A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The (...) analysis is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why the (...) medical profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach. (shrink)

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or (...) theories, these approaches are consistent with and should not be considered adversaries of a principle-based account. (shrink)

Yoga-Sutras of Patanjali is a foundational psychological text that organizes, codifies, and systematically presents in s_tra form the psychology as practised in India around second century BCE. Its theme is to help humans free themselves from their congenital bondage due to conditioned existence and consequent suffering. The goal is to restore the person to her inherent unconditioned blissful being. The quintessence of Yoga is meditation. Meditation consists of dharana and dhyana, a contemplative state of passive attention precipitated by a prolonged (...) practice of concentration. Dhy_na practice leads to sam_dhi, a stand-still altered state in which the mind is controlled and restrained from habitual cognitive processing. This paper provides a theoretical background of Patanjali Yoga and a select review of empirical research on the neurophysiological correlates of meditation, highlighting on the one hand some of its methodological shortcomings and conceptual problems and suggesting on the other hand the areas of promise for further research on meditation. (shrink)

The authors discuss the nature of consciousness, the methods for studying it, its relevance to our values, and the role of consciousness for enhancing human abilities and wellness.

Kate Storey is experienced in direct service, education and administration in both hospital and community settings. She is a family member; she was diagnosed with depression in 1980 and is “in recovery”. She is a doctoral student in the Faculty of Education at the University of Western Ontario with research interests in recovery education and empowerment. Tanya Shute is Executive Director of the Krasman Centre: a Consumer Survivor Initiative, which embraces a wellness and recovery focus. She is a social activist (...) who identii es as having personal experience with mental health challenges and substance abuse. Her undergraduate degree from York University is in Public Policy and Administration; she is completing her MSW in social policy at Laurentian University. Ann h ompson is a “survivor/ provider” trained in critical social work at York University, who is exploring the application of recovery principles in programs/organizations supporting consumer/survivors and family members. Ann is a certii ed Wellness Recovery Action Plan Facilitator and has adapted the WRAP framework to a family setting. She developed the Critical Perspectives in Mental Health curriculum in the Masters Social Work program at York University. (shrink)