Ethics Archives - Page 53 of 81 - Protection of Conscience Project Library

Advance Directives and Dementia

Gregory E Kaebnick

Abstract
A competent person can avoid the onset of dementia by refusing life-sustaining medical care and by voluntarily stopping eating and drinking, bringing life to an end well before any health crisis. A competent person can also try to limit the duration of dementia by drafting an advance directive that sets bounds on the life-sustaining care, including artificial nutrition and hydration, that medical caregivers can provide when the person no longer has the capacity to make her own medical decisions. But between these two strategies there can lie a significant gap. A person could live with moderate to severe dementia for a considerable time, no longer able to voluntarily stop eating and drinking yet also not yet requiring the life-sustaining care forbidden by advance directive. This gap has been much discussed in recent years in the Hastings Center Report. Several years ago (in the May-June 2014 issue), Paul Menzel and M. Colette Chandler-Cramer argued for what they described as a moderate correction to the dominant view that food and water should always be offered to a patient with dementia if the patient expresses a desire to eat and drink. The problem is taken up again by the legal scholar Norman L. Cantor in this issue (July-August 2018), and Cantor, too, tries to find a moderate alternative.

Kaebnick GE. Advance Directives and Dementia. Hastings Cent Rep. 2018 Aug 16;48(4):2.

(Thesis) Morality as Natural History: An adaptationist account of ethics

Oliver Scott Curry

Abstract
What are moral values and where do they come from? David Hume argued that moral values were the product of a range of passions,inherent to human nature, that aim at the common good of society. Recent developments in game theory, evolutionary biology, animal behaviour, psychology and neuroscience suggest that Hume was right to suppose that humans have such passions. This dissertation reviews these developments, and considers their implications for moral philosophy. I first explain what Darwinian adaptations are, and how they generate behaviour. I then explain that, contrary to the Hobbesian caricature of life in the state of nature, evolutionary theory leads us to expect that organisms will be social, cooperative and even altruistic under certain circumstances. I introduce four main types of cooperation – kin altruism,coordination to mutual advantage, reciprocity and conflict resolution –and provide examples of ‘adaptations for cooperation’ from nonhuman species. I then review the evidence for equivalent adaptations for cooperation in humans. Next, I show how this Humean-Darwinian account of the moral sentiments can be used to make sense of traditional positions in meta-ethics; how it provides a rich deductive framework in which to locate and make sense of a wide variety of apparently contradictory positions in traditional normative ethics; and how it clearly demarcates the problems of applied ethics. I defend this version of ethical naturalism against the charge that it commits ‘the naturalistic fallacy’. I conclude that evolutionary theory provides the best account yet of the origins and status of moral values, and that moral philosophy should be thought of as a branch of natural history.

Curry OS. (Thesis) Morality as Natural History: An adaptationist account of ethics. London School of Economics and Political Science. 2004.

Speciesism as a precondition to justice

Y Michael Barilan

Abstract
Over and above fairness, the concept of justice presupposes that in any community no one member’s wellbeing or life plan is inexorably dependent on the consumption or exploitation of other members. Renunciation of such use of others constitutes moral sociability, without which moral considerability is useless and possibly meaningless. To know if a creature is morally sociable, we must know it in its community; we must know its ecological profile, its species. Justice can be blind to species no more than to circumstance. Speciesism, the recognition of rights on the basis of group membership rather than solely on the basis of moral considerations at the level of the individual creature, embodies this assertion but is often described as a variant of Nazi racism. I consider this description and find it unwarranted, most obviously because Nazi racism extolled the stronger and the abuser and condemned the weaker and the abused, be they species or individuals, humans or animals. To the contrary, I present an argument for speciesism as a precondition to justice.

Barilan YM. Speciesism as a precondition to justice. Politics and the Life Sciences. 2005;23(1):22-33.

(Correspondence) Access to Emergency Contraception – In Response

Rebecca J Cook, Bernard M Dickens

Journal of Obstetrics and Gynaecology Canada

Extract
The CMA Code of Ethics begins with the principle that an ethical physician will consider first the well-being of the patient. Physicians who feel entitled to subordinate their patients’ desire for well-being to the service of their own personal morality or conscience should not practise clinical medicine.

Cook RJ, Dickens BM. (Correspondence) Access to Emergency Contraception – In Response. J. Obstet Gynaecol Can. 2004 Feb;112.

War Crimes and Legal Immunities: The Complicities of Waffen-SS General Karl Wolff in Nazi medical experiments

Michael Salter, Suzanne Ost

Extract
There is a considerable amount of academic and popular literature on Nazi medical experimentation within concentration camps, however, the existing research largely focuses on the doctors and the details of their experiments and has neglected two interesting themes. The first neglected theme is the potential legal liabilities and defense strategies of those among the SS leadership, such as SS General Karl Wolff. Wolff facilitated these experiments in a purely administrative capacity, but without his contribution this type of war crime would not have been possible. Secondly, the research has neglected the extent to which Wolff was able to avoid legal accountability for these and other war crimes, as a result of his wartime cooperation with a U.S. intelligence agency and his post-war assistance to interrogators within the Allied Military Intelligence as well as the Nuremberg prosecutors. [2] The present article, which is the first in a series of related studies, focuses largely on the first theme. This article gives particular attention to Wolff’s attempts to avoid prosecution by insisting that the experiments were of a voluntary nature, based on the consent of the research subject, and were, therefore, not criminal acts. Additionally, the article focuses on Wolff’s claim that he did not possess the requisite mens rea or intent necessary to secure a criminal conviction.

Salter M, Ost S. War Crimes and Legal Immunities: The Complicities of Waffen-SS General Karl Wolff in Nazi medical experiments. Rutgers J Law Rel. 2004(1);1-69.

A physician’s professional duty to inform despite personal ethical objections

Laura D Briley

Extract
This physician may feel ethically torn, but it is the physician’s duty to help enable this patient to make the best decision. By informing the patient about abortion, the physician is not endorsing the procedure, or swaying this mother in either direction, but simply providing information. This use of information will strengthen the relationship between patient and physician because it fosters autonomy and offers a sense of support during a time when it is needed most. Although it may not be a physician’s duty to perform an abortion when the physician feels ethically opposed, it is the duty of the physician to inform a woman about the procedure without allowing personal beliefs to influence her decision.

Briley LD. A physician’s professional duty to inform despite personal ethical objections. Curr Surg. 2003;60(6):594.

Access to emergency contraception

Rebecca J Cook, Bernard M Dickens

Abstract
The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Cook RJ, Dickens BM. Access to emergency contraception. J Ob Gyn Canada. 2003 Nov;25(11):914-916.

Private Conscience: Public Duty

Graham Zellick

Extract
The premise of this lecture is that there are two different sets of ethical rules, the purely private and a special set arising in the workplace which will differ from occupation to occupation. . . .

• First, I hope it is axiomatic that ethics and morals must accompany individuals at all times no matter what they are doing.

• Secondly, that the moral or ethical position of the individual may in certain circumstances have to take on board other considerations which also have a moral and ethical dimension and that the ultimate decision, though different from one that would be reached in private life by the individual, is nevertheless justifiable and ethical.

• Thirdly, that to violate these precepts, even if it is done in order to give primacy to one’s own ethical code, is not ethical: the individual should resign or seek an alternative occupation. In other words, there are times when to listen to one’s private conscience while remaining deaf to the moral demands of one’s occupation can itself be seriously unethical.

• Fourthly, that weighing these considerations in the balance is no easy task and succumbs to no formula. It calls for the exercise of keen judgment informed by a developed moral framework.

Zellick G. Private Conscience: Public Duty. European Judaism. 2003 Autumn;36(2):118-131.

When Free Exercise Exemptions Undermine Religious Liberty and the Liberty of Conscience: A Case Study of the Catholic Hospital Conflict

Brietta R Clark

Extract
Conclusion
Using this framework, I propose a more protective principle for free exercise protection than currently exists, one that requires a heightened scrutiny of all laws that burden religious liberty, even neutral laws of general applicability. This review should examine carefully the need for the government law and the possibility of an exemption or accommodation that will not undermine the purpose of the law. However, I would not go as far as some states in providing almost absolute free exercise protection from government laws serving important government interests. Rather, the principle I advocate requires a balancing of interests tipped to favor laws protecting third parties’ from harm over religious claimants’ objections. The Catholic hospital conflict demonstrates how even under this more protective free exercise principle, the rule of law and the self–limiting principle of the liberty of conscience and religious liberty operate as justifiable limits on the scope of free exercise protection. The hospitals’ free exercise interests must be balanced against the potential harm to patients who cannot access necessary reproductive health care and information, which means that in many cases exemptions for religious hospitals will be denied.

Clark BR. When Free Exercise Exemptions Undermine Religious Liberty and the Liberty of Conscience: A Case Study of the Catholic Hospital Conflict. Oregon Law Review. 2003 Fall;82(3):625-694.

Moral Diversity Among Physicians and Conscientious Refusal of Care in the Provision of Abortion Services

Karen E Adams

Journal of the American Women's Medical Association — Journal of the American Women’s Medical Association

Abstract
Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians’ moral values take on special significance, however, when considering services patients may request but that contradict that physician’s moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician’s freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient’s right to full disclosure of options and informed consent is not compromised by the physician’s personal moral stance.

Adams KE. Moral Diversity Among Physicians and Conscientious Refusal of Care in the Provision of Abortion Services. J American Med Women’s Ass (1972). 2003;58(4):223-226.