Strachan Donnelley

Toward an expanded vision of clinical ethics education: from the individual to the institution.

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.

Cost Containment, DRGs, and The Ethics of Health Care

This series of articles by Charles Dougherty, Robert Berenson, and Kathleen Powderly and Elaine Smith, as well as “Cost Containment: Challenging Fidelity and Justice” by E. Haavi Morreim (Hastings Center Report, December 1988), result from a Hastings Center project, “Ethics and Prospective Payment Systems: DRGs.” The two-year project was jointly funded by The General Electric Foundation and the American Medical Association Education and Research Foundation. The project tried to gauge the systematic effects of the introduction of cost containment strategies, prospective payment by Diagnostic Related Groups in particular, on the provision of health care and the ethical practice of medicine. Cost containment strategies, no matter how necessary in curbing spiraling medical costs, leave no sector or participants in the health care system untouched—hospitals and other health care institutions; doctors, nurses, social workers and other health care professionals; patients, their families, and the thirty-six to forty million medically indigent. The articles discuss the several and interrelated ethical issues raised by the DRG prospective payment system (Dougherty); its particular affect on the doctor-patient relationship and how it is transforming the ethical practice of medicine (Berenson and Morreim); and its specific impact on the professions and professional ethics of nursing and social work (Powderly and Smith). The overall message of the articles is that the health professions, their provision of care, and the ethics of their practices—as driven by economic considerations and realities—are in the midst of a more or less radical sea change.

The ethical challenges of animal biotechnology

Abstract This article gives a brief overview of the ethical challenges, theoretical and practical, presented by the burgeoning advances in animal biotechnology. Considering the range of interventions, the various motives for which they are undertaken, and the plurality of values and ethical obligations (often conflicting) involved, the author questions whether our present schemes of ethics that deal with “animal issues” are adequate to the task. He calls for the development of a “humans within nature” ethical perspective that coordinates ethical concerns for humans, animals, and nature and that combines attention to issues of ‘welfare’, ‘respect’, and ‘responsibility’. Crucial in this endeavor is the elaboration of a notion of ‘natural integrity’ and its ethical significance. In the interim, the author suggests generalizing the ethical review of scientific research protocols presently practiced by Animal Care and Use Committees to fit the many cases of animal biotechnology. Particular uses should be ethically judged by an art of “moral ecology”. We should consider the various values and ethical obligations involved in particular contexts and juxtapose the relative weight of their respective claims until we arrive at a judgment marked by overall ethical proportionality.

Natural Responsibilities: Philosophy, Biology, and Ethics in Ernst Mayr and Hans Jonas

Mayr from biology, Jonas from philosophy, both worked their way--against the philosophical current--toward a biologically informed philosophy that both draws from the natural sciences and reflects a responsibility toward nature.