Medicine and Health Sciences Commons^™

Health Care Ethics In Canada, Françoise Baylis, Barry Hoffmaster, Susan Sherwin, Kirstin Borgerson

C. Barry Hoffmaster

No abstract provided.

The Nature Of Suffering: Moving Beyond Definition To Understanding, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Real Ethics, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

The Nature Of Moral Compromise: Principles, Values, And Reason, Cliff Hooker, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Re-Reasoning Ethics, Cliff Hooker, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

The Rationality And Morality Of Dying Children, Barry Hoffmaster

C. Barry Hoffmaster

Formal reason is not adequate to explain how we think through real-life problems and make moral decisions about them. A far richer account of rationality is necessary. Interviews conducted with children who have leukemia, and who must figure out by themselves that they are dying and how they should handle that information, illustrate a range on informal tools that must be part of that account.

How Experience Confronts Ethics, Barry Hoffmaster, Cliff Hooker

C. Barry Hoffmaster

Analytic moral philosophy's strong divide between empirical and normative restricts facts to providing information for the application of norms and does not allow them to confront or challenge norms. So any genuine attempt to incorporate experience and empirical research into bioethics--to give the empirical more than the status of mere 'descriptive ethics'--must make a sharp break with the kind of analytic moral philosophy that has dominated contemporary bioethics. Examples from bioethics and science are used to illustrate the problems with the method of application that philosophically prevails in both domains and with the conception of rationality that underlies this method. …

What Does Vulnerability Mean?, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Downward Delegation Of Implantable Cardioverter Defibrillator Decision-Making In A Restricted-Resource Environment: The Pitfalls Of Bedside Rationing, Christopher Simpson, Barry Hoffmaster, Paul Dorian

C. Barry Hoffmaster

Implantable cardioverter defibrillators have been shown to reduce all-cause mortality in some patient populations at risk of sudden death. New Canadian guidelines recommend implantable cardioverter defibrillator therapy for these patients. However, the need for these devices exceeds the funded volumes in many Canadian jurisdictions. As a result, rationing of this resource has been necessary. While rationing at the macro (Ministry of Health) and meso (hospital) levels has achieved some level of acceptance by society, the responsibility for the decisions taken at the micro (individual) patient level actually rests with the physician at the bedside. This 'bedside rationing' creates a moral …

Attitudes Regarding Organ Donation From Non-Heart-Beating Donors, Sean Keenan, Barry Hoffmaster, Frank Rutledge, Jeannette Eberhard, Liddy Chen, William Sibbald

C. Barry Hoffmaster

PURPOSE: To determine the attitudes toward organ donation from non-heart-beating cadaver donors in a sample of the general public and health care workers.

MATERIALS AND METHODS: A moderator-administered questionnaire was completed by members of the general public, recruited randomly from a professional consumer research group's database, and health care workers recruited from the same database, family practice clinics, and local hospitals. Two primary scenarios were tested: (1) patient in coma, not going to survive intensive care unit (ICU), and (2) patient lapsing in and out of consciousness, lifetime institutional care.

RESULTS: Sixty members of the general public and 68 health …

Bioethics In Social Context, Barry Hoffmaster

C. Barry Hoffmaster

"The problems of bioethics are embedded in people's lives and social worlds. They are shaped by individual biographies and relationships, by the ethos and institutions of health care, by economic and political pressures, by media depictions, and by the assumptions, beliefs, and values that permeate cultures and times. Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.

The original essays in this volume use qualitative research methods to expose the multiple contexts within which the problems of bioethics arise, are defined and debated, and ultimately resolved. In a provocative concluding essay, …

Expensive Medical Technologies And “Indication Extrapolation”: The Case Of Implantable Cardioverter-Defibrillators, Christopher Simpson, George Klein, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Anatomy Of A Clinical Ethics Consultation, Barry Hoffmaster

C. Barry Hoffmaster

Theoretical accounts of the nature and purposes of clinical ethics consultation are disappointingly superficial and diffuse. Attempts to illuminate the goals, the forms, the substance, and the criteria for the success of ethics consultations need to focus on detailed reports of cases and the contexts in which they occur. The uncommonly rich description of the consultation surrounding Mrs. Roses plight provides a splendid opportunity to explore such matters. The ethics consultant pursues a number of ventures providing and clarifying information, improving communication, educating and counseling, and being a friend with variable degrees of success. What the ethics consultant can do …

The Forms And Limits Of Medical Ethics, Barry Hoffmaster

C. Barry Hoffmaster

As medical ethics has evolved over the past several decades, it has come to be regarded as a domain of applied ethics, that is, the application of a rationally based, philosophical theory to moral problems in health care. But an array of difficulties arise in the attempt to apply general moral theories or norms to concrete problems, difficulties that expose the incompleteness and indeterminacy of philosophical moral theory. The doubtful ability of applied ethics to be practically helpful has led to the development of two main competitors. One is the attempt to reprise and rehabilitate the tradition of moral casuistry, …

Can Ethnography Save The Life Of Medical Ethics?, Barry Hoffmaster

C. Barry Hoffmaster

Since its inception contemporary medical ethics has been regarded by many of its practitioners as ‘applied ethics’, that is, the application of philosophical theories to the moral problems that arise in health care. This ‘applied ethics’ model of medical ethics is, however, beset with internal and external difficulties. The internal difficulties point out that the model is intrinsically flawed. The external difficulties arise because the model does not fit work in the field. Indeed, the strengths of that work are its highly nuanced, particularized analyses of cases and issues and its appreciation of the circumstances and contexts that generate and …

A Survey Method For Investigating Ethical Decision Making In Family Practice, Barry Hoffmaster, Moira Stewart, Ronald Christie

C. Barry Hoffmaster

BACKGROUND: The tension between respect for patient autonomy versus concern for patient welfare is a challenging ethical issue for physicians. The purpose of this research was to describe a method for analyzing ethical decisions and to report the results of a survey of ethical decision making among family physicians.

METHODS: We developed a survey instrument that used simulated case scenarios, each of which posed an ethical dilemma. The ethical problems on the survey included the extent to which diagnostic information should be revealed to patients, the extent to which physicians should become involved in patients' life-style issues, and how to …

Between The Sacred And The Profane: Bodies, Property, And Patents In The Moore Case, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Ethical Decision Making By Family Doctors In Canada, Britain And The United States, Barry Hoffmaster, Moira Stewart, Ronald Christie

C. Barry Hoffmaster

Family doctors in Canada and the U.S. and general practitioners in England and Wales were sent a questionnaire containing six cases that raised moral issues. The doctors were asked to select the most appropriate course of action for each case as well as reasons for that decision. The ethical problems concerned how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients, and how to deal with a possible family problem. The respondents selected different courses of action for the cases. More U.S. than Canadian or British physicians chose to divulge information, …

Morality And The Social Sciences, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Ethical Decision Making By British General Practitioners, Ronald Christie, Charles Freer, Barry Hoffmaster, Moira Stewart

C. Barry Hoffmaster

General practitioners in England and Wales were sent a questionnaire asking how they would handle the ethical problems posed by six case vignettes and their reasons for their decisions. The ethical problems included: how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients and how to deal with a possible family problem. The varying patterns of response to the six cases suggested that ethical issues are resolved in a case-by-case, not a theoretical, basis.

The Ethics Of Patenting Higher Life Forms, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Ethical Decision Making By Canadian Family Physicians, Ronald Christie, Barry Hoffmaster, Moira Stewart

C. Barry Hoffmaster

Canadian family physicians were sent questionnaires that asked how they would handle the ethical problems posed by six sample cases and what reasons were relevant to their decisions. The ethical problems concerned how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients and how to deal with a possible family problem. The study identified characteristics of family physicians that affect their ethical decision making and tested a theoretical model that regards ethical problems as conflicts between respecting patient autonomy and promoting patient welfare. The varied responses suggested that ethical issues are …

The Patient In The Family And The Family In The Patient, Barry Hoffmaster, Wayne Weston

C. Barry Hoffmaster

The notion that the family is the unit of care for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as …

Ethical Issues In Family Medicine, Ronald Christie, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

How Family Physicians Approach Ethical Problems, Ronald Christie, Barry Hoffmaster, Martin Bass, Eric Mccracken

C. Barry Hoffmaster

The defining features of family medicine as described in the literature have important ethical implications. In an attempt to study the day-to-day practice of family physicians regarding these ethical issues, a 28-item questionnaire was sent to 95 part-time and 17 full-time family physician teachers associated with the University of Western Ontario's Department of Family Medicine. Of the 112 questionnaires mailed out, 97 were returned for a response rate of 86.6 percent. There was a significant spread of answers, suggesting there is no uniform opinion in the sample population. The findings suggest that there are important differences between the description of …

Caring For Retarded Persons, Barry Hoffmaster

C. Barry Hoffmaster

No abstract provided.

Ethical Considerations In Caring For Retarded Patients, Ronald Christie, Barry Hoffmaster

C. Barry Hoffmaster

The treatment of the mentally retarded patient may raise dramatic ethical issues for the family physician. A case is used to illustrate an example of ethical decision-making and the moral issues explored.

Contemporary Issues In Biomedical Ethics, John Davis, Barry Hoffmaster, Sarah Shorten

C. Barry Hoffmaster

No abstract provided.