Extract In his article ‘‘Research Priorities and the Future of Pregnancy’’ in this issue of CQ, Timothy Murphy evaluates some of the arguments I advanced in an earlier publication, ‘‘The Moral Imperative for Ectogenesis.’’ In this reply to Murphy’s article, I acknowledge some of his points and seek to show why some of his objections are not as powerful as he thinks. I start here by summarizing the argument put forward in my original article.
Extract When Asians migrated to Western countries they brought welcome recipes for curries and dim sum. Sadly, a few of them also imported their preference for having sons and aborting daughters. Female feticide happens in India and China by the millions, but it also happens in North America in numbers large enough to distort the male to female ratio in some ethnic groups.1–4 Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups?
Extract Easy access to abortion and advances in prenatal sex determination have combined to make Canada a haven for parents who would terminate female fetuses in favour of having sons, despite overwhelming censure of the practice, economists and bioethics experts say.
Arguing that Canadian lawmakers’ silence on the issue is undermining the status of women, they’re calling for federal legislation to uphold societal and professional values opposing sex-selective abortion, either through a direct ban or restrictions on the disclosure of fetal gender. They also contend that sex-selective abortion is forcing physicians to compromise between their ethical obligations to discourage sex selection and legal obligations to respect their patients’ autonomy. . .
Extract “Do doctors have the right to refuse certain treatments on the grounds of personal conscience?” Is the question asking about Conway’s point about what the doctor sincerely, on medical grounds, considers to be in the patient’s best interests, or is the question asking about a doctor’s refusal to attend to a patient on the basis of some irrational prejudice? Horses of quite different colours — racing in different races.
Abstract One of the requirements in the Dutch regulation for euthanasia and assisted suicide is that the doctor must be satisfied ‘that the patient’s suffering is unbearable, and that there is no prospect of improvement.’ In the notorious Chabot case, a psychiatrist assisted a 50 year old woman in suicide, although she did not suffer from any somatic disease, nor strictly speaking from any psychiatric condition. In Seduced by Death, Herbert Hendin concluded that apparently the Dutch regulation now allows physicians to assist anyone in suicide simply because he or she is unhappy. In this paper, I reject Hendin’s conclusion and in particular his description of Mrs Boomsma as someone who was ‘simply unhappy.’ After a detailed narration of her lifestory, I turn to the American philosopher Harry Frankfurt’s account of volitional incapacity and love for a more accurate characterization of her suffering. Having been through what she had, she could only go on living as another person than the one she had been when she was a happy mother. That would have violated her integrity, and that she could not bring herself to do.
Abstract There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives.
Extract One in seven UK based scientists or doctors has witnessed colleagues intentionally altering or fabricating data during their research or for the purposes of publication, found a survey of more than 2700 researchers conducted by the BMJ.
The survey, which was emailed to 9036 academics and clinicians who had submitted articles to the BMJ or acted as peer reviewers for the journal (response rate 31%), found that 13% of these researchers admitted knowledge of colleagues “inappropriately adjusting, excluding, altering, or fabricating data” for the purpose of publication.
M Sercu, P Pype, T Christiaens, M Grypdonck, A Derese, M Deveugele
Journal of Medical Ethics
Abstract Background: In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter.
Aim: To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs).
Results: Although GPs can understand a patient’s request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient’s request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation.
Conclusions: Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law.
Extract Upon completion of her DDS degree, Martha . . .enters into a verbal agreement with the principal dentist . . . After working at the practice for several months, Martha notices that her paycheques seem to be consistently smaller than expected . . . she sees that the office has not been collecting the twenty percent co-payment from the insured patients, and has been routinely writing this amount off . . . Her initial gut reaction is that the insured patients are benefiting from the practice, so maybe it’s not such a big deal. However, her recent education in dental ethics causes her to take a more reflective approach.
M E Losa Iglesias, R Becerro de Bengoa Vallejo, P Salvadores Fuentes
Journal of the American Podiatric Medical Association
Abstract Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress.
Methods: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace.
Results: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients’ treatment and economic constraints, overload of paperwork, and acting against one’s conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results.
