A book for nurses, doctors and all who provide end of life care, this essential volume guides readers through the ethical complexities of such care, including current policy initiatives, and encourages debate and discussion on their controversial aspects. dived into two parts, it introduces and explains clinical decision making-processes about which there is broad consensus, in line with guidance documents issued by WHO, BMA, GMC, and similar bodies. The changing political and social context where 'patient choice' has become a central (...) idea, and the broadened scope of potients' best interests, have added to the complexity of decision-making in end of life care. The authors discuss issues widely encountered by GPs, nurses, and hospital clinicians. These include patient choice, consent, life-prolonging treatment, and symptom relief including sedation. Part rwo explores the more controversial current end of life care initiatives, such as advance care planning preferred place of care and death, euthanais and assited suicide, extended ideas of 'best interests', and the view that there are therapeutic duties to the relatives of Throughout their discussion the authors draw attention to loose ends and contradictions in some of the proposals. Examining the current policy of comsumerist choice, they reject its place in the health service, proposing a a realistic, fair, humane and widely adoptable system of end of life care. -/- As knowledge of ethical theories is required in training courses, and the vocabulary of ethical theory is widespread in current discussions a substantial appendix on ethical theories and terms is available online. -/- Written by the same authors as The Philosophy of Palliative Care: Critique and Reconstruction, which won the Medical Journalists' Association Specialits Book Award 2007, this new book for non-specialists is essential reading for all health care professionals involved in providing end of life care. (shrink)
Critiquing many areas of medical practice and research whilst making constructive suggestions about medical education, this book extends the scope of medical ethics beyond sole concern with regulation. Illustrating some humanistic ways of understanding patients, this volume explores the connections between medical ethics, healthcare and subjects, such as philosophy, literature, creative writing and medical history and how they can affect the attitudes of doctors towards patients and the perceptions of medicine, health and disease which have become part of contemporary culture. (...) The authors examine a range of ideas in medical practice and research, including: the idea that patient status or the doctor/patient relationship can be understood via quantitative scales the illusion fostered by medical ethics that doctors, unlike those in other professions, are uniquely beneficent and indeed altruistic. An excellent text for undergraduate and postgraduate students of law, medical ethics and medical healthcare law, Bioethics and the Humanities shows the real ethical achievements, problems and half-truths of contemporary medicine. (shrink)
This paper examines the ethicalproblems that arise when research is carriedout after autopsy on dead infants. It comparesthe right of parents against that of the publicinterest in matters of research on dead minors. The basis for the respect that is widelyaccorded to the body of a dead person isexamined and is shown to ground the parentalinterest. A discussion of the nature of thefamily suggests that `informed consent' is notthe best term to apply to the process ofparental consultation. Some reasons areprovided (...) against using this term in the contextin which bereaved parents are consulted aboutautopsy and research on their dead infants. Itis suggested that a term such as `authorize'might better apply to this situation. (shrink)
Next SectionThe eighteenth century is commonly thought of as the “age of reason”, an age in which the imagination was not given a central role in the arts, far less in science. But in Hume's attempts to account for our belief in a continuing external world he is forced into invoking the activity of the imagination. His views on the activity of the imagination greatly influenced Adam Smith, who adapted them to fashion a theory of the psychology of scientific discovery. (...) In this theory the imagination is shown to be active in creating systematic explanations of the phenomena of nature, to the extent that Smith depicts the aim of scientific theory as that of satisfying the imagination. Smith's account of the logic of scientific theory can be defended even in contemporary philosophy of science. In particular, it can be maintained that all scientific theories are works of the imagination and that the concept of truth does not directly apply to them. (shrink)
Judgement is traditionally seen as applicable in two spheres of human endeavour: the theoretical (or the sphere in which we consider both what must be the case and what is likely to be the case) and the practical (or the sphere in which we consider what we ought to do, either because it is in our interests or becausemorality requires it). Now insofar as we are speaking of 'judgement' two conceptual assumptions are being made. Firstly, we are assuming that there (...) are imponderables and complexity, and secondly, despite the imponderables and complexity, that there is still room for the exercise of reason. Granted this view ofjudgement we can state our two main theses. Firstly, we shall argue that, despite the pressures of market forces, employee needs, and shareholder interests, there is still room in business practice for judgements so understood. Secondly, we shall argue that these judgements need not inevitably be directed down thesingle track of the financial interests of the company and its shareholders. The second thesis can be understood as a moral thesis in either of two ways. Either it can be seen as the thesis that companies have broad social responsibilities extending well beyond the immediate interests of the company, or as the thesisthat companies share the social interests of the communities to which they belong; they are citizens writ large, to gloss Plato. (shrink)
The treatment decisions of competent adults, especially treatment refusals, are generally respected. In the case of minors something turns on their age, and older minors ought increasingly to make their own decisions. On the other hand, parents decide on behalf of infants and young children. Their right to do so can best be justified in terms of the importance of preserving intimate family relationships, rather than in terms of the child's best interests, although the child's best interests will most often (...) follow from this arrangement. Nevertheless, there are and ought to be legal, ethical, and financial constraints on parental decision making. (shrink)
The book offers an introduction to the moral concepts and value of health care. It is written by a moral philosopher, a doctor and a nurse and contains questions, cases and exercises which are suitable for medical, nursing and all students and commentators on health care. Moral dilemmas include consent, confidentiality, the giving or withholding of information, and the economics of health care. The issues of artificial reproduction, terminal care and the research and testing of drugs are addressed.
The difficulties of establishing a definition of torture are discussed, and a definition is suggested. It is then argued that, irrespective of general ethical questions, doctors in particular should never be involved because of their social role.
There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.
Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)
In this book Bernard Williams delivers a sustained indictment of moral theory from Kant onward. His goal is nothing less than to reorient ethics toward the individual. He deals with the most thorny questions in contemporary philosophy and offers new ideas about issues such as relativism, objectivity, and the possibility of ethical knowledge.
There is a widespread assumption that responsibility in health care is vested in the last resort in the individual doctor who is caring for a given patient. In the first section of this article I shall try to bring out the plausibility of this assumption, and examine the concept of collective responsibility which it allows. In the second and third sections I shall try to show the fatal weaknesses of the assumption in its unmodified form, and shall argue that if (...) we are to understand the nature of health care at the present time we must take the norm to be collective and not individual responsibility. I shall discuss the two relevant senses of collective responsibility and try to show how they can be reconciled with what is acceptable in the widespread assumption of individual responsibility. CiteULike Connotea Del.icio.us What's this? (shrink)
The aim of the article is to distinguish for a medical readership different senses of and connections between the words 'ethics', 'morals', and 'moral philosophy'. 'ethics' and 'morals' can be used as synonyms to refer to first order morality; they can be used to distinguish different areas within morality; 'professional ethics' can be a specialized form of first order morality; or it can refer to codified procedures; 'ethics' can be a synonym for moral philosophy, which is the study of first-order (...) morality. (shrink)