H.A.M.J. ten Have

Pressure and coercion in the care for the addicted: ethical perspectives

The use of coercive measures in the care for the addicted has changed over the past 20 years. Laws that have adopted the “dangerousness” criterion in order to secure patients’ rights to non-intervention are increasingly subjected to critique as many authors plead for wider dangerousness criteria. One of the most salient moral issues at stake is whether addicts who are at risk of causing danger to themselves should be involuntarily admitted and/or treated. In this article, it is argued that the dilemma between coercion on the one hand and abandonment on the other cannot be analysed without differentiated perspectives on the key notions that are used in these debates. The ambiguity these notions carry within care practice indicates that the conflict between the prevention of danger and respect for autonomy is not as sharp as the legal systems seem to imply. Some coercive measures need not be interpreted as an infringement of autonomy—rather, they should be interpreted as a way to provide good care.

Genetic screening: a comparative analysis of three recent reports.

Three recent reports on genetic screening published in the United Kingdom, Denmark and the Netherlands are discussed. Comparison of the Dutch report with the Danish and the Nuffield reports reveals that the Dutch report focuses on the aim of enlarging the scope for action, emphasising protection of autonomy and self-determination of the screenee more than the other two reports. The three reports have in common that the main concern is with concrete issue such as stigmatisation, discrimination, protection of the private sphere and issues linked with labour and insurance. Some potential long term consequences, however, tend to be neglected or underestimated. These omissions are pointed out.

Education of ethics committee members: experiences from Croatia

Objectives: To study knowledge and attitudes of hospital ethics committee members at the first workshop for ethics committees in Croatia. Design: Before/after cross-sectional study using a self administered questionnaire. Setting: Educational workshop for members of hospital ethics committees, Zagreb, 2003. Main outcome measurements: Knowledge and attitudes of participants before and after the workshop; everyday functioning of hospital ethics committees. Results: The majority of the respondents came from committees with at least five members. The majority of ethics committees were appointed by the governing bodies of their hospitals. Most committees were founded after the implementation of the law on health protection in 1997. Membership structure (three physicians and two members from other fields) and functions were established on the basis of that law. Analysis of research protocols was the main part of their work. Other important functions—education, case analysis, guidelines formation—were neglected. Members’ level of knowledge was not sufficient for the complicated tasks they were supposed to perform. However, it was significantly higher after the workshop. Most respondents felt their knowledge should be improved by additional education. Their views on certain issues and bioethical dilemmas displayed a high level of paternalism and over protectiveness, which did not change after the workshop. Conclusions: The committees developed according to bureaucratic requirements. Furthermore, there are concerns about members’ knowledge levels. More efforts need to be made to use education to improve the quality of the work. Additional research is necessary to explore ethics committees’ work in Croatia especially in the hospital setting.

An experimental case-conference programme for obstetrics and gynaecology clinical students.

Since the founding of the University of Limburg (1974), in The Netherlands, an innovative medical curriculum has been guided by educational principles of problem-orientation, continuous assessment, student initiative and attitude development. The teaching of medical ethics was built into the preclinical curriculum from the start. However, the clinical years remained largely unaffected, and only recently has an effort been made to extend the educational philosophy to this more or less traditional part of medical education. Within this context, an experiment of clinical ethics teaching was introduced in the Obstetrics and Gynaecology (Ob/Gyn) clerkships. The objectives, methods and results of this experimental programme are described in this paper. The success of the teaching is based on three features of the programme: 1) its student-centred approach; 2) the programme is designed in a way similar to regular patient conferences; 3) the programme is taught by a team consisting of both clinician and ethicist. Before starting a longitudinal programme of ethics teaching during the clinical years, it proved very helpful to experiment with a well designed and evaluated pilot programme.

Heroin addiction, ethics and philosophy of medicine.

This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion.

Unesco’s Ethics Education Programme

Unesco initiated the Ethics Education Programme in 2004 at the request of member states to reinforce and increase the capacities in the area of ethics teaching. The programme is focused on providing detailed information about existing teaching programmes. It also develops and promotes teaching through proposals for core curricula, through a training course for ethics teachers and by distributing educational resources to support programmes.

UNESCO Global Ethics Observatory: database on ethics related legislation and guidelines

The Database on Ethics Related Legislation and Guidelines was launched in March 2007 as the fourth database of the UNESCO Global Ethics Observatory system of databases in ethics of science and technology. The database offers a collection of legal instruments searchable by region, country, bioethical themes, legal categories and applicability to specific articles of the UNESCO Universal Declaration on Bioethics and Human Rights and International Declaration on Human Genetic Data. This paper discusses the background and rationale for the database and its role as a consultative and comparative resource hub for the study of ethics related legal instruments across the world, with the purpose of informing and inspiring relevant stakeholders on the implementation of the principles contained within the UNESCO declarations on bioethics.

National Bioethics Council: a Brazilian proposal

The number of national bioethics commissions has burgeoned since the establishment of the first one in 1983. They provide an arena in which stakeholders with widely differing moral views can discuss, interact and negotiate about controversial matters. The establishment of the Brazilian committee is used as an example of how such bodies can be introduced. If such councils are to be implemented effectively and regarded as legitimate, the society as a whole should be included in the construction of the proposal and represented on the council, the council should have the benefit of specialist advice when that is needed, and the council should be linked to the elected government in an official advisory capacity. The article describes long process of planning and consultation to establish Brazils National Bioethics Council and of eventually defining its task as advising the president on matters relating to bioethics.