Spirituality,health care,and bioethics

This article explores the relationship of spirituality to health care and bioethics in terms of the need and efforts of people to make sense of their lives in the face of illness, injury, or impending death. Moving beyond earlier associations with specific religious traditions, spirituality has come to designate the way in which people can integrate their experiences with their sense of ultimate meaning and related values. The holistic model of health care also affirms that one should not simply treat a body in pain, but respond to the suffering of the whole person within his or her full life. A narrative emphasis in ethics also maintains that ethical decisions occur within the framework of interacting life-stories, each of which embodies a certain core vision and set of values. In each instance it is the life stories of people, their lived narratives, that provide a common thread. The telling of these stories and the discernment of the lived spirituality they contain may assist persons in the process of achieving understanding, making decisions, and finding purpose in the experience of illness, injury, or disability.Maureen Muldoon, Ph.D., is Associate Professor in the Department of Religious Studies, University of Windsor, Windsor, Ontario, and Norman King, Ph.D., is Professor in the same department.     

Love,care, control and punishment*

Love, care, control and punishment—each has its particular, though not exclusive, institution. Institutions are projections of our needs or the needs of the past. The family is the institution of love. Education, health and social services are the institutions of care. The police and the army are the institutions of control. The courts and the prisons the institutions of punishment.     

Justice, health care, and the elderly

Concern over rising health costs in the United States has led to an intensifying policy debate over health care for the elderly and a rethinking of questions on intergenerational justice and the claims of the aged on social resources. Major contributions to this debate have been made by Daniel Callahan in his Setting Limits (Simon & Schuster; 1987) and by Norman Daniels in his Am I My Parents' Keeper? (Oxford University Press; 1988). Brock reviews Callahan's and Daniels' work, identifying the central focus of both as the age-group problem of resource allocation. He sees Callahan as calling upon a communitarian political philosophy and Daniels as arguing from a tradition of political liberalism. While disagreeing in part with both authors, Brock identifies compatible elements in their arguments that contribute significantly to the public debate over health care and the aged.     

Television,madness and community care

This paper describes the forms and contents of television representations of mental illness in the UK in 1992. The theoretical framework is provided by Moscovici's theory of social representations and some modifications are proposed for the case of madness. Quantitative and qualitative methods are used in the empirical analyses. It is shown that madness has multiple meanings on television, while at the same time violence is commonly included. It is also suggested that a partial reconfiguration of the representational field has taken place in recent years. Media stories about the responsibility of the policy of community care for scandals and tragedies are now commonplace. © 1998 John Wiley & Sons, Ltd.     

Psychology,health and health care

This article traces the development of the World Health Organization's emphasis on psychological and behavioural factors in health and notes its encouragement of recognition of these factors by member states. The article further outlines the reasons for this increasing recognition and stresses the important role of psychological and behavioural factors in the maintenance of health and prevention of illness.     

Kant,health care and justification

An argument based on Kant for access to health-care for all is a most helpful addition to prior discussions. My paper argues that while such a point of view is helpful it fails to be persuasive. What is needed, in addition to a notion of the legislative will, is a viewpoint of community which sees justice as originating not merely from considerations of reason alone but from a notion of community and from a framework of common human experiences and capabilities.     

Conscience,tolerance, and pluralism in health care

Theoretical Medicine and Bioethics - Increasingly, physicians are being asked to provide technical services that many (in some cases, most) believe are morally wrong or inconsistent with their...     

Judaism, justice, and access to health care

This paper develops the traditional Jewish understanding of justice (tzedakah) and support for the needy, especially as related to the provision of medical care. After an examination of justice in the Hebrew Bible, the values and institutions of tzedakah in Rabbinic Judaism are explored, with a focus on legal codes and enforceable obligations. A standard of societal responsibility to provide for the basic needs of all, with a special obligation to save lives, emerges. A Jewish view of justice in access to health care is developed on the basis of this general standard, as well as explicit discussion in legal sources. Society is responsible for the securing of access to all health care needed by any individual. Elucidation of this standard of need and corresponding societal obligations, and the significance of the Jewish model for the contemporary United States, are considered.     

The bioethics of care: widows, monastics, and a Christian presence in health care.

At the beginning of the twenty-first century, with vocations to the Christian religious orders of the West in marked decline, an authentic Christian presence in health care is threatened. There are no longer large numbers of women willing to offer their life labors bound in vows of poverty, chastity, and obedience, so as to provide a real preferential option for the poor through supporting an authentic Christian mission in health care. At the same time, the frequent earlier death of men leaves a large number of widows, some in need of care and some able to provide care. Drawing on the role of widows sketched in 1 Timothy 2, one can envision Christian widows entering a life of prayer and service in health care settings. As female monastics, such widows could reintroduce a salient Christian presence in health care. How one ties this response to the message of 1 Timothy 2 will depend on one's understanding of the status of Scripture, the significance of tradition, the nature of theological epistemology, the meaning of theology, the nature of the Church, and the ontology of gender. The position taken on these issues will define the character of a Christian bioethics of care.     

Widows, women, and the bioethics of care.

Widows, women, and the bioethics of care must be understood within an authentic Christian ontology of gender. Men are men and women are women, and their being is ontologically marked in difference. There is an ontology of gender with important implications for the role of women in the family and the Church. The Christian Church has traditionally recognized a role for widows, deaconesses, and female monastics, which is not that of the liturgical priesthood, but one with a special relationship to care and therefore with particular implications for health care and a Christian bioethics of care in the twenty-first century. In the shadow of early male mortality, women as wives should turn to support their husbands and as widows to support those in need. Widows, in becoming authentic Christian monastics, can bring into the world an icon of rightly ordered women providing rightly ordered Christian care for those in need. They can enter the moral vacuum created by misunderstandings of the place of women and the service vacuum created by a disappearance of religious nuns in Western health care facilities with a presence that is at one with the Church of the Fathers.     

Comradery,community, and care in military medical ethics

Medical ethics prohibits caregivers from discriminating and providing preferential care to their compatriots and comrades. In military medicine, particularly during war and when resources may be scarce, ethical principles may dictate priority care for compatriot soldiers. The principle of nondiscrimination is central to utilitarian and deontological theories of justice, but communitarianism and the ethics of care and friendship stipulate a different set of duties for community members, friends, and family. Similar duties exist among the small cohesive groups that typify many military units. When members of these groups require medical care, there are sometimes moral grounds to treat compatriot soldiers ahead of enemy or allied soldiers regardless of the severity of their respective wounds.     

Personal privacy in the health care system: employer-sponsored insurance, managed care, and integrated delivery systems

Widespread collection and use of identifiable information can promote social goods while, at the same time, infringing on personal privacy. Information systems are developing within the context of a fundamental transformation in the organization, delivery, and financing of health care. Changes in the health care system include rapid development of employer-sponsored health coverage, managed care organizations, and integrated delivery systems. These complex, multifaceted arrangements for delivering and paying for health care require ever-more-sophisticated information systems that facilitate extensive sharing of personal data. Systemic flows of sensitive health information occur both vertically and horizontally among employers, hospitals, insurers, laboratories, and suppliers. Beyond this complex web of vertical and horizontal sharing are the multiple demands for information management, quality assurance, research, governmental regulation, and public health. Theoretical problems exist with the law and ethics of informational privacy. The traditional method of exercising control over personal health information is through informed consent. Informed consent, however, within a modern health information infrastructure becomes highly complex. In this kind of environment, the doctrine of informed consent is flawed and does not provide sufficient control over personal information to assure adequate protection of privacy.