This article questions the commonly held view that professional ethics is grounded in general ethical principles, in particular, respect for client (or patient) autonomy and beneficence in the treatment of clients (or patients). Although these are admirable as general ethical principles, we argue that there is considerable logical difficulty in applying them to the professional-client relationship. The transition from general principles to professional ethics cannot be made because the intended conclusion applies differently to each of the parties involved, whereas the (...) premise is a general principle that applies equally to both parties. It is widely accepted that professionals are required to recognize that clients or patients possess rights to autonomy that are more than the general rights to personal autonomy accepted in ordinary social life, and that professionals are expected to display beneficence toward their clients that is more than the beneficence expected of anyone in ordinary social life. The comparative component of professional ethics is an intrinsic feature of the professional situation, and thus it cannot be bypassed in working out a proper professional ethics. Thus, we contend, the proper professional treatment of clients or patients has not been explained by appeal to general ethical principles. (shrink)

This review examines issues relating to biomedical ethics and literature in the African drama The President’s Physician by Emmanuel Babatunde Omobowale. The play investigates the psychological dilemma of Doctor Bituki Warunga, a personal physician to General Kalunga Ntibantunganyah who brutally and inhumanely rules Wavaria, a fictional African country. The doctor is faced with deciding to uphold the ethics of his profession versus terminating the tyrant’s life to set the nation free. The play aims to help budding medical doctors rightly inculcate (...) the principles of medical ethics—autonomy, beneficence, competence, and power—by providing a fictional platform to investigate difficult issues that can arise in clinical practice. The play highlights Warunga’s complex dilemma as he struggles to uphold the Hippocratic Oath and at the same time satisfy his conscience towards his contribution to his country’s freedom. This review explores the difficulties in decision-making when professional duties not only clash with personal preferences but also with the well-being of an entire nation. This discussion is done alongside the ethical concept of utilitarianism and also highlights significant literary concepts such as satire, symbolism, intertextuality, utopian aesthetics, and authorial vision as conveyed in the text. (shrink)

Bioethics promises a considered, unprejudicial approach to areas of medical decision-making. It does this, in theory, from the perspective of moral philosophy. But the promise of fairly considered, insightful commentary fails when word choices used in ethical arguments are prejudicial, foreclosing rather than opening an area of moral discourse. The problem is illustrated through an analysis of the language of The Royal Society Expert Panel Report: End of Life Decision Making advocating medical termination.

The author examines the motives for the behaviour and actions of Dr. Skreta, the main character of Kundera’s novel The Farewell Waltz. The starting point of the novel was the social and political situation in totalitarian Czechoslovakia at the turn of the 1960s and 1970s. He compares it to the situation in the developed western world and comes to a realization that there were many similarities in medicine; however, there were significant differences with regard to external factors. The health care (...) system in western democratic societies were placed in contrast with Czechoslovakia, where a doctor’s activities and the system of health care were subordinated to the political, ideological, and social intentions of totalitarian power. In this context, the author has come to the conclusion that Dr. Skreta’s motives for acting arose from his moral responsibility for the country’s future. Dr. Skreta waged a latent personal “moral war” against the totalitarian regime. This was also reflected in his opposition to the preferred morality of socialist health care professionals. Part of this was his eugenics project. According to the author, in the context of ethics of social consequences, Dr. Skreta was a responsible moral agent seeking a better future not only for the country and its people, but his personal selfish interests. (shrink)

In the 1970s “bioethics” emerged as a new interdisciplinary discourse on medicine, health care, and medical technologies, primarily in Western, developed countries. The main focus was on how individual patients could be empowered to cope with the challenges of science and technology. Since the 1990s, the main source of bioethical problems is the process of globalization, particularly neo‐liberal market ideology. Faced with new challenges such as poverty, inequality, environmental degradation, hunger, pandemics, and organ trafficking the bioethical discourse of empowering individuals (...) is no longer sufficient. Global bioethics nowadays is concerned with applying and implementing a universal ethical framework. Islamic bioethics has contributed to creating such framework (exemplified in the UNESCO Universal Declaration on Bioethics and Human Rights) while at the same time it is continuously articulating and interpreting this framework in specific settings and contexts. (shrink)

The six papers in the 2014 clinical ethics number of the Journal get us back to the basics in the work of clinical ethics and clinical ethicists: getting clear about concepts that should be used in achieving deliberative clinical ethics. The papers explore the concepts of the best interests of the patient, health and disease understood in their proper relationship to autonomy in our species, the therapeutic obligation, and the therapeutic imperative. The final paper appraises the systematic review, a scholarly (...) tool for tracking the basic concepts of clinical ethics in the literature. (shrink)

The Hippocratic Oath and the Declaration of Geneva of the World Medical Association are compared in terms of content and origin. Their relevance for current medical practice is investigated. The status which is ascribed to these documents will be shown and the status which they can reasonably claim to have will be explored. Arguments in favor of the Hippocratic Oath that rely on historical stability or historical origin are being examined. It is demonstrated that they get caught up in paradoxes. (...) Should doctors swear the Hippocratic Oath or the Declaration of Geneva? The Hippocratic Oath is a remarkable historic document, which contains important elements still relevant for medical ethics today. Its interpretation as a timeless, still valid medical code is unfounded. The historical arguments, that should justify its validity, are untenable. The Declaration of Geneva, and not the Hippocratic Oath, can legitimately claim to come close to representing the most important principles of professional medical conduct in today’s globalised world. (shrink)

Do not attempt cardiopulmonary resuscitation decisions (DNACPR) are considered good medical practice for those dying at the end of natural life. They avoid intrusive and inappropriate intervention. Historically, informing patients of these decisions was discretionary to avoid undue distress. Recent legal rulings have altered clinical guidance: disclosure is now all but obligatory. The basis for these legal judgments was respect for the patient’s autonomy as an expression of their human rights. Through critical analysis, this paper explores other bioethical considerations and (...) the potential harms if they are ignored. Arguably, disclosure of DNACPR status on its own will do little to improve patient experience. A focus on good communication with those identified as approaching end-of-life will facilitate personalized care. Discussions around DNACPR may still occur, but only if likely to be beneficial and at a patient-appropriate pace (not dictated by the need to activate the decision). (shrink)

We describe a number of conscientious objection cases in a liberal Western democracy. These cases strongly suggest that the typical conscientious objector does not object to unreasonable, controversial professional services—involving torture, for instance—but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive. We analyse the conflict between these patients' access rights and the conscientious objection accommodation demanded by monopoly providers of such healthcare services. It is implausible that professionals who voluntarily join (...) a profession should be endowed with a legal claim not to provide services that are within the scope of the profession's practice and that society expects them to provide. We discuss common counterarguments to this view and reject all of them. (shrink)

In the 1970s “bioethics” emerged as a new interdisciplinary discourse on medicine, health care, and medical technologies, primarily in Western, developed countries. The main focus was on how individual patients could be empowered to cope with the challenges of science and technology. Since the 1990s, the main source of bioethical problems is the process of globalization, particularly neo-liberal market ideology. Faced with new challenges such as poverty, inequality, environmental degradation, hunger, pandemics, and organ trafficking the bioethical discourse of empowering individuals (...) is no longer sufficient. Global bioethics nowadays is concerned with applying and implementing a universal ethical framework. Islamic bioethics has contributed to creating such framework (exemplified in the UNESCO Universal Declaration on Bioethics and Human Rights) while at the same time it is continuously articulating and interpreting this framework in specific settings and contexts. (shrink)

Although many of the pioneers of present-day bioethics came from religious and theological backgrounds, the recent controversy about the role of religion in bioethics has elicited much attention. Timothy Murphy would ban religion from bioethics altogether. Much of the ado hinges on conflicting understandings of just what bioethics is and just what religion is. This paper attempts to make more explicit how the fields of bioethics and religion have been understood in this context, and how they should not be understood. (...) We begin by looking at bioethics as a field: its origins, purpose, scope, and its methods. We then examine the notion of religion, looking especially at its importance for bioethics. Humanity is not just Homo sapiens but also Homo religiosus. Religion is more than a code of ethics; it gives insight into many of the foundational matters of bioethics. (shrink)

In his Disrupted Dialogue: Medical Ethics and the Collapse of Physician-Humanist Communication Robert Veatch presents a scholarly tour de force of eighteenth- and nineteenth-century Anglophone medical ethics to demonstrate how the easy communication between physicians and humanists in the Scottish Enlightenment progressively dissipated as medicine became detached from humanistic disciplines. In this paper I offer two comments—that the discourse of medical ethics in the Scottish Enlightenment was a discourse of Baconian moral science and that nineteenth-century medical ethics in the United (...) States became detached from that discourse. The result was that a principal resource for physicians at the birth of bioethics, the American Medical Association’s Principles of Medicine Ethics of 1957, did not equip physicians with the conceptual tools they needed to formulate and address the ethical challenges that became the agenda of bioethics. The paper opens with a brief portrait of Robert Veatch, the author’s connections to him, and his little-known role as an impresario of the classical music of the Blue Ridge and Appalachia. (shrink)

Doctors are increasingly enjoined by their professional organisations to involve themselves in supraclinical advocacy, which embraces activities focused on changing practice and the system in order to address the social determinants of health. The moral basis for doctors’ decisions on whether or not to do so has been the subject of little empirical research. This opportunistic qualitative study of the values of medical graduates associated with the Sydney Medical School explores the processes that contribute to doctors’ decisions about taking up (...) the advocate role. Our findings show that personal ideals were more important than professional commitments in shaping doctors’ decisions on engagement in advocacy. Experiences in early life and during training, including exposure to power and powerlessness, significantly influenced their role choices. Doctors included supraclinical advocacy in their mature practices if it satisfied their desire to achieve excellence. These findings suggest that common approaches to promoting and facilitating advocacy as an individual professional obligation are not fully congruent with the experiences and values of doctors that are significant in creating the advocate. It would seem important to understand better the moral commitments inherent in advocacy to inform future developments in codes of medical ethics and medical education programs. (shrink)

Bioethicists have typically disdained where they did not simply ignore the Hippocratic tradition in medicine. Its exclusivity—an oath of and for physicians—seemed contrary to the perspective that bioethicists have attempted to invoke. Robert M. Veatch recently articulated this rejection of the Hippocratic tradition, and of a professional ethic of medicine in general, in a volume based on his Gifford lectures. Here that argument is critiqued. The strengths of the Hippocratic tradition as a flexible and ethical social doctrine are offered in (...) its stead. (shrink)

The principle of respect for autonomy requires informing patients adequately and appropriately about diagnoses, treatments, and prognoses. However, some clinical cases may cause ethical dilemmas regarding telling the truth. Under the existence especially of certain cultural, social, and religious circumstances, disclosing all the relevant information to all pertinent parties might create harmful effects. Even though the virtue of telling the truth is unquestionable, sometimes de facto conditions compel physicians to act paternalistically to protect the patient/patients from imminent dangers. This article, (...) which aims to study the issue of whether a physician should always tell the truth, analyzes an interesting case that represents the detection of misattributed paternity during pre-transplant tests for a kidney transplant from the son to the father in Turkey, where social, cultural, and religious factors have considerable impact on marital infidelity. After analyzing the concept of telling the truth and its relationship with paternalism and two major ethical theories, consequentialism and deontology, it is concluded that the value of the integrity of life and survival overrides the value of telling the truth. For this reason, in the case of a high possibility of severe and imminent threats, withholding some information is ethically justifiable. (shrink)