This inquiry suggests a new epistemological foundation for understanding and discernment in biomedical ethics. This foundation, based on Aristotle's phronesis or practical wisdom, contains elements of the lived human experience which are seen as essential aspects of ethical, as well as medical, deliberation. The Aristotelian intellectual virtues of theoria and phronesis, used as "ideal types" of rationality, provide epistemological prejudices that structure two distinct ways of thinking. With this distinction, an alternative to certain dominant trends within biomedical ethics arises as phronesis provides more human centered prejudices for understanding. In conclusion, we shall see, using the doctrine of informed consent, that a phronetic rationality allows different, more humane meanings to come into being. Phronesis, it will be argued, provides a mode of rationality which promotes compassion and engagement in both ethics and medicine and consequently, is the more appropriate way of thinking in these important human practices.

Severe Acute Respiratory Syndrome (SARS) was first recognized in Guangdong Province, China, in November 2002. Subsequent to its introduction to Hong Kong in mid-February 2003, the virus spread to more than 30 countries infecting over 8,000 individuals across five continents. Toronto was particularly affected and SARS's outbreak there resulted in the emergence of five ethical issues in the following areas: isolation and quarantine, privacy and personal information, professional duty of care, collateral damage and the WHO's SARS-related Travel Advisory for Toronto. In what follows each of these issues will be explored in depth.

Patients who refuse a specific medical treatment for religious reasons must often overcome strongly entrenched presumptions held by physicians and judges, presumptions frequently based on personal values. A case in point is the refusal of blood transfusion therapy by Jehovah's Witnesses. / This paper rests on the following theory: The sanctity of life principle is not necessarily violated by respecting the autonomous decision of a patient who, for religious or moral reasons, chooses one therapy over another that may be favored by the treating physician. Where a patient has decided for conscientious reasons against a certain treatment in any given medical situation, the need to be informed will shift from the patient to the physician. The physician must understand the nature of the religious or moral conviction, as well as his own moral and legal obligation to respect the patient's wishes by providing the best medical care under the circumstances.

This thesis critically reviews medical journal literature on the physician-patient interview. The review focuses on literature which is written by and for physicians, in Canadian and American, English language medical journals. Articles, essays and letters to the editor are examined as a cultural exchange amongst physicians that both shapes and is shaped by the values of the medical profession. Chapter One presents literature concerning physician-patient communication in general. The following Chapters Two, Three and Four ("The Physician as Medical Interpreter," "Physician and Patient: in Conflict and in Silence," and "The Patient as Narrator,") focus on themes in the medical journal literature written by physicians on the clinical interview. These Chapters examine the values, explicit and implicit, of this literature. The values are examined for possible epistemological origins in traditional medical ethics, philosophical bioethics, contemporary social movements for the dignity and rights of the individual, and other sources. Thematic shifts in these values over the past twenty years, and the sources of these shifts, are also examined. Finally, the Conclusion evaluates the significance of this literature for the development of a medical morality.

The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.

The provision of medical care to top-level athletes in New Zealand comes with a number of challenging ethical issues. Some of these arise out of the commercial interest present in sport that links sporting success with funding, sponsorship deals and media interest. The requirement that athletes stay at peak physical function in order to be successful can, at times, be at odds with concepts of well-being and good health. The employment structure under which doctors are engaged by teams and the employment contracts which define these relationships can be the source of divided loyalty for doctors. For example, sharing health information beyond the doctor-athlete relationship may be in line with contractual obligations, but at odds with what the athlete requests. Divided loyalties also exist when athletes wish to participate in sport despite high risk of harm. Here there is a difference between what the doctor understands as the athlete�s best interest, and the athlete�s consideration of best interest. This thesis adopts two strategies for examining the area of sports medicine in elite athletes in New Zealand. The first section utilizes qualitative research. Sixteen sports doctors were interviewed and the data analysed. The next section involves normative reflection. Here two issues (where a range of behaviours were exhibited by participants) selected from the data are considered and discussion is presented on how doctors should respond to these issues. An examination of the level of guidance offered to sports doctors from the Australasian College of Sports Physician�s Code of Ethics follows. The level of guidance offered is considered inadequate and the thesis ends with a call to attend to these concerns.

This thesis is an exploration of professional behaviour in health care settings, using a Model of Treatment Engagement that is developed as a tool for ethics critique. The Model is tested and refined using data on: a psychiatric ???treatment??? carried out on over 1,127 occasions in a 15 - 40 bed non-acute hospital during the period 1961-1979; the problematic withdrawal of all life-support from a 37 year old man who had suffered acute brain trauma some five days previously, in a tertiary hospital in March 2000; and a clinical experiment recently proposed for the emergency setting and intended to encompass five hospitals and the NSW Ambulance Service. In each case, the Model proves useful in identifying the shift from the treatment paradigm and the ethical imperative of ensuring the patient (or his/her agent) appreciates the difference between what is proposed and what would normally be done. It reveals how doctors who dealt with the patient but did not decide on treatment contributed to ethically troublesome practice. It clarifies how having multiple doctor players in the treatment situation gave rise to the need to suppress dissenting views. Doctors who were close enough to the action to comprehend its nature, by not dissenting, reinforced the problematic choice for the actor and validated it in the eyes of observers. The lack of dissent at the level of doctors working under supervision, appeared to be a function of institutional arrangements. At the consultant level, there was evidence of pressure to concur from other consultants and indirect evidence of a fear of ostracism. The public responses in the two modern cases point to there being a strong idea in Sydney???s medical community that dissent should not be publicly displayed once a decision on how to treat has been made. I conclude there are two steps to reviewing ethically problematic treatment situations. The first consists of identifying the shift from the treatment paradigm. The second consists of establishing why the problematic choice is translated into action. The Treatment Engagement Model is put forward as a useful tool for both these analyses.

Bibliography: p. 379-394. / xi, 394 p. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1988

Genetic medicine is an emerging area of healthcare which constantly raises novel ethical challenges in the clinical realm due to its capacity to reveal information that has deeply personal meaning. Genetic tests can reveal more than is strictly essential for immediate medical care because they can diagnose conditions that cannot be cured, treated or effectively managed. The diagnosis of a genetic condition in one individual can have repercussions throughout an extended family, and genetic knowledge has created innovative, technologically driven, reproductive options. For clients of genetic counselling, moral choice does not readily result from uncluttered logic or easy personal preference, nor does it involve the application of sterile principles and laws, but is a much richer process involving personal history and culture, as well as reflection upon personal values, current resources and projected life goals. For these reasons, I question the validity of the exclusive use of a narrow version of Principlism, as it is commonly operationalised, for the medical sub-specialty of clinical genetics. Its heavy emphasis on individual autonomy, which has become synonymous with clinical medicine, does not take into account the fact that most genetic tests have little or no immediate clinical utility, or that genetic medicine is primarily about the way in which genetic conditions pass through families, and management of recurrence risks by choice of reproductive options. Therefore, the aim of this dissertation is to develop and explore a broader contextual moral framework, which is better suited to deliberation about complex ethical dilemmas in clinical genetics, than the current dominant approach which tends to follow a restrictive and non-inclusive application of Principlism. To achieve this aim, I have started with a review of relevant history and socio-political forces that have shaped the current status of the genetic medicine, and examined the evolution of current attitudes that underpin recognition, analysis and management of the ethical challenges in genetic medicine. I have analysed the manner in which Principlism and other normative theories are employed by bioethicists and clinicians in response to ethical dilemmas, and presented an alternative approach which employs a broader contextual ethical framework. I have devised an approach which attends to the importance of both current social opinion, and the tradition of evidence-based medicine, with reference to selected traditions in philosophical analysis. vi In conclusion, I advocate attention to concrete circumstances, which includes recognition of historical development, which has shaped current medical and wider social values, beliefs, norms and attitudes political context, including critical analysis of relevant political motivations social context, particularly situational power structures, trust relationships and relational obligations personal values, resources and experiences of the stakeholder(s) the range of realistically available options for the stakeholder(s) the impact of economic limits, which might be institutional and / or personal And, to achieve this objective of building a ‘thick’ ethical discourse, I propose a series of questions, which can be readily utilised by genetic and non-genetic health professionals as well as other members of society to work towards resolutions that represent a balance of fairness, economic responsibility with scarce resources, and socially acceptability. This approach appropriately attends to the relational and communicative aspects of moral dilemmas in clinical genetics, and is likely to yield more meaningful (and less likely paternalistic) conclusions, which would be of greater value to our morally pluralist society.

Thesis (Ph. D.)--University of Washington, 1992. / Vita. Includes bibliographical references (leaves [157]-166).