The parturient woman: can there be room for more than ‘one person with full and equal rights inside a single human skin’*?

AIMS OF THE PAPER: The aim of the paper is to raise awareness around the legal and ethical issues involved in the enforcement of caesarean sections on non-consenting women. The paper considers the competing rights of mother and foetus in situations where a mother's wishes may result in harm or death to the foetus. BACKGROUND/RATIONALE: In this light of various court decisions about enforcing caesarean sections, the paper examines the pertinent legal and ethical issues, recognising that health professionals need to operate within an explicit legal and ethical framework. Content. The arguments about a woman's right to autonomous decision-making and a foetus' absolute right to life are examined with the focus throughout being on the legal framework. The need for health professionals to work within this as well as to avoid the temptation to base individual clinical decisions or professional behaviour on subjective moral judgements is emphasized. The attitudes of the judiciary are considered along with recent legal developments. There is an analysis of the way in which established legal principle is sometimes circumvented to override a woman's right to autonomy. The part played by lawyers and health professionals in denying a woman's competence to consent in order to achieve an outcome of which they approve is critically appraised. The basis for the decisions in these cases is deconstructed, along with a discussion of the role of health professionals in contributing to the dilemmas highlighted. CONCLUSION: It is essential that nurses or midwives caring for pregnant women have a full understanding of the legal and ethical issues surrounding this complicated and emotive area and where they, as health professionals, fit within this. The subject matter is also a useful arena for debating such ethical and legal issues as capacity and competence to consent as well as the extent of the right of any patient to full autonomy.     

The relationship between the application of the nursing ethical code and nurses' work satisfaction

Work satisfaction is known to be one of the major factors related to nurses' quality of care. Being able to apply the professional principles of training influences work satisfaction. The nursing ethical code is a good manifestation of these professional principles. The everyday strains on nurses' work might compromise the amount of energy invested in following the ethical code. The gap between the ethical requirements (as perceived by the nurse) and the perceived extent to which they are applied will influence work satisfaction through the mediating effect of role conflict. Demographic variables including age, tenure and number of children might also exert an effect. Structured questionnaires were used to measure the perceptions of nurses regarding their ability to follow the ethical code in a large hospital in Israel. Practical considerations meant that the questionnaire focused on client privacy issues in the ethical code. Results support the mediating hypothesis as the 'ethical gap' did not correlate directly with work satisfaction. This paper highlights that professionalization, manifested by the ethical code, should be applied on an everyday basis in the workplace.     

Moral deliberation: the role of methodologies in clinical ethics

The experience of the last thirty years has shown that whether the different methodologies used in clinical ethics work well or not depends on certain external factors, such as the mentality with which they are used. This article aims to analyze two of these mentalities: the “dilemmatic” and the “problematic.” The former uses preferably the decision-making theory, whilst the latter emphasizes above all the role of deliberation. The author considers that Clinical Ethics must be deliberationist, and that only in this context the different methodologies can be used correctly. This revised version was published online in July 2006 with corrections to the Cover Date.     

医患和谐需要"双向道德规范"

医患关系的特殊性,决定了协调医患关系需要双向道德规范。而对这一问题的探讨,不仅引发了人们思考特殊领域里人际伦理关系协调的双向性特点。而且也从一般意义上凸显了当前双向伦理规范研究的必要性和迫切性。     

Nurses' Conflicting Values in Competitively Managed Health Care

The combined effect of the medical model of care and a philosophy of health care as a business is threatening the complex human interactions that are essential to nursing. In the United States, nursing in 1999 is practiced in an environment that restricts understanding of its value and purpose.     

后基因组时代生命科学发展的社会伦理思考

随着后基因时代的到来，生命科学必须取得巨大进展，同时不可避免地面临一些社会伦理问题，本文着重从遗传工程与基因歧视、基因诊断与基因检查知情权及知情同意权的原则、基因治疗基因决定论以及基因争夺战等几个方面涉及到的社会伦理问题加以阐述。     

Mild cognitive impairment: Conceptual,assessment, ethical,and social issues

Mild cognitive impairment (MCI) is defined as a condition characterized by newly acquired cognitive decline to an extent that is beyond that expected for age or educational background, yet not causing significant functional impairment. The concept of MCI has received considerable attention in the literature over the past few years, and aspects related to its definition, prevalence, and evolution have been extensively studied and reviewed.Here we attempt to synthesize the implications of the current status of this entity, focusing on the conceptual, methodological, and, in particular, the social and ethical aspects of MCI which have attracted less attention. We discuss the weaknesses of the concept of MCI, which is heterogeneous in etiology, manifestations, and outcomes, and suggest that the emergence of the syndrome at this stage reflects industrial interests related to possible development of drugs for this disorder. On the other hand, the formal diagnosis of MCI, with its implications that the person may develop dementia, may have a grave impact on the psychological state of the individual, at a stage when prediction of outcome is tenuous and possibilities of useful interventions are meager. We present suggestions for the direction of future research in these areas.     

Some Issues in Facial Transplantation

Human facial transplantation, a form of composite tissue allotransplantation, has now become a clinical reality. We carried out the world's second partial facial transplantation in April 2006. We reviewed some issues associated with facial transplantation, especially focusing on the individual who underwent the transplant in our department. We discussed surgical indications, techniques, risks versus benefits, informed consent and psychosocial, societal and financial issues of facial transplantation. In our opinion, with the progresses in composite tissue allotransplantation, partial or full facial transplantation is becoming a timely and effective remedy for the significantly disfigured patients. However, there are a lot of problems unsolved, and as we have performed the transplant on only three individuals, no long‐term outcome data are available. Facial transplantation needs further research.     

Human ageing and the origins of religion

During the evolution of hominids, the population could besustained even with an expectation of life at birth of less than20 years. Under these circumstances very few individuals reachedold age. In these hunter-gatherer communities, altruisticbehaviour was encouraged because it increased the likelihood ofsurvival, whereas self-interest did not. An early moral codebenefited the community as a whole. As social evolutionprogressed, the chances of survival increased, and for the firsttime very elderly individuals appeared. However, the reward forsurvival to old age was merely decrepitude and death. Underthese circumstances, new incentives became a social necessity,and these took the form of a belief in an eternal afterlife. Religion then became the basis for the moral code, and itprovided an assurance of continual survival after death.