Voices and time: the venture of clinical ethics

Four prominent views of the nature and methods of clinical ethics (especially in consultation forums) are reviewed; each is then submitted to a criticism intended to show both weaknesses and strengths. It is argued that clinical ethics needs to be responsive to the specific complexities of clinical situations. For this, the need for an expanded notion of practical reason within unique situations is emphasized, one whose aim is to facilitate decision-making on the part of those directly responsible for them and consonant with their own respective moral frameworks and conceptions of what is most worthwhile.

Ethics consultation: the least dangerous profession?

Whether ethics is too important to be left to the experts or so important that it must be is an age-old question. The emergence of clinical ethicists raises it again, as a question about professionalism. What role clinical ethicists should play in healthcare decision making – teacher, mediator, or consultant – is a question that has generated considerable debate but no consensus.

The ethics consultant and ethics committees, and their acronyms: IRBs, HECs, RM, QA, UM, PROs, IPCs, and HREAPs

Much has been written about the role of hospital ethics committees. Ethics committees may have begun in Seattle in the early 1960s, but they were reified in. New Jersey by the Quinlan Court in the 1970s and thrived in the national bioethics movement of the 1980s.

In this flurry of ethics activity, several new forms of ethics committees have evolved. New forms of ethics committees include patient care-oriented ethics committees (RM, QM, & QA). Many ethicists are familiar with mission-oriented ethics committees (IRBs & HECs). Such committees have taken on new roles, and Include PROs, IPCs, and HREAPs. In general, these committees are regulatory in nature and may often rely on rules and regulations to assess patient cases, research protocols, and health professional practices.

Does depression invalidate competence? Consultants' ethical, psychiatric, and legal considerations

The ethical principle of respect for autonomy has come into its own In American medicine since World War II as equal in importance to the traditional medicomoral principles of nonmaleficence and beneficence. Respect for autonomy provides the ethical underpinning for the patient's right to exercise an informed choice – whether to consent to or to refuse recommended medical treatment. However, an informed choice demands a certain level of competence. Typical criteria for patient competence to accept or to refuse medical treatments Include ability to make a choice and ability to comprehend the nature of the treatment, as well as the risks and benefits of accepting or refusing the treatment.

Moral philosophy and public policy: the case of NRTs

In this paper, I will express some reservations about the usefulness of moral philosophy for the analysis of public policy issues.... My question is whether taking morality seriously requires taking moral philosophy seriously. This paper focuses on one particular public policy context -- namely, government commissions into new reproductive technologies, such as Britain's Warnock Committee, Australia's Waller and Michael Committees, Canada's Baird Commission, and many others.... Moral philosophers are sometimes asked to participate in these commissions, either as Commissioners, staff, or expert advisers. How can moral philosophers contribute to the analysis of public policy recommendations on NRTs? A survey of the literature suggests that there are two main views on this question, one of which is ambitious, the other more modest. The ambitious view says that moral philosophers should attempt to persuade Commissioners to adopt the right comprehensive moral theory (e.g. adopt a deontological theory, rather than utilitarianism or contractarianism), and then apply this theory to particular policy questions. The more modest view shies away from promoting a particular moral theory, given that the relative merits of different moral theories are a subject of dispute even amongst moral philosophers. Instead, it says that moral philosophers should attempt to ensure that the Commission's arguments are clear and consistent. On this view, philosophers should focus on identifying conceptual confusions or logical inconsistencies within the Commission's arguments without seeking to influence its choice of the underlying theory.

A description of humanist scholars functioning as ethicists in the clinical setting

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway.

Invoking the law in ethics consultation

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability (personal observation). At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting.

Assessing bioethics today

During 1992, academic bioethicists celebrated the 30th anniversary of bioethics. Some like to date the origin of modern secular bioethics to the advent of transplant technology that began with kidney transplantation in the early 1960s in the Seattle, Washington, area. This is certainly a good candidate for a starting point. Another might be the work of Joseph Fletcher in the New York area with the Euthanasia Society of America and with clergy training. Still another candidate for the origins of secular bioethics would be the trial of physicians at the University of Virginia for transplanting a kidney at which the same Joseph Fletcher testified. At that trial, the alteration occurred in American law from a definition of death that focused on the cessation of heartbeat to one that focused on the cessation of brain function.

A new role for psychologists--hospital ethics committees

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.

The role of philosophy in public policy and bioethics: introduction

As various societies have created public commissions to help develop proposals for public policies relating to issues in bioethics, philosophers have sometimes been called upon to serve on the staff of, or to provide consultation to, these public bodies. This issue of the Journal is devoted to examining problems that arise as one tries to articulate the proper role of philosophers serving in these capacities. It includes articles by Frances M. Kamm ("The philosopher as insider and outsider"), Martin Benjamin ("Philosophical integrity and policy development in bioethics"), Richard W. Momeyer ("Philosophers and the public policy process: inside, outside, or nowhere at all?"), Paul T. Menzel ("Public philosophy: distinction without authority"), and E. Haavi Morreim (Physician investment and self-referral: philosophical analysis of a contentious debate").

Clinical ethics: a role theoretic look

The new phenomenon of clinical ethics is analyzed from a role theoretic perspective that differentiates consulting, teaching, watching, and witnessing. Teaching and consulting are seen as main role alternatives in clinical ethics practice, with watching and witnessing defining transitional states that reveal the complexity of clinical ethics. The problem of the legitimation of clinical ethics is discussed in terms of legal, professional, and social accountability and authorization. It is argued that the problem of legitimation is tied up with the related issue of expertise that, in turn, reflects the complex role alternatives of consulting, teaching, watching, and witnessing. Finally, the question of methodology and practice of clinical ethics is explored in connection with the four role alternatives delineated.

Role of an ethicist in the conduct of clinical trials in the United States

The social and ethical implications of new medical techniques and the development of community representatives in decisions regarding human research are discussed. The particular role of the ethicist and how medical experimentation is viewed from the perspective of the doctor, the patient, an the funding donor are examined. Some of the more common ethical issues occurring in medical research are treated, with particular reference to those in clinical trials. Finally, some unresolved problems in future medical research are discussed.