This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual cli but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history (...) and rationale for this approach, its goals, pedagogical assumptions, and design. (shrink)

Transplantation of tissue from fetal cadavers threatens ethical values and our social ethos in complex and subtle ways, requiring restraints that can prevent harmful normative and attitudinal shifts yet permit pursuit of medical benefits for those desperately in need.

The powerful new methods, expansive scope, and accelerated pace of human molecular genetics combine to catapult us into ethically unfamiliar territory. These features lend special urgency to questions of genetic ownership and privacy, disease and normalcy, identity and genetic determinism, and early diagnosis and therapy.

Many of the controversies surrounding the withholding of resuscitation are illuminated when we examine the language of resuscitation and resuscitative decisionmaking, and the contexts in which these decisions are made. Resuscitation and its withholding have multiple and often conflicting symbolic and emotional meanings for patients, families, and clinicians, and recognizing this divergence is essential to communication and to decisionmaking.

_Lost Lullaby_ makes one think the unthinkable: how a loving parent can pray for the death of her child. It is Deborah Alecson's story of her daughter, Andrea, who was born after a full-term, uneventful pregnancy, weighing 7 pounds 11 ounces, perfectly formed and exquisitely featured. But an inexplicable accident at birth left her with massive and irreversible brain damage. On a vitality scale of one to ten, her initial reading was one. And so begins Deborah Alecson's heart-rending struggle to (...) come to terms with two desperately conflicting and powerful emotions: her desire to nurture and love Andrea, and her desire to do everything in her power to bring about her death. Told in a mother's voice, with a simplicity and directness that heighten the intensity of the drama that unfolds, _Lost Lullaby_ reaffirms the human dimension of what is too often an abstract and purely theoretical discussion. During the two months that Andrea spent in the Infant Intensive Care Unit, Ms. Alecson spoke with lawyers, doctors, and ethicists in an effort to understand the legal, medical and ethical implications of her plight. She recounts those discussions and describes legal cases that have a direct bearing on her own situation. Her battle—both in coming to the agonizing decision to let her child die and in convincing the medical and legal establishments to respect that decision—will engender empathy for the plight of many families, and an awareness of the need to use medical technology with restraint. It is a must-read for everyone who cares about how we make life-and-death decisions on these new medical, legal, and moral frontiers. (shrink)

Many of the controversies surrounding the withholding of resuscitation are illuminated when we examine the language of resuscitation and resuscitative decisionmaking, and the contexts in which these decisions are made. Resuscitation and its withholding have multiple and often conflicting symbolic and emotional meanings for patients, families, and clinicians, and recognizing this divergence is essential to communication and to decisionmaking.

The line between Germ-Line genetic therapy and somatic cell is more and more difficult to discern. With new abilities to effect Germ-Line genetic therapy it is less clear why such therapy should not be undertaken. Nonetheless, questions persist as to who is the patient in such therapy and about the extent of discretion that should be allowed prospective parents and the physician/researcher. Keywords: embryo, Germ-Line, patient, somatic therapy CiteULike Connotea Del.icio.us What's this?