The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

Proof by Assumption of the Possible in Prior Analytics, 1.15; How Not to Blend Modal Frameworks

The present paper aims to show that the reconstruction of the formal framework of the proofs in Pr. An. 1.15, as proposed by Malink and Rosen 2013 (‘Proof by Assumption of the Possible in Prior Analytics 1.15’, Mind, 122, 953-85) is due to affront a double impasse. Malink and Rosen argue convincingly that Aristotle operates with two different modal frameworks, one as found in the system of modal logic presented in Prior Analytics 1.3 and 8-22, and one occurring in many of Aristotle’s works, such as the Physics, De Caelo and the Metaphysics. However, they misconstrue the latter framework. More precisely, they misconstrue the domain of significance of what they call the ‘Principle of Necessitation’. As a consequence, bringing the two frameworks into one results into a contradictory modal logic. On the other hand, if the Principle of Necessitation is rectified, the proofs put forward by Malink and Rosen in the same paper are no longer available.     

Contact sports, moral functioning and planned behaviour theory

The goal was to test the psychometric properties of the Moral Functioning Scale in a Greek athletic context, and to investigate any possible relation between moral functioning and planned behaviour. The sample comprised 384 athletes, 103 from the sport of football (soccer), 97 from basketball, and 184 from water polo. To measure moral functioning the researchers used a scale developed by Gibbons, Ebbeck, and Weiss. Planned Behaviour was assessed with a questionnaire based on Planned Behaviour Theory. Hierarchical regression analysis indicated strong association for Attitudes, Intention, Role Identity, and Perceived Behavioural Control with the four dilemmas of the moral functioning scale. The moral reasoning measure is a promising tool for measuring athletes' moral dilemmas in Greece.     

The family covenant and genetic testing

The physician-patient relationship has changed over the last several decades, requiring a systematic reevaluation of the competing demands of patients, physicians, and families. In the era of genetic testing, using a model of patient care known as the family covenant may prove effective in accounting for these demands. The family covenant articulates the roles of the physician, patient, and the family prior to genetic testing, as the participants consensually define them. The initial argument defines the boundaries of autonomy and benefit for all participating family members. The physician may then serve as a facilitator in the relationship, working with all parties in resolving potential conflicts regarding genetic information. The family covenant promotes a fuller discussion of the competing ethical claims that may come to bear after genetic test results are received.     

A multigenerational study on the correlation of values and advance directives

The development of the Values History instrument for use in advance directive decision making has raised the question of the importance of values in eliciting advance directives. This pilot study examines the relationship between the domains of values and advance directives drawn from the Values History in three generation intrafamily triads. Significant correlations between values and advance directives were found primarily within the youngest generation. Results reveal a relatively high familiarity by the participants of the various established forms of advance directives. Also, a significant percentage of parents and grandparents was found to have signed some form of advance directive.     

Primary care physician attitudes and values toward end-of-life care and physician-assisted death

This study explores how primary care physician attitudes toward physician-assisted death (PAD) are related to their personal values toward end-of-life care and PAD. A group of 810 Michigan family physicians, internists, and general practitioners, divided into 4 typology groups by their intention toward participating in PAD, rated their attitudes toward PAD, along with their values and preferences for their own end-of-life care. Respondents who most objected to PAD were less likely to have executed an advance directive and more likely to have values promoting continued life-sustaining treatment in their own terminal care. Furthermore, a significant number of physicians, who had strong values against their own withdrawal of treatment in terminal care, were opposed to the withdrawing or withholding of life-sustaining treatment in patient care. Considerations of personal physician values are relevant in the discussion of PAD and the withdrawal of treatment in terminal care.