Category Archives: Early Access

Doing Clinical Ethics

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“Dr. Orr, is this a situation where it would be permissible to withdraw care?” asked one of my classmates. Looking intently at the student and ensuring everyone was listening, Dr. Orr answered, “We may withdraw certain treatments, but we never withdraw care.” It has been 16 years since I heard Bob’s response to that student’s question. Whether I am teaching clinical ethics to medical students or discussing a complex case with members of my hospital ethics committee, I often find myself repeating Bob’s profound insight. His statement has the same impact on my students and colleagues today as it did on me in that classroom many years ago.

It has been 16 years since I heard Bob’s response to that student’s question. Whether I am teaching clinical ethics to medical students or discussing a complex case with members of my hospital ethics committee, I often find myself repeating Bob’s profound insight. His statement has the same impact on my students and colleagues today as it did on me in that classroom many years ago.

The opportunity to study clinical ethics with Bob was what ultimately convinced me to pursue an advanced degree in bioethics. I had heard him speak on this topic at a conference a few years prior, and I knew that spending time with him would make a significant difference in how I directed the ethics committee at my hospital and taught the residents and students in our family medicine residency. When I enrolled in Bob’s class, I had no idea that one day I would teach several courses with him, use his approach to clinical ethics to change how my hospital ran its ethics committee, and pass his teaching methods on to hundreds of students, residents, and colleagues. In the process, Bob became a friend and mentor. Not only did he help me grow in my understanding and practice of clinical ethics, but he also helped me appreciate the incredible privilege we have been given to serve God and our fellow human beings through medicine.

A Lady with Few Directives

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QUESTION: How should we make decisions about resuscitation status for this confused woman with no designated surrogate?
STORY: Nellie is a 97-year-old woman who was living alone in her own home until she was admitted to the hospital four days ago with weakness, decreased mobility, and confusion. She was found to have pneumonia, sepsis, renal insufficiency, and dry gangrene of one toe. She has responded surprisingly well to treatment, but remains frail, somewhat confused, and is at risk of further complications. Dr. Roberts, who has not previously known the patient, has attempted to have conversations with Nellie about her wishes regarding resuscitation, intubation, and other end-of-life care, but she has given inconsistent responses. He believes that CPR with chest compressions is unlikely to work if Nellie’s heart should stop because of her very frail ribs—however, he is not absolutely certain.

The Moral Status of the Embryo in the Ethical Debate over In Vitro Fertilization

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Abstract

On February 29, 2024, the Alabama State Legislature raised a national debate over the ethics of In Vitro Fertilization. The Los Angeles Times on March 4 declared the law’s assumption that the embryo is a person (and by extension would have moral status) must be opposed because it stifles the right of women to have abortions and use IVF. In this paper I argue that an embryo has moral status based on what I call its “organic destiny,” which reveals its goodness of existence. I explain this according to the inner directivity of biological life to mature through the stages of being an embryo, newborn, toddler, to adulthood. The biggest ethical problem with the procedure of IVF is what to do with the leftover embryos not used in the process. IVF per se does not necessarily overlook the moral status of the embryo, but to discard the leftovers because they are now superfluous would overlook and disrespect their moral status. Thus, for the procedure of IVF to recognize ethically the moral status of the embryo, it should proceed with only one embryo at a time.

Keywords: In Vitro Fertilization, Moral Status, Embryo, Organic Destiny, Aristotle, Bible

Aggressive Interventions for an Infant with Thanatophoric Dysplasia

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Question: What medical and surgical treatments should be offered to an infant with a birth diagnosis that portends a lifetime of chronic problematic therapeutic needs?
History: Chelsea is a 7-week-old girl with thanatophoric dysplasia (TD) who has had a long and tumultuous hospital course since birth. Her diagnosis was discovered on prenatal ultrasounds, and her parents met with pediatric subspecialists, including both neonatology and pediatric palliative care. They received counseling on Chelsea’s diagnosis, its severe lung pathology, and poor survival rates. They discussed possible management and anticipated challenges, including the possibility that Chelsea would not respond to such interventions. The team and the parents focused on the “moment-by-moment” information gathering and decision-making in the delivery room, only briefly touching on the inevitable long-term support needs if Chelsea survived. Despite the counseling the parents received, they felt as if a trial of resuscitation was in Chelsea’s best interests after birth.

Professional Integrity in Healthcare Professionals: What, Why, and How

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Abstract

In this article, the authors discuss some empirical and conceptual basics of professional integrity of conduct in healthcare professions, such as nursing and medicine. They do so in three sections: the basics of professional conduct, including what they are, why they are, and how they work together, integrating original research as well as practical applications. We suggest professional integrity is integral to ethical caring practice, for the good for the patient is at stake, involving the trust of the patient in the professional, in her professional position, and in her profession as a whole. Professional integrity is the moral quality to keep together three dimensions of one’s person, one’s professional practice, and the patient’s interest. Several factors are identified either supporting or eroding professional integrity and the ability to manage integrity issues in practice. Those factors constitute five rules of thumb as well as reflective tools.

Keywords: professional ethics, professional integrity, moral wholeness, reliability, trustworthiness

The Ethics of Uterine Transplant in Absolute Uterine Factor Infertility: A Review of Uterine Transplant Today from the Lens of the Belmont Report

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Abstract

The miracle of childbirth and childrearing has been apparent since the beginning of time. Most women can birth children, and consequently, it is distressing for those who suffer from infertility. Medicine and research have advanced to provide relief from this type of suffering. Previously, absolute uterine factor infertility, or absence of a uterus, has been untreatable. However, advances in surgical and transplant techniques have made uterus transplantation a possibility for this type of infertility. Many risks are involved for women and children throughout the transplantation, pregnancy, and birthing process. As scientists, medical professionals, and Christians, we must ask, do the ends justify the means? This article will review the promises, perils, science, and current statistics of uterine transplantation from the specific view of research ethics. It will analyze the ethical permissibility or impermissibility of continuing research or approving this type of infertility treatment from the lens of the Belmont Report, with additional attention to the Montreal Criteria, traditional transplant ethics, the epistemology of science, the purpose of medicine, the particular view of Christian bioethics, and biomedical ethics. After reviewing these methods with statistical analysis of current research data, it will be perceptible from all presented views, with special attention to the research lens of the Belmont Report and Christian bioethics, that they do not permit uterine transplantation.

Keywords: AUFI, Biomedical Ethics, Christian Bioethics, Infertility, IVF, Medical Ethics, Transplant Ethics, Reproduction, Uterus, Organ Transplantation.