A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for (...) the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals. (shrink)

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing (...) hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Knud Ejler Løgstrup’s _The Ethical Demand_ is the most original influential Danish contribution to moral philosophy in this century. This is the first time that the complete text has been available in English translation. Originally published in 1956, it has again become the subject of widespread interest in Europe, now read in the context of the whole of Løgstrup’s work. _The Ethical Demand_ marks a break not only with utilitarianism and with Kantianism but also with Kierkegaard’s Christian existentialism and with (...) all forms of subjectivism. Yet Løgstrup’s project is not destructive. Rather, it is a presentation of an alternative understanding of interpersonal life. The ethical demand presupposes that all interaction between human beings involves a basic trust. Its content cannot be derived from any rule. For Løgstrup, there is not Christian morality and secular morality. There is only human morality. _The Ethical Demand _is of the highest relevance to contemporary debate, especially around those issues raised by Levinas. It will exert a steadily increasing influence both in theology and philosophy. (shrink)

This edition continues the debate on bioethical issues in nursing and health care. Revised chapters include discussions on transcultural ethics in nursing practice, and homophobia and the moral entitlement of AIDS and HIV-positive patients.

For most nurses world-wide, activities are centred around working directly with patients and so the nurse-patient relationship is of the greatest importance. Ethnocentrism on the part of the health care community has led to misdiagnosis, mistreatment and undertreatment of culturally diverse individuals world-wide. This author discusses a tool, Greipp's Model of Ethical Decision-Making, which can be used to assist nurses in analysing the effects of culture, beliefs and diversity upon the caregiver and care recipient within an ethical framework.