The Need for an Effective Process to Resolve Conflicts Over Medical Futility: A Case Study and Analysis.

The issue of medical futility requires a well-defined process in which both sides of the dispute can be heard and a resolution reached in a fair and ethical manner. Procedural approaches to medical futility cases provide all parties involved with a process-driven framework for resolving these disputes. Medical paternalism or the belief in the absolute rightness of the medical model will not serve to resolve these disputes. Although medical futility is first determined by medicine, in order for the determination to meet legal criteria, it must be subject to review. The hope is that through a review process that meets legal criteria, the issue can be resolved without the need for court proceedings. If resolution cannot be obtained through this process, surrogates still have the right to seek court intervention. This issue is of relevance and importance in critical care nursing because of the role and position of critical care nurses, who have direct contact with patients and patients' families, the potential for moral distress in cases of possibly futile treatment, and the expanding roles of nurses, including critical care nurses and advanced practice nurses, in management and policy development.

Clarification and Mitigation of Ethical Problems Surrounding Withdrawal of Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is temporary life-support technology that provides time to rest the cardiac and respiratory system of critically ill people with acute, reversible medical conditions. Health care providers face emotional and challenging situations, where death may result, when withdrawing ECMO. A deepening of understanding of the ethical issues involved can aid clinicians in handling such difficult situations, leading to a possible mitigation of the moral problems. Toward this end, the ethical issues raised in the consideration of ECMO withdrawal are analyzed with respect to the ethical principles and concepts of autonomy, nonmaleficence/beneficence, medical futility, moral distress, and justice. In particular, these issues are considered in relation to how they affect and can be addressed by staff nurses and advanced practice nurses in the intensive care unit. Advanced practice nurses in particular can represent the voice of nurses to promote a healthier workplace in situations of moral distress related to stopping ECMO life-support technology and in developing clear and consistent guidelines for ceasing ECMO treatment, all leading toward clarification and mitigation of the ethical problems surrounding the withdrawal of this critical technology.

Devotion, Diversity, and Reasoning: Religion and Medical Ethics.

Most modern ethicists and ethics textbooks assert that religion holds little or no place in ethics, including fields of professional ethics like medical ethics. This assertion, of course, implicitly refers to ethical reasoning, but there is much more to the ethical life and the practice of ethics-especially professional ethics-than reasoning. It is no surprise that teachers of practical ethics, myself included, often focus on reasoning to the exclusion of other aspects of the ethical life. Especially for those with a philosophical background, reasoning is the most patent and pedagogically controllable aspect of the ethical life-and the most easily testable. And whereas there may be powerful reasons for the limitation of religion in this aspect of ethics, there are other aspects of the ethical life in which recognition of religious belief may arguably be more relevant and possibly even necessary. I divide the ethical life into three areas-personal morality, interpersonal morality, and rational morality-each of which I explore in terms of its relationship to religion, normatively characterized by the qualities of devotion, diversity, and reasoning, respectively.

Utilizing codes of ethics in health professions education.

Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy, however, regarding the value and use of these codes both in professional practice and in the education of healthcare professionals. I intend to review and analyze the various aims and purposes of ethics codes particularly within the study and practice of healthcare in light of various criticisms of codes of ethics. After weighing the strength and import of these criticisms, I plan to explore effective means for utilizing such codes as part of the ethics education of healthcare professionals. While noting significant limitations of this tool, both in practice and in education, I plan to demonstrate its potential usefulness as well, in both generating critical thinking within the study of ethics and as a guide for practice for the professional.

Emmanuel Levinas and the face of Terri Schiavo: bioethical and phenomenological reflections on a private tragedy and public spectacle.

The controversial case of Terri Schiavo came to a close on March 31, 2005, with her death following the removal of a percutaneous endoscopic gastrostomy tube. This event followed years of controversy and social upheaval. Voices from across the entire political and cultural spectrums filled the airwaves and op-ed pages of major newspapers. Protests ensued outside of Ms. Schiavo's care facility. Ms. Schiavo's parents published videos of their daughter on the internet in an effort to prove that she was not in a vegetative state and could potentially recover. There is a certain mystery to the entire controversy given the fact that, legally, it was largely a matter of settled law. Precedent cases and legal statutes clearly set out the proper procedures and decisions to be followed in this case. Nonetheless, powerful challenges and virulent opposition to these standards arose. Through an investigation of this case as well as a comparative study of the case of Dax Cowart (in particular, the documentary depictions of Dax Cowart's case) and of a photograph by Joel-Peter Witkin, I plan to investigate the source of these social upheavals and hypothesize that they were largely the result of a phenomenological reaction to the human face.

The role of the American Nurses Association Code in ethical decision making.

Ethical decision making is complex and difficult. For this reason, many professions compose ethical codes to aid their practitioners, to aid those in the profession in dealing with perplexing situations that inevitably arise. The American Nurses Association (ANA) Code of Ethics is of course one such code. It outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse. The relationship of the individual practitioner to the code, however, is an aspect of professional moral life that requires interpretation and may not always be well understood. A historical and theoretical analysis of the ANA Code can provide for an understanding as to how it is to be used not as a substitute for moral thinking but as an aid to moral thinking.