During the last decade, several court cases have focused attention on the moral and legal aspects of withholding or withdrawing food and fluids from certain patients. The courts have not been unanimous in their judgments on these matters. In attempting to explore this issue, this article reviews both the nursing and medical literature on the withdrawing and withholding of food and fluids with particular attention to empirical studies. Several themes which emerge from the literature are used to explore the similarities (...) and differences between the practices of nursing and medicine where nutritional support is concerned. (shrink)

Madeleine Simms begins her article by saying that it will attempt to `redress the balance' of views on the conflicting rights of handicapped children and their parents. I, on the other hand, will argue that no semblance of a balance has yet been achieved, and that her questions and conclusions merely serve to tip the scales further away from a genuine rights-based theory to a pragmatic utilitarian assessment of individual `worth'.

This article examines recent developments in the regulation of the medical profession in England, with particular reference to doctors working in the National Health Service (NHS). It is argued that the Health Act 1999 and associated government policies are bringing about a shift from a «light touch», self-regulatory paradigm to a government-driven, interventionist approach. It is suggested that the reason for the change is not simply a governmental concern with the quality and nature of care provided by doctors, but more (...) significantly, a concern with the cost of that care. The article offers a critique of the new regime, drawing on the socio-legal literature on regulation. Some aspects of the reforms ignore the need to persuade doctors to comply, and may therefore result in cheating or «creative compliance»; other aspects of the reforms provide doctors with opportunities to «neutralize» their impact. It concludes with an examination of the wider significance of the change in regulatory paradigm, and of the agenda for future research in this field. (shrink)

Epitome V (1621), and consisted of matching an element of area to an element of time, where each was mathematically determined. His treatment of the area depended solely on the geometry of Euclid's Elements, involving only straight-line and circle propositions – so we have to account for his deliberate avoidance of the sophisticated conic-geometry associated with Apollonius. We show also how his proof could have been made watertight according to modern standards, using methods that lay entirely within his power. The (...) greatest innovation, however, occurred in Kepler's fresh formulation of the measure of time. We trace this concept in relation to early astronomy and conclude that Kepler's treatment unexpectedly entailed the assumption that time varied nonuniformly; meanwhile, a geometrical measure provided the independent variable. Even more surprisingly, this approach turns out to be entirely sound when assessed in present-day terms. Kepler himself attributed the cause of the motion of a single planet around the Sun to a set of `physical' suppositions which represented his religious as well as his Copernican convictions; and we have pared to a minimum – down to four – the number he actually required to achieve this. In the Appendix we use modern mathematics to emphasize the simplicity, both geometrical and kinematical, that objectively characterizes the Sun-focused ellipse as an orbit. Meanwhile we highlight the subjective simplicity of Kepler's own techniques (most of them extremely traditional, some newly created). These two approaches complement each other to account for his success. (shrink)

The current debates about seat belts in motor cars and the evils of smoking may only be straws in the wind if the scenario sketched in this paper were translated into a social, political programme. Then 'illness would increasingly be seen as a failure to keep healthy and thus culpable. The failures [the patients] ... must either be irresponsible and hence punishable at least by the imposition of financial penalties or insane and thus in need of corrective therapy.' If this (...) sounds like 1984 the reader must read the whole argument set out in this paper and make his own judgment. He may not be encouraged by what he reads but he will be forewarned. There is no answer to the question, What shall I do, if this prophecy is true? (shrink)

This paper discusses two interrelated concepts: (1) the ethics of planned social change and (2) primary health care. It takes the World Health Organization’s definition of primary health care as a point of departure to examine four identified potential areas where ethical dilemmas may occur. In addition, questions are raised about nursing education, as well as about the class and status differences between nurses and patients and communities. It takes the position that our first task is to encourage more discussion (...) and examination of ethical issues in the planned social change of primary health care. (shrink)

In recent months there has been considerable discussion on the ethics of using organs from anencephalic babies for transplantation purposes. The heart of an anencephalic in Ireland was so used, but the recipient died very soon after the operation. Since this case came to light the Royal College of Physicians has imposed a ban on the use of these babies as donors while a working party investigates the issues involved.* This article attempts to examine the problem and reaches the conclusion (...) that in practice it is not ethical to use the organs of anencephalics for transplants. (shrink)

This article raises some questions about the global influence of nursing in the USA and describes some problems that may come about because of it. Selected American values that are embedded in nursing and ethics are found in American nursing education, practice and research. These can then be exported to countries with very different cultural definitions and values. One such country is Japan. The discrepancy between national cultural norms and imported ideals of nursing practices can create ethical problems for nurses (...) in these countries. (shrink)