End-of-life care, particularly for patients with advanced dementia, tests the medical covenant, both the integrity and aptness of what physicians have to offer and the fidelity with which they offer it. This article considers five ways of justifying the unilateral withholding of future treatment: (1) an affirmation of professional autonomy; (2) a defense of professional integrity; (3) a parentalist exercise of power on behalf of the patient and/or family; (4) a protection of the interests of third parties (footing the bill); (...) or (5) a protection of the interests of second parties (the physician or other providers). The article concludes with a sixth response to care for the stricken patient and family that seeks to attend more fully to the clinical reality of bonded humans in the throes of disease and death. (shrink)
This paper was first presented as a plenary lecture to the Association for Education in Journalism and Mass Communication in August, 1985. The author, who is the Cary M. Maguire University Professor of Ethics at Southern Methodist University, discusses the intellectual, moral, and organizational marks of the professional that led reformers at the beginning of the twentieth century to locate professional training in the university. That discussion is followed by consideration of the moral consequences of university education for professionals, and (...) how journalists and all other professionals are, at base, teachers. The third part of the paper reflects upon the peculiarities of journalism as aprofession, and concludes with considerations of the special mission of journalism. (shrink)
: Money motivates people, lubricates the movement of resources, mobilizes talent, and breaks down some barriers. But money also has a darker side; it can distract, corrupt, distort, and cruelly exclude. Money is a useful but unruly servant; sometimes, a hard master. The professional, at least in part, belongs to the world of money. We sometimes distinguish the amateur from the professional in that the amateur does it for love; the professional, for money. The professional has one foot in the (...) marketplace, but also, purportedly, professes something else--beyond the bottom line. The following discussion explores the morally complex ties and tensions between money and the medical professions. (shrink)
A word, first, about the religious sensibility that I have found helpful to describe the care professionals owe to dying patients, particularly patients with advanced dementia.That word is covenant. It is a biblical term; but, today, it covers such dubious devices as real estate covenants. A real estate covenant often operates below the moral level of a contract to wall some people out of a neighborhood. Classically understood, however, the word covenant helps probe the obligations of doctors to their patients (...) more deeply than the notion of a contract. Covenants of the sort I have in mind and contracts appear to be first cousins; they both include an agreement and an exchange between parties. But, in spirit, contracts and covenants differ markedly. Contracts are external; covenants are internal to the parties involved. We sign contracts in order to discharge them expediently. Contracts are limited and time-bound — whether a contract to fix plumbing or to charge such and such for a medical procedure. (shrink)
William F. May, a leading expert on medical ethics, here explores two of today's most crucial tests of the traditional covenant between physicians and patients--active euthanasia and health care reform.
Partly diagnostic, this essay explores the religious background to the shift in the dominant political anxieties of our time: from injustice to anarchy. The primordial elements of water, fire, earth, and air supply us with powerful images for the dissolution of institutional forms and structures into chaos. In its response to the threat of chaos, the United States runs the danger currently of shifting in its sense of itself: from leading citizen among the nations to imperial power ruling over all (...) nations. On the domestic scene, the country also shows signs of reconfiguring its life after the pattern of imperial Rome. While both order and justice are fundamental social goods—neither of which can be ignored—the essay argues, in closing, for the priority of justice in God's charitable ordering of all things. This article was the Presidential Address at the 2003 SCE annual meeting in Pittsburgh. (shrink)
Within medical ethics, moralists have reflected more on the professional's quandaries than on the patient's ordeal. Yet if professionals are to help their patients, they must see clearly the variety of suffering their patients experience. For a child who has been sexually abused, the caregiver must see the pain of the child's fractured self.