Robert L. Schwartz

Assessment of ethical decisions and values

Summary. The development and pilot testing of the Professional Decisions and Values Test (PDV) is described. The PDV is designed to assess how ethical conflicts are dealt with by medical and law students and which moral values motivate them. Data from two consecutive classes of entering medical and law students are presented and their action tendencies and ethical values are compared. The findings support the construct validity of the test. Regarding reliability, stability over time is present for action tendencies but not for values. Perhaps the ethical values of entering medical and law students do not become stable until later. Change in ethical values can be studied with the PDV for groups, not individuals, during the first year of professional education.

Multiculturalism, Medicine, and the Limits of Autonomy: The Practice of Female Circumcision

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma.

The Risks of Reducing Consciousness to Neuroimaging

Consciousness is a fundamental concept in science, medicine, law, and philosophy. Unfortunately, perhaps, for discourse in this area, it is a different fundamental concept in each of these disciplines (and for different subdisciplines within some of them, too). Consciousness has become a requirement of (and sometimes a synonym for) for whatever it is that we see as essentially valuable in human life. In law, for example, if the permanent absence of consciousness is not enough to define someone as dead, such a diagnosis at least justifies allowing someone to die (Symposium: Brain Imaging and the Law 2007). In medicine, the diagnosis of states of consciousness, like diagnoses of vegetative state (VS) or minimally conscious state (MCS), are also basic to treatment of traumatic brain injury, and thus to medical and scientific research on traumatic brain injury. The earliest medical commentators described living in a vegetative state as to “live merely a physical life devoid of intellectual activity or social intercourse” (Jennett and Plum 1972, 736). Philosophers, of course, continue to argue about the functional meaning of consciousness and its application to human beings, as they have for thousands of years. While the very thoughtful analysis of Fins and colleagues (2008) of the ethical pathway necessary to permit and encourage brain imaging research on those whose consciousness is either absent or limited will surely advance this important research, the authors begin with presumptions about consciousness that are hardly universal. As the research in this area progresses rapidly, those involved need to consider its immediate but indirect implications in medicine, law, and elsewhere. What effect, for example, might it have on doctors, judges, and others who must decide the consequences of limited consciousness for a patient who has suffered traumatic brain injury or some other consciousness limiting event? (Tovino, 2007). When a patient’s neural structures are severely damaged to the point of vegetative or minimally conscious state, the subjective self that endures has different meaning in different disciplines and in different cultures. One significant consequence of neuroimaging research with those with traumatic brain injury is that the neuroimaging will bring hard, scientific, visually accountable proof of conditions that have heretofore been ambiguous. It is not surprising that neurologists and scientists are unhappy with

Funding the Costs of Disease Outbreaks Caused by Non-vaccination

While vaccination rates in the United States are high - generally over 90 percent - rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials.

Professional decisions and ethical values in medical and law students.

No abstract available.

The Role of Institutional and Community Based Ethics Committees in the Debate on Euthanasia and Physician-Assisted Suicide

In many countries the debate over the role that physicians may (or should) play in ending life has been limited to the judiciary and other law making institutions, professional medical organizations; and academics. Because of their multidisciplinary and diverse membership, ethics committees may be a particularly appropriate venue through which these discussions can be expanded to include a much larger community. In addition, ethics committees generally act in only advisory capacities because they do not actually make decisions, so they may provide a forum for open discussions in ways that the court and the medical boards (which make licensing determinations) cannot.

Everything You Always Wanted to Ask a Lawyer about Ethics Committees

It should come as no surprise that we will get three different answers to the same question since we have three lawyers on the panel. The law is a matter of policy , and there is usually no single “right” answer to these questions. Each lawyer will come to a question from a very different perspective and bring a different approach to the answer.

Making patients pay for their life-style choices.

Smokers impose a terrible cost on all of the rest of us. Those who choose to smoke are more likely than nonsmokers to suffer from cancer, heart disease, and a host of other diseases that require intensive and expensive medical intervention. Although they may suffer these diseases, we all pay for their habit through higher healthcare costs, which are reflected in higher insurance premiums, higher taxes, and fewer healthcare resources available for nonsmokers. It is simply unfair for smokers to impose this cost on the rest of us; they should bear this self-induced cost themselves.

Implications of the Constitutional Right of Privacy for the Control of Drugs

Probably no Constitutional issue has created as much interest in academic circles over the past several years as has the development of the Constitutional right of privacy and, with the exception of the debate over affirmative action, no issue has led to such a volume of both judicial and scholarly writing. There are now several excellent descriptions, analyses, and histories of the right of privacy.1 The purpose of this survey presentation is to evaluate the development of the Constitutional right of privacy and those social policies that must underlie it in order to determine how the United States Supreme Court might apply the right of privacy to drug prohibitions and regulations and what implications the underlying social policies ought to have for our drug laws.