DOCSLIB.ORG

Tables of Contents

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Tables of Contents The Journal of Clinical Ethics: Tables of Contents 2019 The Journal of Clinical Ethics, Volume 30, Number 3, Fall 2019 At the Bedside Treating Children Maximally: Practical Applications Edmund G. Howe, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 171-82. Lainie Friedman Ross suggests that clinicians increase our efforts to meet children’s most basic needs in several ways. These include prioritizing, to a greater extent, children’s present and future feelings; placing greater decisional weight on other family members’ needs; spotting earlier threats from surrogate decision makers so that we can better prevent these threatened harms; and finding ways to intervene earlier so that we can allow parental surrogate decision makers to remain in this role. I offer some practical ways in which Ross’s ideas might be applied. Features Better than Best (Interest Standard) in Pediatric Decision Making Lainie Friedman Ross, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 183-95. Healthcare decision making for children has adopted the best interest of the child standard, a principle originally employed by judges to adjudicate child placement in the case of parental death, divorce, or incompetence. Philosophers and medical ethicists have argued whether the best interest principle is a guidance principle (informing parents on how they should make healthcare decisions for their child), an intervention principle (deciding the limits of parental autonomy in healthcare decision making), or both. Those who defend it as only a guidance principle often cite the harm principle as the appropriate intervention principle. In this article, I challenge current use of the best interest principle in pediatric decision making as a guidance principle and as an intervention principle. I propose a model that I call constrained parental autonomy, which focuses on promoting and protecting the child’s primary goods or basic needs. I show that constrained parental autonomy can serve as both a guidance principle and an intervention principle in making decisions. I conclude by examining a case study involving bone marrow donation by a young child to her sister. Offering the “Reasonable Interests Standard” in Response to Ross’s Analysis of the Best Interests Standard D. Micah Hester, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 196-200. Ross’s argument against the best interest standard (BIS) makes a clear case for the problems of the BIS, and she also notes challenges with such notions as the harm principle. In light of these critiques, Ross champions her longstanding pediatric moral norm for decision making, constrained parental autonomy (CPA). This article argues that while Ross’s critique of the traditional accounts of the BIS is correct, her solution still raises some concerns. As such, I offer the “reasonable interests standard” as a way of addressing what I see as weaknesses in both the BIS and CPA. Guidance and Intervention Principles in Pediatrics: The Need for Pluralism Mark Christopher Navin and Jason Adam Wasserman, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 201-6. Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians’ and parents’ decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child’s basic needs or primary goods, and both physicians and parents should be guided by a commitment to protect a child’s basic needs and primary goods. In contrast, we argue that no principle—neither Ross’s CPA, nor the best interest standard or the harm threshold—can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments. Decision Making on Behalf of Children: Understanding the Role of the Harm Principle Douglas S. Diekema, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 207-12. Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance or interference principle for decision making on behalf of children, but that her model of constrained parental autonomy can serve as both. I will argue that Buchanan and Brock were correct that a single model or standard cannot serve as both a guidance and interference principle in pediatrics and that the best interest standard is a sufficient guidance principle. The harm principle fulfills the conditions necessary for an interference principle, at least insofar as deciding when state intervention to interfere with parental decision making is justified. When Better Isn’t Good Enough: Commentary on Ross’s “Better than Best (Interest Standard) in Pediatric Decision Making” Erica K. Salter, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 213-7. In this commentary, the author discusses two strengths and two weaknesses of “Better than Best (Interest Standard) in Pediatric Decision-Making,” in which Lainie Friedman Ross critiques the best interest standard and proposes her own model of constrained parental autonomy (CPA) as a preferable replacement for both an intervention principle and a guidance principle in pediatric decision making. The CPA’s strengths are that it detaches from the language and concept of “best” and that it better respects the family as a distinct and intimate decision-making unit. The first weakness of the framework, as an intervention principle, is that because it imports a Rawlsian understanding of basic interests, it neglects certain populations of children (for example, children with intellectual disabilities). The second weakness is that, as a guidance principle, it is unclear what actual guidance the CPA is positioned to offer and how that guidance would be justified. To conclude, this commentary offers suggestions for what should be required of both an intervention principle and a guidance principle in pediatric decision making. Constrained Parental Autonomy and the Interests of Children in Non-Intimate Families Erin Paquette, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 218-22. Children’s age and developmental capacity leave them incapable of making medical decisions for themselves. Decisions for children are traditionally made under the best interest standard. Ross calls into question whether the best interest standard can function as both a guidance and intervention principle, able to be applied across the spectrum of pediatric decision making. Ross describes constrained parental autonomy as an alternative model, arguing that it affords parents the ability to make decisions within the context of their family while upholding a child’s current and future interests. Although the model provides a robust framework for intrafamilial decision making, I question whether it can be broadly applied to children living in non-intimate families. The Best Interest Standard Is the Best We Have: Why the Harm Principle and Constrained Parental Autonomy Cannot Replace the Best Interest Standard in Pediatric Ethics Johan C. Bester, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 223-31. While the best interest standard (BIS) enjoys wide endorsement as ethical and decision-making standard in pediatrics, it has been criticized as vague and indeterminate. Alternate decision-making standards have been proposed to replace or augment the BIS, notably the harm principle (HP) and constrained parental autonomy (CPA) model. In this edition of The Journal of Clinical Ethics, Lainie Friedman Ross argues that CPA is a better standard than the BIS or the HP as both guide and limiter in pediatrics. In response, I review the important work done by the BIS in pediatrics, and argue that neither the HP nor the CPA can take over these functions or replace the BIS. Among other things I argue: (1) The BIS provides more robust protections for the moral claims of children. (2) The CPA model and the HP do not resolve the indeterminacy and vagueness present in complex medical situations, and the BIS is better suited to deal with this vagueness and indeterminacy. (3) The BIS is a general principle of medical ethics with special application in pediatrics; it fits seamlessly into the system of medical ethics and fulfills many functions within pediatrics. The HP and the CPA model do not fit in so readily within medical ethics, and are not equipped to take over the functions of the BIS. In Further Defense of “Better than Best (Interest)” Lainie Friedman Ross, The Journal of Clinical Ethics 30, no. 3 (Fall 2019): 232-9. In their thoughtful critiques of my article “Better than
Load more

Recommended publications
  • CECA COMMITTEE MEETING MINUTES May 17, 2012 PRESENT
    CECA COMMITTEE MEETING MINUTES May 17, 2012 PRESENT ABSENT Armand Antommaria Jack Gallagher Art Derse Christine Mitchell Bob Baker (Code liaison) Nneka Mokwunye Ken Berkowitz Tia Powell Jeffrey Berger Marty Smith Joseph Carrese Brian Childs Paula Goodman-Crews Ann Heesters Martha Jurchak Kayhan Parsi Kathy Powderly Terry Rosell Wayne Shelton Jeffrey Spike Anita Tarzian (chair) Lucia Wocial Pearls & Pitfalls paper The “HCEC PEARLS AND PITFALLS”: Suggested Do’s And Don’ts for Health Care Ethics Consultants” manuscript has been accepted by JCE. JCE will retain the copyright for the full article, but the Pearls & Pitfalls themselves can be posted on ASBH website and used by others (with appropriate citation). Timing of the publication has not yet been established. Joe mentioned the statement in the current manuscript that readers can provide feedback about the paper on the ASBH website. Kayhan mentioned that ASBH’s website is currently undergoing revision, and will check with Chris Welber at AMC regarding the ability to have visitors post feedback on a specific location of the website. The manuscript will be modified accordingly before publication to match website capacity. Update from Board The Board is asking that CECA submit the Request for Proposals that was previously put on hold pending the Quality Attestation efforts underway. The Board has decided to pursue both activities in parallel. Anita will circulate the current RFP draft to CECA members to identify a process for completing this and submitting to the Board. The Board is developing operating standards for ASBH standing committees, which will impact CECA’s recent discussion about term limits and member rotation.
    [Show full text]
  • Nontherapeutic Growth Attenuation, Parental Medical Decision Making, and the Profoundly Developmentally Disabled Child’S Right to Bodily Integrity
    KOLL.DOCX (DO NOT DELETE) 12/17/2009 2:48 PM GROWTH, INTERRUPTED: NONTHERAPEUTIC GROWTH ATTENUATION, PARENTAL MEDICAL DECISION MAKING, AND THE PROFOUNDLY DEVELOPMENTALLY DISABLED CHILD’S RIGHT TO BODILY INTEGRITY MARY KOLL* Should parents of a profoundly developmentally disabled child be permitted to permanently terminate their child’s healthy bodily de- velopment in order to arguably increase the child’s quality of life? While such a procedure may sound like something out of science fic- tion, a highly publicized medical journal article released in 2006 de- scribed the case of Ashley X, a profoundly developmentally disabled child who received high-dose hormone treatment—along with a mas- tectomy and a hysterectomy—to permanently stunt her growth and al- legedly increase her quality of life. Though the authors of the article presented this type of nontherapeutic growth attenuation as a viable medical option for profoundly disabled children, critics from all over the world characterized the procedure—which came to be known as the “Ashley Treatment”—as a grave and unacceptable human rights violation. Nonetheless, the Ashley Treatment has also been met with support from some, most notably the parents of profoundly disabled children, many of whom have expressed a desire for their own child- ren to undergo similar procedures. This Note explores the question of whether parents should be permitted to choose such interventions on behalf of a child from the perspective of the child’s rights, specifi- cally, the child’s fundamental right to bodily integrity. Following a brief description of the case of Ashley X and the ensuing controversy, the author describes the right to bodily integrity, including its origins, its modern constitutional status, and its application to profoundly dis- abled children.
    [Show full text]
  • Thesis Statement
    PERSONAL ASSISTANTS AND COLLABORATIVE DECISION MAKING: PROMOTING A BETTER BALANCE OF AUTONOMY AND WELL-BEING FOR ADULTS WITH MODERATE, MILD, AND BORDERLINE MENTAL RETARDATION by Sarah M. Pope B.S., University of New Hampshire, 2000 J.D., University of Pittsburgh, 2007 Submitted to the Graduate Faculty of The Center for Bioethics and Health Law in partial fulfillment of the requirements for the degree of Master of Arts University of Pittsburgh 2007 UNIVERSITY OF PITTSBURGH THE CENTER FOR BIOETHICS AND HEALTH LAW This thesis was presented by Sarah M. Pope It was defended on April 13, 2007 and approved by Elizabeth Chaitin, DHCE, Center for Bioethics and Health Law James Flannery, JD, School of Law Thesis Advisor: Alan Meisel, JD, Center for Bioethics and Health Law, School of Law ii Copyright © by Sarah M. Pope 2007 iii PERSONAL ASSISTANTS AND COLLABORATIVE DECISION MAKING: PROMOTING A BETTER BALANCE OF AUTONOMY AND WELL-BEING FOR ADULTS WITH MODERATE, MILD, AND BORDERLINE MENTAL RETARDATION Sarah M. Pope, J.D., M.A. University of Pittsburgh, 2007 Autonomy is a core value of American tradition and is promoted in health care through the doctrine of informed consent. The notion underlying informed consent is that patients should have the right to decide, and are often in the best position to know, what will enhance their own well-being. Although this ethic has been extended to incompetent patients, by employing surrogate decision making, providing surrogate decision makers for adults with moderate, mild, and borderline mental retardation (“M-BMR”), who could potentially make their own decisions if adequate supports were offered, unreasonably restricts the autonomy of such individuals and often results in disregard for the patients’ human dignity.
    [Show full text]
  • The Strange Case of Ashley X
    Forever Small: The Strange Case of Ashley X EVA FEDER KITTAY I explore the ethics of altering the body of a child with severe cognitive disabilities in such a way that keeps the child ‘‘forever small.’’ The parents of Ashley, a girl of six with severe cognitive and developmental disabilities, in collaboration with her physi- cians and the Hospital Ethics Committee, chose to administer growth hormones that would inhibit her growth. They also decided to remove her uterus and breast buds, assuring that she would not go through the discomfort of menstruation and would not grow breasts. In this way she would stay ‘‘forever small’’ and be able to be carried and handled by family members. They claimed that doing this would ensure that she would be able to be part of the family and of family activities and to have familial care. But the procedure has raised thorny ethical questions. I wish to explore these questions philosophically by bringing to bear my own experiences as a mother of a grown daugh- ter with severe cognitive impairments. PRELUDE THE CASE In 2002, the parents of a six-year-old girl with a condition that will require physical care throughout her life, and who had begun to exhibit signs of pre- cocious puberty, requested, and were granted, permission to have high doses of estrogen administered to induce the premature closing of the long-bone epiphyses, thus maintaining the girl’s height at 4’5’’. The intention was to facilitate her care by keeping her small. To reduce the uterine bleeding that accompanies the procedure, as well as the risk of uterine cancer, she underwent a hysterectomy prior to the estrogen treatment.
    [Show full text]
  • The Belmont Report Ethical Principles and Guidelines for the Protection of Human Subjects of Research
    THE BELMONT REPORT ETHICAL PRINCIPLES AND GUIDELINES FOR THE PROTECTION OF HUMAN SUBJECTS OF RESEARCH The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research April 18, 1979 SUMMARY: On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law, there-by creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the charges to the Commission was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and to develop guidelines which should be followed to assure that such research is conducted in accordance with those principles. In carrying out the above, the Commission was directed to consider: (i) the boundaries between biomedical and behavioral research and the accepted and routine practice of medicine, (ii) the role of assessment of risk-benefit criteria in the determination of the appropriateness of research involving human subjects, (iii) appropriate guidelines for the selection of human subjects for participation in such research and (iv) the nature and definition of informed consent in various research settings. The Belmont Report attempts to summarize the basic ethical principles identified by the Commission in the course of its deliberations. It is the outgrowth of an intensive four-day period of discussions that were held in February 1976 at the Smithsonian Institution's Belmont Conference Center supplemented by the monthly deliberations of the Commission that were held over a period of nearly four years. It is a statement of basic ethical principles and guidelines that should assist in resolving the ethical problems that surround the conduct of research with human subjects.
    [Show full text]
  • The Ashley Treatment: the Current Legal Framework Protects the Wrong Rights
    Minnesota Journal of Law, Science & Technology Volume 10 Issue 2 Article 12 2009 The Ashley Treatment: The Current Legal Framework Protects the Wrong Rights Jillian Kornblatt Follow this and additional works at: https://scholarship.law.umn.edu/mjlst Recommended Citation Jillian Kornblatt, The Ashley Treatment: The Current Legal Framework Protects the Wrong Rights, 10 MINN. J.L. SCI. & TECH. 773 (2009). Available at: https://scholarship.law.umn.edu/mjlst/vol10/iss2/12 The Minnesota Journal of Law, Science & Technology is published by the University of Minnesota Libraries Publishing. KORNBLATT J. The Ashley Treatment: The Current Legal Framework Protects the Wrong Rights. MINN. J.L. SCI. & TECH. 2009;10(2): 773-800. Note The Ashley Treatment: The Current Legal Framework Protects the Wrong Rights Jillian Kornblatt* In 2006 two Seattle doctors performed several procedures to attenuate the growth of a profoundly neurologically and cognitively disabled six-year-old girl. When the doctors described the treatment in a medical journal, the story gained worldwide publicity and quickly became the subject of a highly contentious and emotionally charged controversy. As a result, a federally-sanctioned disability rights protection organization conducted an investigation and concluded that the treatment should not have been performed without a court order and that doing so violated the girl’s constitutional rights. Part I of this Note considers the legal framework applied to the treatment decision and how the framework would apply to other children whose parents requested the treatment. Part II then analyzes whether this framework adequately protects the best interests and constitutional rights of potential candidates for this treatment and their parents.
    [Show full text]
  • Fact Sheet: Women with Disabilities and Legal Issues
    TASC is sponsored by the Administration on Developmental Disabilities (ADD), the Center for Mental Health Services (CMHS), the Rehabilitation Services Administration (RSA), the Social Security Administration (SSA), and the Health Resources Services Administration (HRSA). TASC is a division of the National Disability Rights Network (NDRN). Fact Sheet: Women with Disabilities and Legal Issues Concerning Reproductive Health August, 2011 Prepared by: National Health Law Program Jina Dhillon and Celine Lefebvre1 with a grant from the Training and Advocacy Support Center (TASC) Introduction This fact sheet describes significant reproductive health-related legal issues that women with disabilities may face. Women with disabilities are particularly susceptible to discriminatory standards of care, coercion and misinformation about their reproductive autonomy. Courts have issued decisions involving the capacity to consent to sterilization, abortion and similar procedures, or the ability of a guardian to make reproductive health determinations in the best interests of the individual. This fact sheet provides an overview of case law in this area as well as a brief discussion of other issues identified by legal scholars as important areas for advocacy. Reproductive Health Issues Sterilization People with mental and physical disabilities have often been subjected to forced sterilization. The notion that these women and men are unable to make meaningful decisions about their reproductive capacity often leads caretakers, guardians, and the courts to consider sterilization as the best option for them. Case law regarding sterilization stems from the United States Supreme Court’s 1927 decision in Buck v. Bell, in which the U.S. Supreme Court upheld a Virginia statute that instituted compulsory sterilization of individuals with mental disabilities.2 Since then, many cases have addressed the issue of sterilization of women with disabilities.
    [Show full text]
  • An Exploration of the Societal Impact of Neuroethics in Scientific and General Communities
    Syracuse University SURFACE Syracuse University Honors Program Capstone Syracuse University Honors Program Capstone Projects Projects Spring 5-1-2015 An Exploration of the Societal Impact of Neuroethics in Scientific and General Communities Katelyn Marie Edel Syracuse University Follow this and additional works at: https://surface.syr.edu/honors_capstone Part of the Ethics and Political Philosophy Commons, and the Other Neuroscience and Neurobiology Commons Recommended Citation Edel, Katelyn Marie, "An Exploration of the Societal Impact of Neuroethics in Scientific and General Communities" (2015). Syracuse University Honors Program Capstone Projects. 847. https://surface.syr.edu/honors_capstone/847 This Honors Capstone Project is brought to you for free and open access by the Syracuse University Honors Program Capstone Projects at SURFACE. It has been accepted for inclusion in Syracuse University Honors Program Capstone Projects by an authorized administrator of SURFACE. For more information, please contact [email protected]. An Exploration of the Societal Impact of Neuroethics in Scientific and General Communities A Capstone Project Submitted in Partial Fulfillment of the Requirements of the Renée Crown University Honors Program at Syracuse University Katelyn Marie Edel Candidate for Bachelor of Arts and Renée Crown University Honors May 2015 Honors Capstone Project in Neuroscience Capstone Project Advisor: ___________________________ William Peace, Professor in the Renée Crown University Honors Program Capstone Project Reader: ____________________________
    [Show full text]
  • Tables of Contents
    The Journal of Clinical Ethics: Tables of Contents 2020 Winter 2020, Volume 31, Number 4 AT THE BEDSIDE Beyond Shared Decision Making Edmund G. Howe COVID-19 Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency Benjamin Tolchin, Stephen R. Latham, Lori Bruce, Lauren E. Ferrante, Katherine Kraschel, Karen Jubanyik, Sarah C. Hull, Jennifer L. Herbst, Jennifer Kapo, Ernest D. Moritz, John Hughes, Mark D. Siegel, and Mark R. Mercurio Micro and Macro Ethical Considerations of COVID-19 Amitai Etzioni FEATURES Helping Children Hurt Themselves: Why Pediatricians Ought to Support Adolescent Football Players in Their Athletic Goals Ruth Tallman The Pediatrician’s Moral Obligation to Counsel Directively Against Youth Tackle Football Lainie Friedman Ross The Compromising Interpretive Model as a Harm Reduction Strategy for Families that Have Chosen High School Football Ruth Tallman Living in the Hospital: The Vulnerability of Children with Chronic Critical Illness Alexandra R. Ruth, Renee D. Boss, Pamela K. Donohue, Miriam C. Shapiro, Jessica C. Raisanen, and Carrie M. Hen- derson Psychiatric Advance Directives as an Ethical Communication Tool: An Analysis of Definitions Billy Table, Jaime Thomas, and Virginia A. Brown Moral Distress: A Framework for Offering Relief through Debrief Shilpa Shashidhara and Shaylona Kirk CLINICAL ETHICS TRAINING Do Clinical Ethics Fellowships Prepare Trainees for Their First Jobs? A National Survey of Former Clini- cal Ethics Fellows Robert M. Guerin, Douglas S. Diekema, Sabahat Hizlan, and Kathryn L. Weise The Making of a Clinical Ethicist: A Personal Tribute to Al Jonsen Ruchika Mishra Remembering Al Jonsen Edmund G.
    [Show full text]
  • Code Gray.Pub
    Written by Christine Mitchell, RN, FAAN and Ben Achtenberg with a historical commentary by Susan Reverby, PhD and assistance from Joan Sawyer and Karen Wolf, RN, MS Contents INTRODUCTION ....................................................................................... 3 Background ............................................................................................3 Synopsis of the Film ..............................................................................3 Suggested Uses .......................................................................................4 Scheduling ..............................................................................................4 FILM AS A TOOL FOR DISCUSSION .......................................................4 WHAT IS NURSING ETHICS? ...................................................................5 GLOSSARY ...................................................................................................5 SOME GENERAL DISCUSSION QUESTIONS ........................................6 CASE 1: BENEFICENCE ............................................................................7 Description of the Case .........................................................................7 The Principle: Beneficence ...................................................................7 Questions for Discussion ......................................................................8 CASE 2: AUTONOMY ................................................................................9 Description
    [Show full text]
  • Institutional Review Board (IRB)
    Institutional IRB Essentials: Review All research team members need to complete the Board (IRB) Human Subjects Research course in CITI before the IRB application can be approved. This includes the Protecting the rights and welfare faculty advisor and students. CITI: of human subjects involved in www.citiprogram.org research activities You need to have final, written IRB approval before you begin. All consent forms and study materials must be approved by the IRB before being used. It’s fine if you’ve already started a literature review, but the IRB review and approval must be completed before you involve any human subjects in your research, including any study advertisement or subject recruitment. Office of Research Assurances (ORA) Morrill114 Hall, Room What is the Institutional Levels of review for IRB How long is the process? Review Board (IRB)? determination Providing that you (and your research team) have done your part in completing As Federally mandated, The University of • Full [convened] Committee Review- the Human Subjects Protection course Idaho IRB is an ethics committee greater than minimal risk through CITI and submitting all of the composed of scientists and non- • Expedited Review-no more than correct documents, then the IRB office scientists who serve as advocates for minimal risk can usually process Exempt reviews human subjects involved in research. • Exempt Review-less than “minimal within one business week and Expedited The IRB is charged with the risk” reviews within two to three business responsibility of reviewing and • Not Human Subjects Research weeks. If we need to contact you for overseeing human subjects research additional information or corrections, conducted by UI researchers.
    [Show full text]
  • Chapter 2 the Underlying Principles of Ethical Patient Care
    Chapter 2 The Underlying Principles of Ethical Patient Care Medical ethics is based on a series of ethical principles that are particularly relevant to medical practice and patient care. The principles were first developed by Tom Beauchamp and James Childress in their 1979 book, Principles of Biomedical Ethics, now in its fifth edition. Since then they have become recognized and used by those who work in medical ethics, training medical students and residents, working as eth- ics consultants in health care institutions, and serving on hospital ethics committees. These principles are included in the “common morality,” so they will be accepted by most members of the society. They are derived from classical ethical theories and are presupposed by traditional codes of medical ethics. The principles of medical ethics make several contributions to patient care and decision making in the medical context. They offer a way to approach ethical dilemmas that arise in the course of practicing medicine, making difficult health care decisions, and interacting with patients and their families. The principles pro- vide a way to organize our thinking about ethical issues in patient care and a shared language for health care providers to discuss these issues. Finally, the principles call attention to aspects of a medical situation that might be overlooked, and remind us that medicine is, ultimately, an ethical enterprise. Beauchamp and Childress introduced four basic principles of medical ethics: Principles of 1) Beneficence, 2) Non-Maleficence, 3) Respect for Autonomy, and 4) Justice. In this book we have expanded the original list of four principles to include the Principle of Respect for Dignity and the Principle of Veracity to include elements of patient care and medical decision making that are not explicitly covered by the original four principles, such as emotions and relationships; privacy and bodily integrity; religious, social, and cultural differences; and the importance of good communication skills.
    [Show full text]