Journal of medical ethics
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Journal of medical ethics · Nov 2012
Evaluating a patient's request for life-prolonging treatment: an ethical framework.
Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. ⋯ Instead, we integrate the relevant arguments that have been put forward in the academic discussion about 'futile' treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families.
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Journal of medical ethics · Nov 2012
Could it be permissible to prevent the existence of morally enhanced people?
This paper discusses Nicholas Agar's argument in Humanity's End, that it can be morally permissible for human beings to prevent the coming into existence of morally enhanced people because this can harm the interests of the unenhanced humans. It contends that Agar's argument fails because it overlooks the distinction between morally permissible and morally impermissible harm. It is only if the harm to them would be of the morally impermissible kind that humans are provided with a reason to prevent the coming into existence of enhanced people. But if their enhancement includes moral enhancement, it is unlikely that the enhanced people will cause morally impermissible harm.
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Journal of medical ethics · Oct 2012
Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit.
In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. ⋯ Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement.