This paper looks at the ambiguities which PAS (physician assisted suicide) and voluntary active euthanasia (VAE ) present to the patient, his or her loved ones and the health-care team. The author pleads for a greater emphasis on humanizing the experience of the dying so that a team can meet their physical, emotional and spiritual needs.

This paper argues that we have wrongly and not for the patient’s benefit made a form of stark autonomy our highest value which allows physicians to slip out from under their basic duty which has always been to pursue a particular patient’s good. In general – I shall argue – it is the patient’s right to select his or her own goals and the physician’s duty to inform the patient of the feasibility of that goal and of the means needed (...) to attain it. If the goal is not one that is possible, the patient, with the physician and family, must select a feasible goal and then discuss the costs/benefits of various approaches. The physician should take a leading role in helping the patient select the goal. I argue that to simply present a laundry list of means and insist that patients choose for themselves is not only abandoning patients to their autonomy but is, in fact, a crass form of violating the patient’s autonomy. Freely choosing not to choose is a choice a patient with decisional capacity is entitled to make and one that needs to be respected. (shrink)

'Concerns about livestock farming mainly focus on animal welfare. Societal groups address livestock farmers on their duty of care because more and more animals are kept in increasingly intensive systems. Most farmers, as caring farmers, are willing to take various measures to improve the welfare of their animals. However, not all solutions to animal welfare problems are seen as a welfare improvement or give rise to other welfare concerns. How will farmers be able to perform their duty of care?'.

This research investigates the impact of various factors on ethical behavior of 180 not-for-profit hospital employees. Ethical behavior of peers, ethical behavior of successful managers, and emotional intelligence had a significant positive impact on ethical behavior of respondents. Physicians and hospital employees with political connections within the organization were significantly less ethical than other employees. The results have many implications for researchers and healthcare practitioners.

This paper discusses physician-assisted suicide and voluntary active euthanasia, supplies a short history and argues in favour of permitting both once rigid criteria have been set and the cases retro-reviewed. I suggest that among these criteria should be that VAE should only be permitted with one more necessary criterion: that VAE should only be allowed when physician assisted suicide is not a possible option. If the patient is able to ingest and absorb the medication there is no reason why VAE (...) should be permitted. A brief history of VAE and PAS is given and some of the arguments which have been given are analyzed. The Principle of the Double Effect is briefly discussed and why, in my opinion, it is not a valid principle is briefly discussed. (shrink)

Dealing with ethical issues is a central aspect of many professions. Consequently, ethics is taught to diverse student groups in universities and colleges, alongside philosophy students. In this paper, we address the question of how ethics is best taught to such “non-philosophy” student groups. The standard way of introducing ethics to non-philosophy students is to present them with a set of moral theories. We refer to this approach as the “smorgasbord approach”, due to the impression it is likely to make (...) on non-philosophy students approaching ethics as an academic discipline for the first time. This approach invites the assumption that adopting an ethical position is mainly a matter of choosing from this smorgasbord of different theories. We argue that this approach is problematic for several reasons, both theoretical and practical, and we suggest a methodsbased approach – focusing on methods for moral reasoning – as a more fruitful alternative. The main purpose of this paper is to explain and defend this methods-based approach to teaching ethics to non-philosophy students. In so doing, we also consider and meet some expected objections to this approach. (shrink)

Neurosurgeons have an especially high rate of exposure to serious ethical challenges in their line of work. The aim of this study was to assess the type and frequency of ethical theories used by neurosurgery residents to make extra- ethical decisions in challenging situations and their relation with the level of residency, and curricular training about medical ethics. A total of 12 neurosurgery residents in Mashhad University of Medical Sciences (MUMS) were interviewed; all the participants were male and aged 29–40 (...) years old. Of all, six were senior and six were junior. Using a systematic review of neurosurgery and medical ethics textbooks, five common cases were selected and a semi-structured, open-ended interview was developed. The interviews were digitally recorded and analyzed in two separate stages. Comparison of the results of the two stages led us to the final judgment about the dominant ethical theory used in each case. In all 60 cases, the decision-making process was compatible with either Deontology (30 cases) or Consequentialism (30 cases). Only in two cases, beside Deontology, the Virtue ethics was used as an alternative in special situations. The ethical theories were not consistent for all the 12 subjects and all the five questions. No statistically significant difference was found between senior and junior residents, neither for each question nor for the aggregate (Odds Ratio = 1.31, 95 % CI = 0.42-4.09, Relative Risk = 1.41, 95 % CI = 0.69-1.9, P-value > 0.20). Only one of the subjects had extracurricular training in medical ethics, consequently precluding further analysis. Although not intended to be evaluated by this study, similar heterogeneity was observed in final decisions. When faced with medical ethics challenges, neurosurgery residents did not follow a consistent ethical theory for making decisions. The type and frequency of theories did not seem to be changed during the residency period. (shrink)

In this paper the authors address the recent argument that we have an obligation to seek or actively bring about our own death when we burden others too greatly. Some of the problems with this argument and some of the practical conseqeuences of adopting such a point of view are discussed in this paper. We argue that the argument rests on an individualistic approach which sees the family being burdened as standing alone instead of seeing it as embedded in a (...) burden-sharing community. (shrink)

This study aimed to elucidate the withdrawal behaviors syndrome (lateness, absence, and intent to leave work) among nurses by examining interrelations between these behaviors and the mediating effect of organizational commitment upon ethical perceptions (caring climate, formal climate, and distributive justice) and withdrawal behaviors. Two-hundred and one nurses from one hospital in northern Israel participated. Data collection was based on questionnaires and hospital records using a two-phase design. The analyses are based on Hierarchical Multiple Regressions and on Structural Equation Modeling (...) with AMOS. Affective commitment was found to mediate the relationship between different dimensions of nurses’ ethical perceptions (caring climate, formal climate, and distributive justice) and their intent to leave work. Lateness was found to be positively related to absence frequency which was found negatively related to intent to leave. Males were late more frequently than females, while seniority was related only to absence frequency. The findings indicated that each withdrawal behavior exhibits unique relationships. The results may help policy makers to focus on improving the ethical environment in order to increase nurses’ commitment and reduce their intent to leave. Improving the ethical environment may be achieved through ethical education for nurses which may promote ethical considerations becoming an integral part of nurses’ work. (shrink)

This study examines factors impacting ethical behavior of 103 hospital nurses. The level of emotional intelligence and ethical behavior of peers had a significant impact on ethical behavior of nurses. Independence climate had a significant impact on ethical behavior of nurses. Other ethical climate types such as professional, caring, rules, instrumental, and efficiency did not impact ethical behavior of respondents. Implications of this study for researchers and practitioners are discussed.

This study examines factors impacting ethical behavior of 203 hospital employees in Midwestern and Northwestern United States. Ethical behavior of peers had the most significant impact on ethical behavior. Ethical behavior of successful managers, professional education in ethics and sex of the respondents also significantly impacted ethical behavior. Nurses were significantly more ethical than other employees. Race of the respondent did not impact ethical behavior. Overclaiming scales indicated that social desirability bias did not significantly impact the results of our study. (...) Implications of this study for researchers and practitioners are discussed. (shrink)

The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

This article specifies the place of the Hippocratic Oath in the programme of bioethical education on graduate schools where future medical and healthcare workers are being educated. The presented conceptualization of contents and described methodology of work show how the curriculum contents, dominated by historical facts, are being actualized by the use of knowledge students have acquired earlier, and problematized by an active inclusion of students in collecting new information relevant for the content, and then using the acquired knowledge to (...) solve a concrete bioethical issue or problem. The offered activity of students and teacher has the purpose to demonstrate a collaborative relationship between students and teacher and a communication in which students and teacher mutually takeover tasks for the realisation of the curriculum content. (shrink)

Dieser Artikel spezifiziert die Stellung, die der Hippokratische Eid im bioethischen Edukationsprogramm an den medizinischen Fakultäten einnimmt. Die vorgestellte Konzeptualisierung des Inhalts und die beschriebene Methodologie eines solchen Edukationsprogramms zeigen, dass das von historischen Fakten dominierte Curriculum durch die Vorkenntnisse der Studenten aktualisiert und durch ihre aktive Teilnahme am Zusammentragen neuer und relevanter Informationen problematisiert wird; daraufhin werden die neu erworbenen Kenntnisse umgesetzt, um eine Lösung für ein konkretes bioethisches Problem zu finden. Die aufgezeigten Möglichkeiten für Aktivitäten von Studenten und (...) Professoren sollen die Kooperation zwischen ihnen betonen, ferner die Kommunikation, bei der beide Seiten verschiedene Aufgaben zur Umsetzung des Curriculums übernehmen. (shrink)