Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which we call “complex discharges,” are beset with tensions between the interests of the (...) institution and the interests of the patient as well as tensions within the ethics consultant whose commitments are shaped both by the values of the organization and the values of their own profession. The clinical ethics literature on this topic is limited and provides little guidance. What is needed is guidance for consultants operating at the bedside and for those participating at a higher organizational level. To fill this gap, we offer guidance for facilitating a fair process designed to resolve the conflict without resorting to coercive legal measures. We reflect on three cases to argue that the approach of the consultant is generally one of mediation in these types of disputes. For patients who lack decision making capacity and lack a surrogate decision maker, we recommend the creation of a complex discharge committee within the organization so that ethics consultants can properly discharge their duties to assist patients who are unable to advocate for themselves through a fair and transparent process. (shrink)

The Iranian prophet and reformer Zarathustra (Greek: Zoroaster) founded his religion in the 6th Century BC. In a series of visions he was taken up to Heaven and Ahura Mazda - creator of all that is good - charged him with enlisting Humanity in the fight against Aura Mainyu - the principle of chaos and destruction - offering Mankind a free choice between Good and Evil. It is hard to overstate the importance of Zoroastrianism. According to Professor of Iranian Studies (...) Dr Mary Boyce: "It was the first to teach the doctrines of an individual judgment, Heaven and Hell, the future resurrection of the body, the general Last Judgment, and life everlasting for the reunited soul and body." 'The Teachings of Zoroaster' is an excellent introduction to this little-known and often misunderstood religion, giving Zoroastrianism its rightful place as the precursor of many Christian, Judaic and Islamic beliefs. (shrink)

After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 However, there is a (...) significant tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)