traditional society. We also offer a generalizable model where inquiry precedes pre-formulated judgment to help clinicians provide enhanced care for this population.     

Family decision-making for nursing home residents: Legal mechanisms and ethical underpinnings

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and specific ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers.     

Religion in the Nordic Countries: Between Private and Public

A new visibility of religion in public life can be observed in the Nordic countries. This visibility is not due to a popular claim for a return of religion in the public sphere. As research conducted at Uppsala University in Sweden indicates, the visibility of religion in the Nordic countries reflects several concurring factors: the state’s continued relationship with churches and other religions; the growth of new forms of social exclusion drawing religion into public discussions on ethical and social issues; growing religious pluralism prompting political and legal regulation; a spirituality relating to existential issues and issues related to quality of life. The results raise important questions about Nordic modernity. They suggest that religion becomes public in several ways and emerges as an arena that connects the private and the public beyond conventional distinctions.     

“Sanctity-of-Life“—A Bioethical Principle for a Right to Life?

For about five decades the phrase “sanctity-of-life“ has been part of the Anglo-American biomedical ethical discussion related to abortion and end-of-life questions. Nevertheless, the concept’s origin and meaning are unclear. Much controversy is based on the mistaken assumption that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. In this paper, I offer an analysis of the religious and philosophical history of the idea of “sanctity-of-life.” Drawing on biblical texts and interpretation as well as Kant’s secularization of the concept, I argue that “sanctity” has been misunderstood as an ontological feature of biological human life, and instead locate the idea within the historical virtue-ethical tradition, which understands sanctification as a personal achievement through one’s own actions.     

Legal and Ethical Implications of Using Religious Beliefs as the Basis for Refusing to Counsel Certain Clients

This article addresses potential legal and ethical implications of lawsuits that have been brought when counselors and counseling students have used their religious beliefs as the basis for refusing to counsel lesbian, gay, bisexual, and transexual clients. Four lawsuits are reviewed, issues relevant to the cases are identified, and implications for counselor educators and counseling students are discussed.     

Uncertainty in ethical consumer choice: a conceptual model

The market place has seen significant growth in the demand for ‘ethical’ products and services. Yet, consumers often experience knowledge, evaluation and choice uncertainties in decision‐making processes, particularly in relation to products such as ethical clothing. The authors explore this pertinent form of consumer uncertainty through three qualitative studies of ethical consumers that examine their approaches to clothing consumption. In‐depth interviews and focus groups confirm uncertainty arises; the results also identify the causes and consequences of consumer uncertainty in this context. The causes of uncertainty pertain to issues surrounding complexity, ambiguity, conflict and credibility that give rise to uncertainties that result in delaying purchase decisions, compromising beliefs and negative emotions. This study contributes to literature by offering a holistic understanding of the challenges facing consumers when making ethical choices. Copyright © 2013 John Wiley & Sons, Ltd.     

The Well- and Unwell-Being of a Child

The concept of the ‘well-being of the child’ (like the ‘child’s welfare’ and ‘best interests of the child’) has remained underdetermined in legal and ethical texts on the needs and rights of children. As a hypothetical construct that draws attention to the child’s long-term welfare, the well-being of the child is a broader concept than autonomy and happiness. This paper clarifies some conceptual issues of the well-being of the child from a philosophical point of view. The main question is how well-being could in practice acquire a concrete meaning and content for a particular issue or situation. A phenomenological-hermeneutic research perspective will be outlined that allows the child’s well-being to be elucidated and specified as an anthropological and ethical idea. It is based on a contextual understanding of generative relationships, a combination of the theory and practice of making sense, here described as ‘generative insight’, which could provide ethical guidance for decision making in families, legal practice, medicine or biomedical research.