The increased recognition and reported prevalence of autism spectrum disorders combined with the associated societal and clinical impact call for a broad grassroots community-based dialogue on treatment related ethical and social issues. In these Stony Brook Guidelines, which were developed during a full year of community dialogue with affected individuals, families, and professionals in the field, we identify and discuss topics of paramount concern to the ASD constituency: treatment goals and happiness, distributive justice, managing the desperate hopes for a cure, (...) sibling responsibilities, intimacy and sex, diagnostic ethics, and research ethics. The members of the dialogue core committee included doctors, ethicists, administrators, social workers, ministers, disability experts, and many family members of individuals with autism who were especially engaged in community activities on behalf of their constituency, including siblings, parents, and grandparents. Our guidelines are not based on “top-down” imposition of professional expertise, but rather on a “bottom-up” grass roots attention to the voices of affected individuals and families speaking from experience. These guidelines can inform clinical practice, but they also are meaningful for the wider social conversation emerging over the treatment of individuals with ASD. (shrink)
Recent work on the ethics of love may be divided into norm-centered and affective-centered approaches. Norm-centered approaches, exemplified by Hallett and Outka, argue for either moral parity between self and other or for self-subordination; they regard self-love as legitimate within strict boundaries; and they sharply distinguish agape from other forms of love. Affective-centered approaches, exemplified by Vacek and Post, con- centrate on love for God as the central context for neighbor-love; they ac- cord a high status to friendship, marriage, and (...) other primary relationships; and they regard all forms of love as Christian in that they are transformed by grace and constitute cooperation with God. The re- maining agenda for both approaches is primarily theological, including especially the need to develop an extended application of the doctrines of creation and grace for the status of "special relations" in the ethics of love. (shrink)
This article examines the role of two distinct forms of analogy in moral discourse. The use of analogy in moral discourse. The use of analogy in abortion debates in used as an example of the dominance of analogy in applied ethics.
The Clinton administration's revised rules regulating but not prohibiting the common practice in managed care of linking physician compensation with cost cutting and control of services demonstrates the complexity of ethical issues in managed care. As originally proposed, the federal guidelines on payment for Medicare and Medicaid services would have precluded any interrelationship between payment to physicians and delivery of services. Such a restriction would have gutted the primary mechanism in managed care plans to curb the unacceptably high cost of (...) healthcare delivery: making physicians directly responsible for cost control by placing them at direct financial risk. At first blush such a linkage seems to involve an obvious and irreconcilable conflict of interest. How can a physician be responsible for the well-being of a patient while at the same time aware that a proportion of his or her income is linked to the provision of cost-conscious care? (shrink)
This article focuses on the elderly patient with a progressive and irreversible dementia, most often of the Alzheimer type. However dementia, the decline in mental function from a previous state, can occur in all ages. For example, if Alzheimer's disease is the dementia of the elderly, increasingly AIDS is the dementia of many who are relatively young. I will not present the major ethical issues relating to dementia care following the progression of disease from the mild to the severe stages, (...) for I have done this elsewhere. Among the issues included are: presymptomatic testing, both psychological and genetic; responsible diag- nostic disclosure and use of support groups; restrictions on driving and other activities; preemptive assisted suicide; advance directives for research and treatment; quality of life in relation to the use of life-extending technologies; and euthanasia. (shrink)
Burnout among physicians, nurses, and students is a serious problem in U.S. healthcare that reflects inattentive management practices, outmoded images of the “good” provider as selflessly ignoring the care of the self, and an overarching rubric of Patient Centered Care that leaves professional self-care out of the equation. We ask herein if expanding PCC to Patient and Professional Centered Care would be a useful idea to make provider self-care an explicit part of mission statements, a major part of management strategies (...) and institutional goal setting, and of educational programs. We offer several practical suggestions for PPCC implementation, including structuring healthcare systems so as to nurture professional meaning, integrity, and inter-personal reflective emotional processing as a buffer against burnout and as a key to better patient care. It should not bring into question the primacy of practitioner commitment to the good of patients, nor should it be taken to suggest in any way a shift in focus away from patients’ values and respect for patient autonomy. PPCC asserts that the respect for patient’s values and autonomous choices properly remains the ethical benchmark of modern healthcare systems, along with altruistic professional commitment to the optimal care of patients. However, it enunciates an explicit commitment to structuring systems that allow for and actively encourage the professional well-being and wellness upon which good patient care depends. (shrink)
The human life span has been extended considerably, and among the very old, women outnumber men by a large margin. Thus, the aging society cannot be adequately addressed without taking into account the experience of women in specific. This article focuses on women as caregivers for aging parents. It critically assesses what some women philosophers are saying about the basis and limits of these caregiving duties.
The Greater Cleveland community Dialogue on values and Health Care most recently took up the questions of health care rationing and of access to long-term care. The Dialogue, funded by the Cleveland Foundation, involves a Core Group of thirty community leaders representing major interest groups, joined together in an attempt to build consensus or acceptable compromise. The purpose of the dialogue is to identify moral values that can provide signposts for public policy regarding health care distribution.
Adoption, from the Latin opiate, “to choose,” means “to take into a relationship, especially another's child as one's own”. The word implies a permanent taking of responsibility. While the assumption that biological parents should rear their children is vital to society, adoption provides an alternative that is sometimes necessary.
Early last year, the GenEthics Consortium (GEC) of the Washington Metropolitan Area convened at George Washington University to consider a complex case about genetic testing for Alzheimer disease (AD). The GEC consists of scientists, bioethicists, lawyers, genetic counselors, and consumers from a variety of institutions and affiliations. Four of the 8 co-authors of this paper delivered presentations on the case. Supplemented by additional ethical and legal observations, these presentations form the basis for the following discussion.
Edited by Thomas A. Shannon, this series provides anthologies of critical essays and reflections by leading ethicists in four pivotal areas: reproductive technologies, genetic technologies, death and dying, and health care policy. The goal of this series is twofold: first, to provide a set of readers on thematic topics for introductory or survey courses in bioethics or for courses with a particular theme or time limitation. Second, each of the readers in this series is designed to help students focus more (...) thoroughly and effectively on specific topics that flesh out the ethical issues at the core of bioethics. The series is also highly accessible to general readers interested in bioethics. (shrink)
Although studies show that those who are physically or psychologically overwhelmed by the needs of others do experience a stressful burden that can have significant negative health consequences, little attention has been given to whether there are health benefits from helping behaviour that is fulfilling, not overwhelming. In this book, Stephen Post brings together distinguished researchers from basic science to address this question in objective terms. The book provides heuristic models, from evolution and neuroscience, to explain the association between altruism (...) and health, and examine potential public health and practical implications of the existing data. (shrink)
This book draws from previously unpublished letters and interviews with physicists, theologians, and Sir John’s close associates and family to present Sir John’s ideas on pure unlimited love. Post, who was in dialogue with Sir John for fifteen years on this topic and who had founded the Institute for Research on Unlimited Love, addresses how John Templeton arrived at his philosophy as a youth growing up in Tennessee. Post also shares how classical Presbyterian ideas came to synergize in his mind (...) with the more eastern influences of American transcendentalism and the Unity School of Christianity and ponders if Sir John truly believed that science and spiritualty might fully converge on the same view of Ultimate Reality with their very different ways of knowing. _Is Ultimate Reality Unlimited Love?_ presents Sir John’s hope for spiritual progress with the eventual convergence of ultimate reality and unlimited love at its very center. (shrink)
The "new family" of disciples was formed by faith and commitment and included those who had traditionally been outsiders. Similarly, Christian ethics can support the bonding in covenant love of nonbiological families brought together by sometimes painful circumstances that can be redeemed by their actions. While the Christian tradition is supportive of the idea that birth parents should rear their children, it also relativizes the biological family by adding meaning to adoption. This is a creative tension.