Psychological background of pro-health behavior.

In this study, psychological conditions of pro-health lifestyle behavior have been analyzed. A first research group consisted of 88 healthy people (44 males, 44 females) aged 19-39. Psychological analysis showed a positive correlation between the internal locus of control and adherence to healthy diets; a correlation extending to the knowledge about healthy food. Social exclusion appeared to reduce the possibility of reaping new knowledge about healthy diets and was negatively correlated with the tendency of using healthy diet or dietary supplements. A second group consisted of 70 women aged 20-65. The subjects in this group were oriented towards using a diet which reduces body mass; pro-health both physical and psychological objectives other than body mass reduction were secondary in this study. General self-esteem and physical self-esteem were found to be positively correlated with the involvement in physical activities and satisfaction from dietary intervention. These outcomes were negatively correlated with body mass. The study shows that the efficiency of prevention is related to the locus of control, self-efficacy expectation, faith in the result, and self-esteem. The information about the interconnections among these variables may be useful in building preventive behavioral programs.

Toward the clarification of ideas: medical futility, persistent/obstinate therapy and extra/ordinary means.

Despite reluctance of a part of medical society to accept the moral and/or legal permission to euthanasia, there is seemingly a common agreement on the need to resolve the problem of excessive therapy. Several ethical concepts are used to justify decisions to withhold/withdraw such treatment. Three of them are of particular value. The ordinary-extraordinary means distinction has a long tradition deeply-rooted in the Catholic medical ethics. During the last decades the concept of futile (or pointless) treatment has reached popularity within bioethical discourse. Also, slightly less common in use, the term 'obstinate therapy' and the relative concept seems to provide interesting insights into ethical debate. What is however to be emphasized is the ambiguity of meanings attached to these terms/concepts which prompt many bioethicists to reject these terms in favor of other concepts. In the present study a PubMed literature database review is done in order to recognize and then to classify the different ways of interpretation of the three concepts related to withholding/withdrawing excessive treatment. Retrieved interpretations of these concepts are evaluated in the light of an integrated model of moral justification. The undertaken analyses permit reaching the conclusion that the concepts which are the subject matter of this article can be properly defined and used only within the context of the so called holistic ethics and as an example of such i.e., a holistic approach to bioethics, the life's programs approach to bioethics is given.

[Neuroethics: new quality of medical ethics?]. / Neuroetyka: nowa jakosc etyki medycznej?

During the last decade there has been a striking growth in interest in ethical issues arising from the development of neurosciences. It was as late as 2002 that the new discipline, called neuroethics, started. It was intended to be a new area of interdisciplinary discourse on moral dilemmas connected with recent advances in, broadly understood, neurosciences. Ten years after its launch neuroethics possesses a distinct body of knowledge and an institutional basis for its further development. As a very young discipline, however, neuroethics is still in a state offlux. Two essential theoretical concepts of how this discipline is to be built on are emerging. Both are discussed in this article. According to the first of them (i.e. ethics of neurosciences), neuroethics is basically understood as a sub--discipline of bioethics. Although there are some reasons for distinguishing several branches or sub-disciplines of bioethics (genethics, neuroethics, nanoethics, etc.), there are sound arguments against such a tendency for the proliferation of biomedical ethics. The second approach to neuroethics (neuroscience of ethics), which aims at studying neuronal correlates of the well-known ethical concepts (e.g. free-will, moral responsibility, etc.), seems to be much more promising. Neuroethics understood in this way (and only in this way) can be considered as a truly new opportunity for collaboration between neuroscientists and ethicists.

Bioethics of life programs: taking seriously moral pluralism in clinical settings.

BACKGROUND: In the more and more globalized world, the experience of moral pluralism (often related to, or based upon, religious pluralism) has become a common issue which ethical importance is undeniable. Potential conflicts between patients' and therapeutic teams' moral views and between moral beliefs of the particular member of this team are being resolved in the light of bioethical theories, among which principlism remains the mainstream approach to biomedical ethics. The question arises, however, whether this approach, in itself, as being strictly bound to the specific and distinct American philosophical tradition, is to be considered the tool for so called ?moral imperialism'. Also architectures of principlism, in particular by elaborating the concept of common morality, defend the applicability of their theory to the pluralistic settings, it should be emphasized that the idea that some norms and standards of moral character are shared by all morally serious people in every culture has attracted criticism both from empirical as well as theoretical backgrounds. OBJECTIVE: This paper aims at reconsidering principlism so that it would be more suitable for resolving moral dilemma in ethically pluralistic clinical settings. METHODS: Lakatos' sophisticated methodological falsification is used into two different ways: (1) to construct a concept of 'life programs' and (2) to confront a newly elaborated ethical theory with principlism. The reflection is limited to the norms related to the key issue in clinical ethics, i.e., respecting the patient's autonomy. RESULTS: The concepts of common morality and particular moralities are interpreted (in the light of Lakatos' philosophy of sciences) as "hard core" and "protective belt" of life programs, respectively. Accepting diversity of research programs, Lakatos maintains the idea of the objectivity of truth. Analogously, the plurality of life programs does not put into question the objectivity of moral values. The plurality of moral norms not only respects the objectivity of the good, but also can be seen as a condition sine qua non of such objectivity in the changing socio-historical context of doctor-patient relationship. CONCLUSIONS: The life program approach to bioethics and clinical ethics in particular, can be seen as a form of widening of principlism. This new approach, being non-relativistic, is at the same time sensitive to moral pluralism experienced in everyday medical practice.

Beyond purely ethical understanding of responsibility: a phenomenological approach.

BACKGROUND: The assumption that moral responsibility is a constitutive feature of the human person could almost be considered as the raison d'être of ethics and consequently of bioethics. In fact, the concept of"common morality", which is becoming ever more popular within the mainstream of bioethics, assumes that certain, even if elementary, experience of moral responsibility (and understanding of it) is shared by all the people of every cultural (moral) tradition. Although the phenomenon of (moral) responsibility is seen as a moral question, its ultimate explanation needs reflection which goes beyond purely ethical considerations. MATERIAL AND METHODS: The phenomenological ontology as elaborated by R. Ingarden is accepted as the theoretical background of deliberations in this study. Methods of reasoning appropriate to this approach to phenomenology are used. RESULTS AND DISCUSSION: The phenomenon of human responsibility is analyzed--according to Ingarden's suggestion--from the point of view of the four "situations" in which responsibility appears: (I) to be responsible for something, (II) to accept responsibility for something, (III) to be called to responsibility for something, and (IV) to be acting responsibly. The ontological foundation of responsibility in each of these situations is then inquired. Ingarden's philosophical reflection leads to discovery of the ultimate ontological foundation of responsibility in: (I) objective axiology, (II) structure of an acting subject, and (III) a causality structure of reality. We discuss whether Ingarden's analyses are coherent with the concept of "common morality". CONCLUSION: Although R. Ingarden is best known, especially to English-speaking readers, for his work in aesthetics, it should be emphasized that his phenomenological ontology can provide interesting insights into the understanding of the concept of responsibility which is fundamental to ethics/bioethics.

[Physicians' attitudes toward pain in newborn infants. Preliminary results of a cross-sectional national survey]. / Postawy lekarza wobec bólu noworodków. Wstepne wyniki ogólnopolskiego badania sondazowego.

BACKGROUND: Since 1980s, the problem of pain experienced by newborns has met with increasing interest both in research work and in clinical practice. It is worth noting that significant progress in neurophysiologic basis of pain and in diagnostic and therapeutic methods have occurred during that time. AIM: This study primarily aims at describing opinions of the doctors who work in the neonatal wards and neonatal intensive care units in Poland regarding the management of pain in newborns. MATERIAL AND METHODS: The respondents of this survey were heads (or persons appointed by them) of 302 neonatal and paediatric intensive care hospital wards, in Poland. The questionnaire prepared for this purpose was used. RESULTS: The respondents demonstrated that essentially they possessed correct knowledge regarding the neurophysiology of pain, the diagnostic and therapeutic methods used in the management of pain in the newborns. The majority of respondents claimed that adequate pain management was used in their daily practice. They felt responsible for the parents' health education concerning the problem of pain in newborns. On the other hand, they complain about the lack of adequate training courses for physicians regarding this subject matter. CONCLUSIONS: It is recommended to organize specialized courses for doctors regarding pain in the newborn, and, in particular, regarding the principles of using opioids in the pain management of newborns.

[The issue of autonomy in medical ethics: philosophy of Karol Wojtyla]. / Kwestia autonomii w etyce medycznej: filozofia Karola wojtyly.

The issue of autonomy seems to play a very central and fundamental role in contemporary medical ethics. However, it should be emphasized, that there is no agreement on how the concept of autonomy ought to be understood. Although as the main intellectual framework to describe the meaning of "autonomy" is the use of philosophical system of John St. Mill or Immanuel Kant, one could identify the tendency to redefine the concept under study. The aim of this article was to find out if the philosophy of Karol Wojtyla could provide--interesting from the bioethical point of view--insights into understanding of the idea of autonomy. The Wojtyla's critique of Kant's and Mill's understanding of autonomy was shortly described and the main elements of Wojtyla's concept of autonomy were analyzed. On the basis of these considerations it was assumed that philosophical background of Wojtyla is so different from those which are used in the contemporary, especially so called Anglo-American, bioethics that introducing it "elements" of his thinking would lead to misunderstandings and indeed even serious errors. On the other hand, however, philosophical works of Wojtyla seems to be very influential in developing 'personalistic' bioethics. But this bioethics could be accepted only by people who share Wojtyla's ontological and probably also theological or religious assumptions.

[Medical research and vulnerable subjects: unemployed people]. / Badania na ludziach i szczególnie wrazliwe grupy osób: bezrobotni.

Although the importance of medical research for the diagnosis and treatment of human diseases is unquestionable, the use of human subjects, however, still presents a complex ethical problem. Moral difficulties occur in particular when the medical research deals with vulnerable subjects. Vulnerable individuals are defined as those who experience diminished actual autonomy. Among the groups which should be considered as being vulnerable are usually listed the following: children, pregnant women, mentally or emotionally disabled, physically disabled, homeless, and institutionalized people. This study addresses key concerns that gave rise to the question of whether unemployed people had to be recognized as vulnerable subjects. The term "vulnerability" was clarified and it was assumed that the "vulnerability" of medical research subjects' had to be understood as a form of continuum from potential, through the circumstantial, temporal, episodic, permanent to inevitable vulnerability. The conclusion was drawn that unemployed people were, at least, potentially vulnerable subjects. Research involving unemployed people presents important moral challenges to researchers and should be undertaken very carefully, following special ethical guidelines.

Genetic medicine: Polish deontological guidelines and the ethical practice of research studies with children.

The purpose of the article is: (1) to describe deontological guidelines which regulate medical research involving human subjects in Poland, and (2) to clarify the understanding of the fundamental ethical concepts presented in these documents. To do this, two main documents are analysed: (1) the Polish Medical Ethics Code, which was approved by the 7th Extraordinary National Doctors' Convention in September 2003 after a long and difficult process of revision, and (2) the Good Practice in Science, a set of rules concerning scientists, approved by the Committee of Ethics of the Polish Academy of Science in 2001. The pluralism of contemporary ethics and of medical ethics in particular, results in various interpretations of the understanding of the crucial terms used in the deontological statements of these codes. The paper suggests that clarity in the understanding of the terms may be achieved by exploring the 'intellectual' context in which the analysed documents have been appearing and in which they are presently functioning. In order to examine such a context, the following aspects are taken into account: (1) the development of bioethics as a discipline in Poland, (2) international deontological documents which are universally accepted and are in use in Poland, (3) legal regulations regarding medical research involving persons which are currently in force in Poland, and (4) the practice of Polish Institutional Review Boards (IRBs).

[Dignity of human life: euthanasia and suicide]. / Godnosc ludzkiego zycia: eutanazja i samobójstwo.

Euthanasia is commonly considered as a form of suicide. The study aims to explore if such a presumption could be justified. Philosophical analysis of concepts of "human being", "human person", "biological life" and "life of human person", undertaken in this article, proved that the effective cause of suicide is obviously different from such a cause of euthanasia. Suicide aims to destruct life of a human person which is considered deprived of its dignity. Euthanasia's effective cause is to protect the dignity of such a life which is threatened by low quality of biological life caused both by the disease as well as by the applied treatment even if palliative only. On the basis of these considerations the main conclusion is drawn: suicide and euthanasia having different moral (material) subjects should be also ethically evaluated in a different way.

The position of a leader nurse.

Traditionally, nursing's leading role is considered as an indirect function, i.e. the professional function, which is aimed at nurse development rather than the patient. In contemporary medicine both therapeutic as well as nursing tasks are performed by a team rather than an individual, being it a doctor or a nurse, respectively. No teamwork can be effective without a leader; this is also true for good nursing in which the leadership is of a very special nature. The paper particularly concentrates on these characteristics of the nurse's leading role, which are related to the fact that the patient, according to the autonomy principle, is recognized as a central person in the therapeutic/nursing team.

[Evaluation of the health care system: pluralism of the concepts of justice]. / Ocena systemu ochrony zdrowia: pluralizm koncepcji sprawiedliwosci.

Georgetown Mantra, recognized as sui generis credo of the principalism in the contemporary bioethics, introduces two radically new principles into medical ethics: observance of the patient's autonomy during the therapeutic process, and justice. The first of them, on the ground of post-modernistic individualism, seems to be well elaborated. The second one, which put attention on the community and its rights, is still not enough present in the contemporary medical ethics and in particular in regard to all those problems which are related to social institutions of health care, their existence and work. As a result of the critic of the post-modernistic thought, the societies are recognized no more as sets of individuals, but rather as composed of different moral communities. In such a way is redefined the term "pluralistic society". The existence of communities of people, which do not share the same concept of rationality and the system of ethic norms is assumed. The evaluation of the health care system presumed (in the formal and essential way, i.e. methods of choosing criteria and use of them) acceptance of the particular ethical system, with its conception of justice. The main aim of the paper is to present and classified different understandings of justice, which are recalled to evaluate health care systems in the sphere of Euro-American culture. At the end some practical conclusions are drawn in regard to ethical evaluation of the Polish health care system.