Search

In his book Engineered Death: Abortion, Suicide, Euthanasia and Senecide, John Woods uses an argument from analogy to establish the following conclusion: even if one grants that foetuses are not persons but only potential persons, killing foetuses is murder. Murder, according to Woods, is the defeasibly wrongful violation of the right to life ascribed to persons. If this argument is successful, it would of course have profound consequences for the ongoing philosophical debate over the morality of abortion. Whether or not they hold that foetuses are persons, philosophers would be forced to adopt the same moral attitude toward foeticide as they would adopt toward the killing of persons. That is, the killing of foetuses and the killing of persons would be defeasibly wrong in the same way; their wrongfulness could be defeated only in special and limited circumstances, perhaps like those suggested by Judith Thomson in her “Defense of Abortion”.

This article examines two currently disputed issues regarding public policy for mentally retarded people. First, questions are raised about the legal tradition of viewing mental competence as an all-or-nothing attribute. It is argued that recently developed limited competence and limited guardianship laws can provide greater freedom for retarded people without sacrificing needed protection. Second, the question of who should act paternalistically for retarded people incapable of acting for themselves is examined. Rothman's claim that special formal advocates are the best representatives for retarded people is discussed and criticized. It is argued that parents, professionals and legal advocates should share decision-making authority on behalf of those who are incompetent.

This article discusses the nature and significance of the holistic health movement in four ways. First, a general characterization of the movement is proposed, based on shared commitment to five assumptions: (1) a positive view of health as well-being, (2) individual responsibility for health, (3) the importance of health education, (4) control of social and environmental determinants of health, and (5) low technology of "natural" therapeutic techniques. Second, a basic difference among advocates of holistic health/medicine is proposed in terms of the presence or absence of commitment to scientific method. Third, holistic health/medicine is briefly compared with concepts of holism in biology and in the social sciences. Finally, criticisms of each of the basic tenets of the holistic health movement are offered.

This is the strong response of Dr. Louis Del Guercio to the prospect of cutbacks in federal support for critical care, taken from his 1977 presidental address to the Society For Critical Care Medicine. Dr. Del Guercio’s remarks illustrate one side of a continuing controversy about how much society ought to invest in critical care medicine, the care of patients with severe, life-threatening illness or injury. This paper will be devoted to an examination of that controversy. First, however, I would like to place the controversy within the broader context of concern about the cost of health care.

Gareth Matthews’ paper [5] is a penetrating discussion of two closely related topics. In the first part of the paper, he offers a description and analysis of what he has called the “Standard Developmental Account” of children’s conceptions of death. In the second part of the paper he focuses on an in-depth study of terminally ill children and compares its findings with the Standard Developmental Account. My commentary will explore the implications Matthews draws from these studies for the questions of whether and how to inform seriously ill children about their disease and help them participate in decisions about its treatment.

Section I / Examining the Rights Tradition.- Rights and Borderline Cases.- Applying Moral Theory to the Retarded.- Joseph Margolis, John Rawls, and the Mentally Retarded.- Do the Retarded Have a Right Not to Be Eaten? A Rejoinder to Joseph Margolis.- The Rights of the Retarded.- Rights, Justice and the Retarded.- Section II / Respect and Labeling.- Respect and the Retarded: Issues of Valuing and Labeling.- Person Ascriptions, Profound Disabilities and Our Self-Imposed Duties: A Reply to Loretta Kopelman.- The World Gained and the World Lost: Labeling the Mentally Retarded.- Labeling the Mentally Retarded: A Reply to Laurence B. McCullough.- Section III / Theology and Philosophy of Religion.- Must God Create the Best?.- Parenting, Bonding, and Valuing the Retarded.- Responsibility for the Retarded: Two Theological Views.- Philosophical and Theological Perspectives on the Value of the Retarded: Responses to William F. May and John C. Moskop.- Section IV / Law and Public Policy.- The Legal Rights of Mentally Retarded Persons in Twentieth Century America.- Examining Legal Restrictions on the Retarded.- Who Speaks for the Retarded?.- Commentary on David J. Rothman's 'Who Speaks for the Retarded?'.- Dilemmas in the Neonatal Intensive Care Unit.- Health Care, Needs and Rights of Retarded Persons.- Notes on Contributors.

In ‘Loving the Chronically 111 Child: A Pediatrician’s Perspective’ [4], Thomas Irons exhorts his fellow physicians to rededicate themselves to the traditional but endangered values of service and love for their patients. These values are symbolized by and embodied in the house call, the healing touch, the soothing voice, and the listening ear, activities and skills central to the practice of an earlier generation of physicians. Irons identifies a number of major obstacles preventing today’s physicians from achieving the ideals of service and love, including fragmentation in health care, limited access to care, paternalism, defensive medicine, retreat into science, and over-reliance on consultation. The latter four of these — paternalism, defensive medicine, retreat into science, and over-reliance on consultation — are described as attempts by the physician to avoid the vulnerability and pain which accompany identification with the patient and his suffering. I believe that physicians would do well to dedicate themselves to the ideals Irons has presented, and I agree that the obstacles he discusses seriously threaten the provision of compassionate care for chronically ill children.

Like their philosophical colleagues, Christian moral theologians have written relatively little about the rights of retarded persons or about our responsibilities to them. It appears that the existence of retarded persons raises difficulties for certain theological as well as philosophical approaches to ethics. Nevertheless, two contemporary American Protestant theologians, Joseph Fletcher and Stanley Hauerwas, have directly addressed the issue of our responsibilities regarding those with different natural endowments. In this paper, I will first review and evaluate the positions adopted by Fletcher and Hauerwas. We will see that despite a common Christian heritage, their approaches stand in striking contrast to one another. I will then attempt to suggest an acceptable middle ground between the two positions.

A Movable Medical Crisis.- Moral Absurdities in Critical Care Medicine: Commentary on a Parable.- Moral Tensions in Critical Care Medicine: "Absurdities" as Indications of Finitude.- "Conceptual Construals" vs. Moral Experience: A Rejoinder.- Can Principles Survive in Situations of Critical Care?.- Coercion, Conversation and the Casuist: A Reply to Jay Katz.- Justice and the Hippocratic Tradition of Acting for the Good of the Sick.- Clinical Ethics and Resource Allocation: The Problem of Chronic Illness in Childhood.- Moral Choice, the Good of the Patient, and the Patient's Good.- What Good is Another Paper on The Good? No Codes and Dr. Pellegrino.- Allocating Resources Within Health Care: Critical Care vs. Prevention.- Report of the President's 2003 Commission on the Fall of Medicine.- Triage and Critical Care.- The Ethics of Critical Care in Cross-Cultural Perspective.- Triage: Philosophical and Cross-Cultural Perspectives.- Critical Care in an Historical Context.- Commentary on Stanley J. Reiser's 'Critical Care in an Historical Context'.- Notes on Contributors.

For several years, organ transplantation has been one of the most highly publicized therapies of modern medicine, a kind of symbol of our high-technology, high-cost efforts to save lives. Children have played an important role in this history; the media focused public attention on Charles and Marilyn Fiske's search for a donated liver for their daughter Jamie in late 1982 ~ and on Baby Fae's 20-day survival in 1984 with a transplanted baboon heart. 2 These cases, especially that of Baby Fae, evoked a flood of controversy and raised a host of complicated issues. In reviewing ethical issues in transplantation for children, this paper touches on some of the medical, scientific, economic, political, and social issues with which ethical issues are unavoidably linked. Three principles of ethics--beneficence, autonomy, and justice--form a framework for the discussion. First, consider the principle of beneficence, which enjoins us to act for the benefit or good of another or others. Benefitting the sick is arguably the fundamental goal of health care and the fundamental professional commitment of the physician. 3 In the case of transplantation, the primary benefits we seek to provide are the preservation of life (a necessary condition for any other benefit) and the improvement of its quality. Thus we speak of organ donors as giving the gift of life. The mere intention to benefit someone, however, is not by itself a sufficient justification for action. If it were, Dr. Bailey's belief that a baboon heart could be of benefit to Baby Fae 4 would have been enough to justify the transplant, and the widespread questioning of his grounds for that belief 59 would be irrelevant to the question of whether that experiment should have been attempted. Rather, scientific medicine demands that our beneficent intentions be well grounded in fact, and thus we look first to animal research

In the current era of cost-containment, Congress may reconsider its support for the End-Stage Renal Disease Program. Substantial reductions in funding for this program could be made by eliminating non-beneficial, marginally beneficial, and relatively inefficient modes of treatment. These measures, however, will only postpone the inevitable day when clearly beneficial treatment must be withheld.

Current federal policy, as reflected in the final Baby Doe rule, will have a chilling effect on the ability of doctors to care appropriately for severely disabled infants. The policy threatens to prolong life unjustifiably for such infants. It will force physicians to violate a duty to do no harm without compensating benefit. And it raises serious problems for the just distribution of health care.

KIE: Cohen reviews two collections of essays on ethical issues in critical care medicine: Ethics and Critical Care Medicine, edited by John C. Moskop and Loretta Kopelman (D. Reidel; 1985), and "Ethical Moments in Critical Care Medicine," a symposium issue of Critical Care Clinics, edited by James P. Orlowski and George A. Kanoti (1986 Jan; 2(7): 189 p.). Some of the topics discussed by the contributors include physician beneficence vs. patient autonomy in critical care decision making; the pressures created by the "rescue ethos" of the critical care setting; the selection of patients for admission to intensive care; the equitable distribution of critical care resources; and the increasing need to factor costs into treatment decisions. E. Cassell, E.D. Pellegrino, J. Katz, D. Walton and N. Donen, J. Moskop, J. Perrin, H.T. Engelhardt, R. Veatch, J. Paris and F. Reardon, S. Youngner, and S. Imbus and B. Zawacki are among the essayists.