Cultivating ethics consultation: commentary on "The development of a clinical ethics consultation service in a community hospital

Conclusion: Simpson's article [in this issue, p. 124-130] provides us with needed data about the development and utilization of an ethics consultation service in a community hospital. It makes clear, however, how much further we have to go in developing guiding standards for practitioners and institutions. We need to learn much more about the effectiveness of ethics consultation in meeting well-defined goals and producing desired processes and outcomes before standards for credentials and accountability have a sound empirical basis.     

The ethics of enforced medical treatment: the balance model

ABSTRACT When is it right to enforce medical treatment on a patient who is refusing that treatment? English law recognises two ethical principles as of paramount importance: the autonomy of the patient; and the consequences of not treating compared with treating. The law, by and large, operates these principles in succession. Thus, in the case of a patient refusing treatment, the law asks first, is the patient competent? Only if the answer is no, are the consequences considered. We criticise the position taken by English law and argue, first, that competence is a graded and not a binary concept, and secondly, that the two ethical principles should be applied not sequentially but at the same time. These two ideas form what we have called the balance model. This model could be used for an empirical study of individuals’ ethical beliefs, and in particular to test the hypothesis that the ethical beliefs of most individuals conform to the balance model rather than to the position taken by English law.     

Inside baseball and ethics consultation: a comment on "ethics been very good to us"

In response to the article by Scofield, I consider the that, how, and why of ethics consultation, moral expertise, and the rules of the game. The question still to be engaged is, how does all of this work out for patients and families?     

The case of Peter: reflections on applied ethics in a neonatal intensive care unit

The case of Peter is reflected upon in order to highlight some of the moral theorising that could be brought to bear in the process of providing palliative care for sick neonates. The situation will be discussed using the theoretical lenses of deontological and virtue ethics. Nursing practice is considered as engaged moral reasoning where the nurse brings his/her beliefs, knowledge and experience into the situation and engages in reflexivity to provide appropriate ongoing patient care. The care should be provided in culturally sensitive manner and tailored to the needs of the newborn and their family. Nurses should initiate early consultations with colleagues, medical staff and families to address concerns about patient well-being in order to enhance the well-being of patients and families and to improve the work environment making it more conducive to care.     

Harmonizing global ethics in the future: a proposal to add south and east to west

This article considers how global ethical matters might be approached differently in the English-speaking literature if values salient in sub-Saharan Africa and East Asia were taken seriously. Specifically, after pointing out how indigenous values in both of these major parts of the world tend to prescribe honouring harmonious relationships, the article brings out what such an approach to morality entails for political power, foreign relations and criminal justice. For each major issue, it suggests that harmony likely has implications that differ from approaches that currently dominate Western thought, namely those of utility, autonomy and capability. Lacking the space to systematically defend harmony as a fundamental value, it nonetheless urges theorists not to neglect it in future work.     

Instrumentalist analyses of the functions of ethics concept-principles: a proposal for synergetic empirical and conceptual enrichment

Theoretical Medicine and Bioethics - Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has...     

Promoting co-operative parenting after separation: a therapeutic/interventionist model of family mediation

With adequate therapeutic support, the ideal of co-operative shared parenting could become a reality for the majority of separated, divorced and remarried families. A therapeutic/interventionist approach to family mediation (as contrasted to the more short-term, future-focused, neutralist mainstream model, structured strictly towards the resolution of issues under dispute) may offer the most effective and efficient means to do this. Within this approach, mediation is used to introduce separating parents to shared parenting as a viable alternative, reduce their anxiety about shared parenting as a living arrangement deviating from the norm, enable them to consider a range of shared parenting options, help them work through the development of a shared parenting plan, and support them in the transition to post-divorce parenting. In its emphasis on parental responsibility and shared parental authority in the resolution of post-separation parenting disputes, the model reflects an orientation consistent with the philosophy of the Children Act 1989, and is ideally suited for use by family therapists working with parents during the divorce transition.     

Yoga and the battlefield of ethics: Highlighting an infusion model for ethics education

This paper articulates an infusion model of ethics education for engineering students by illuminating the value of a religious studies course on yoga. This model is distinguished from four other possible approaches that have traditionally been used to prepare engineering students to face the challenges of the work place. The article is not claiming that this approach should be used to the exclusion of the other approaches, but rather that it adds strength to the other approaches. Specifically, the article claims that the infusion model provides an opportunity for students to reflect upon the foundational ethical positions emanating from the world's religions and thereby provides them with a vista from which they can not only ask what professional ethical code applies in a given situation, but also ponder the nature of character needed to follow that ethical code.     

The gastroenterologist and his endoscope: The embodiment of technology and the necessity for a medical ethics

The purpose of this essay is to argue for the necessity of an ethics of the practice of the specialist-technologist in medicine. In the first part I sketch three stages of medical ethics, each with a particular viewpoint regarding the technology of medicine. I focus on Brody's consideration of the “physician's power” as a example of contemporary medical ethics which explicitly excludes the specialist-technologist as a locus of development of medical ethics. Next, the philosophy of Heidegger is examined to suggest an approach to the problem, and, finally, some of Levinas' contributions regarding the “other” are introduced to suggest a preliminary approach to a medical ethics of the specialist-technologist.