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Extract The moral problem related to defining a space for personal values in medical care is that they may conflict with professional values, legitimising discrimination. Then it would be nearly impossible to criticise doctors and institutions that refuse abortion, do not examine patients of the opposite sex on religious grounds, and refuse to operate on HIV-positive patients or to treat people with different political affiliations. It would be hard to call that kind of environment a “healthy diversity”.
Clinicians have to be prepared to go to court to put their case for the best interests of the child, and then accept the legal decision with good grace, however personally distressing. This is just another example in medicine of the need for all to work with less than desirable outcomes.
Abstract “Access” is the new catchphrase for expanding privacy rights. This shift moves from seeking merely legalization, to demanding government assistance and the participation of private citizens. . . . This article will begin by examining the chief access arguments being used against conscience protections today: that the health professionals hold a monopoly so they are bound to offer abortion, that health professionals must defer their pro-life consciences to abortion’s legal status, and that health professionals must not impose their pro-life views. The article will conclude that, if access principles really flowed from a neutral concern for patient choices, they would require rather than strike down conscience protections. In many cases patients desire in their physicians the traditional Hippocratic values that unequivocally support human life and therefore oppose participating in activities such as abortion. The right of patients to access such physicians can only exist by guaranteeing the right of physicians to practice according to those values.
Abstract Background: Critical illness increases the risk of malnutrition, which can increase infections, prolong mechanical ventilation, delay recovery, and increase mortality. While enteral nutrition (EN) is considered optimal, this is not always an option. Furthermore, algorithms for parenteral nutrition (PN) vary significantly, and it is unclear whether early initiation or delay of parenteral feeding is preferable.
Objective: This study compares intensive care unit (ICU) duration of stay in adults randomized to early initiation of PN (within 48 hr of ICU admission) vs delayed (at eight days or later after ICU admission), as consistent with European and North American guidelines, respectively. . . .
Conclusions: While ICU and 90-day survival were not significantly different, patients in the late PN group were discharged earlier from both the ICU and the hospital. Late PN initiation was also associated with fewer infections, shorter mechanical ventilation time, shorter RRT time, and lower overall healthcare costs. While there were more episodes of hypoglycemia and more inflammation in the late PN group, there was no apparent clinical consequence. No primary or secondary end points showed that early PN was superior.
Reetta Saarnio, Anneli Sarvimäki, Helena Laukkala, Arja Isola
Nursing Ethics
Abstract Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked.
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.
