Medicine and Health Sciences Commons^™

“Dignity In Living And In Dying”: The Henry H. H. Remak Memorial Lecture, George P. Smith Ii

Scholarly Articles

Dignity is seen commonly as an ethical obligation owed to human persons. The dimensions of this obligation in today's post secular society are, however, subject to wide discussion and debate; for the term, human dignity, and its preservation, defies universal agreement. Yet, its preservation, together with the prevention of indignity, is a guiding principle or at least a vector of force in a wide range of issues ranging from recognizing and protecting the civil rights of the citizen members of the LGBTQ community throughout the nation to the care of the disabled and to the dying.

In clinical medicine, safeguarding …

Assessing Assisted Reproductive Technology, Raymond C. O'Brien

Scholarly Articles

Technological innovation possesses both opportunity and challenge. Because assisted reproductive technology (ART) involves sexual intimacy, parenthood, personhood, gender identity, privacy, legacy, and a plethora of religious, historical, sociological, and ethical underpinnings, the challenges presented in such technological innovation are substantial. Nonetheless, the opportunities are significant and progressive. Because of in vitro fertilization, gestational and genetic surrogacy, posthumous conception, and mitochondrial replacement therapy, humans now have the opportunity to overcome infertility, gender obstacles to parentage, dynastic limitations, and diseases that have long plagued mothers and infants. However, challenges include the exploitation of surrogates, unequal access to ART services, possibilities of cloning …

Human Dignity As A Normative Standard Or As A Value In Global Health Care Decisionmaking, George P. Smith Ii

Scholarly Articles

Dignity is seen commonly as an ethical obligation owed to human persons. The dimensions of this obligation in today's post secular society, are -- however -- subject to wide discussion and debate; for, the term, human dignity, and its preservation, defies universal agreement. Yet, its preservation -- together with the prevention of indignity -- should be a guiding principle or at least a vector of force in a wide range of issues in health care management ranging from embryo research and assisted reproduction to biomedical enhancement, and the care of the disabled and the dying. In clinical medicine, safeguarding the …

Existential Suffering And Cura Personalis: Dilemmas At The End-Of-Life, George P. Smith Ii

Scholarly Articles

Existential, or non-somatic suffering, is often associated with the management of refractory pain at the end-stage of life. Because of misleading sympathologies, this condition is often either mis-diagnosed or even ignored. When diagnosed as a part of a futile medical condition, this Paper argues that deep, palliative, or terminal sedation be offered to the distressed, dying patient as an efficacious and ethical response to preserving a semblance of human dignity in the dying process. Not only is this option of care humane and compassionate, it is consistent with the ideal of best patient care. The notion of care should not …

Cura Personalis: A Healthcare Delivery Quandary At The End Of Life, George P. Smith Ii

Scholarly Articles

Holistic Medicine traces its provenance to the foundational value or chrism of the Society of Jesus of cura personalis which directs respect be given to all individuals and to their souls — especially whenever medical healing is required. Today, the notion of best patient care should include not merely attention to somatic issues of refractory pain management but, equally, to non-somatic or existential suffering. It is at the end-stage of life that palliative — as opposed to curative — care must be provided. When a condition is seen as medically futile, this Article advocates palliative or deep sedation — when …

In Memoriam: Edmund D. Pellegrino, George P. Smith Ii

Scholarly Articles

No abstract provided.

Applying Bioethics In The 21st Century: Principlism Or Situationism?, George P. Smith Ii

Scholarly Articles

After an examination of the four cardinal bioethical principles which define Principlism — autonomy, beneficence, non maleficence and justice — an explication of Joseph Fletcher’s theory of Situationism is undertaken.

The conclusion of this Article is that when an ethical dilemma arises and is “tested” as to its moral efficacy, rather than judge the acts in question in order to determine whether they are in conformance with one of the four bioethical principles, it is more humane and practical to determine the ethical propriety of questioned conduct by use of a situation ethic which in fact is more sensitive. This …

Gently Into The Good Night: Toward A Compassionate Response To End-Stage Illness, George P. Smith Ii

Scholarly Articles

End-of-life decision making by health care providers must respect individual patient values. Indeed, these values must always be viewed as the baseline for developing and pursuing patient-centered palliative care for those with terminal illness. Co-ordinate with this fundamental bioethics principle is that of beneficence or, in other words, respect for conduct which benefits the dying patient by alleviating end-stage suffering — be it physical or existential. Compassion, charity, agape and/or just common sense, should be a part of setting normative standards and of legislative and judicial responses to the task of managing death. Aided by the principles of medical futility, …

Bioethics And Human Rights: Toward A New Constitutionalism, George P. Smith Ii

Scholarly Articles

No abstract provided.

Refractory Pain, Existential Suffering, And Palliative Care: Releasing An Unbearable Lightness Of Being, George P. Smith Ii

Scholarly Articles

Since the beginning of the hospice movement in 1967, “total pain management” has been the declared goal of hospice care. Palliating the whole person’s physical, psycho-social, and spiritual states or conditions is central to managing the pain which induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the “right” …

Variables In Health Care Policy Making: Resolving A Quandary, George P. Smith Ii

Scholarly Articles

Contemporary debate in health care resource management is tied to a central moral issue: how to achieve the optimum level of reasonable or appropriate treatment based on the medical condition of each patient. Failure to tackle and resolve this issue in a confident and forthright manner ensures that the present approach to health care decision-making will continue in a state of indecisiveness if not, indeed, lethargy. Undergirding this moral issue is the foundational economic dilemma of controlling costs while limiting access to health care resources. Crafting a just solution to an equitable distribution of finite health care resources is, indeed, …

Of Panjandrums, Pooh Bahs, Parvenus, And Prophets: Law, Religion, And Medical Science, George P. Smith Ii

Scholarly Articles

This Monograph derives from a Lecture, under the same title, given in Sydney, Australia, honoring Michael D. Kirby, AC, CMG, Justice of The High Court of Australia. The first part of the Monograph analyses the significant contributions that Justice Kirby has made as a compassionate champion of human rights and acknowledges what is styled as the Kirby Ethic which, in turn, is seen as the foundation for the body of work of the Justice as well as the moving force in his private life as well. Building upon a theory of transcendent idealism which interprets God's purpose as safeguarding the …

Social Justice And Health Care Management: An Elusive Quest?, George P. Smith Ii

Scholarly Articles

Contemporary debate on health care resource management is tied to a central moral issue: namely, how to achieve an optimum level of reasonable or appropriate treatment based on the medical condition of each patient. Failing to tackle and resolve this issue in a confident and forthright manner assures the present approach to health care decision making to continue in a state of indecisiveness if, indeed, not lethargy.

Undergirding this moral issue is the foundational economic dilemma of controlling costs while limiting access to health care resources. Finding a just solution to an equitable distribution of finite health care resources is …

Cigarette Smoking As A Public Health Hazard: Crafting Common Law And Legislative Strategies For Abatemen, George P. Smith Ii

Scholarly Articles

The debate over when, and to what extent, the government may regulate public smoking, is a contentious one of great moment. The point at which the line will be drawn with regard to an individual's right to smoke in public is narrowing. This right may stop at public restaurants and the workplace; or it may reach as far as public stadia, outdoor gathering spots and public streets. In 2006, one report showed 461 municipalities in thirty-three states and the District of Columbia, had adopted one-hundred percent smoke-free coverage in restaurants, bars or workplaces; and 135 municipalities had one-hundred percent coverage …

The Stem Cell Debate, William J. Wagner, Ursula Weide

Scholarly Articles

No abstract provided.

Law, Religion, And Medical Science: Conjunctive Or Disjunctive?, George P. Smith Ii

Scholarly Articles

No abstract provided.

Human Rights And Bioethics: Formulating A Universal Right To Health, Health Care, Or Health Protection?, George P. Smith Ii

Scholarly Articles

Codifying, and then implementing, an international right to health, health care, or protection is beset with serious roadblocks - foremost among them being contentious issues of indeterminacy, justiciability, and progressive realization. Although advanced - and to some degree recognized under the rubric of a social or cultural entitlement within the law of human rights and, more particularly, the U.S. Declaration on Human Rights, together with International Covenant on Economic, Social and Cultural Rights (ICESCR), the International Covenant on Civil and Political Rights, the European Convention on Human Rights, and presently UNESCO's Draft Declaration on Universal Norms on Bioethics - attainment …

Law, Medicine, And Religion: Towards A Dialogue And A Partnership In Biomedical Technology And Decision Making, George P. Smith Ii

Scholarly Articles

Faith, religion, spirituality, and prayer have a current focused outreach and easy parlance in the market places and public squares of the nation. News stories and court cases abound with dramatic challenges to the placement of monuments to the Ten Commandments in public buildings and grounds, the use of God's name in school pledges of allegiance, the teaching of Darwinian or evolutionary science in public education, the role of faith and religion in health care healing, and even the value of affirmations of religious faith on the political hustings. The purpose of this article is to explore the conjunctive and …

“Just Say No!”: The Right To Refuse Psychotropic Medication In Long-Term Care Facilities, George P. Smith Ii

Scholarly Articles

This Article examines the provisions of The Omnibus Budget Reconciliation Act of 1987 (OBRA '87) surveying the case law as such that deals with the rights of patients in mental institutions to refuse psychotropic medication. The article focuses first on an analysis of the different substantive and procedural rights afforded to patients under state common law, state constitutions and the federal Constitution. It then proceeds to evaluate the impact of OBRA '87 on the rights of long-term care patients who refuse medication and choose to accept minimal administrative hearings instead of pursuing full judicial proceedings designed to protect those rights. …

The Vagaries Of Informed Consent, George P. Smith Ii

Scholarly Articles

The purpose of this Article is to probe the foundations and applications of informed consent in a variety of situations and thereby test its validity. The conclusion to be drawn from this analysis is that while the doctrine has yet to become an integral part of the ethos of medicine, it still provides an important mechanism for maintaining a purposeful discourse between physician and patient and, as such, nurturing and preserving their essential partnership of healing and trust.

Distributive Justice And Health Care, George P. Smith Ii

Scholarly Articles

The challenge of contemporary health care distribution is to structure a framework for normative decision making whereby the goal of distributive justice is achieved equitably for as many citizens as possible. Establishing fair procedures for the distribution of health care resources is a crucial goal for contemporary society to set and, hopefully, to achieve. It is only by and through deliberate debate within a democracy that assumptions, for example, about aging, the value of life for the aged and intergenerational responsibilities of assisting them in their care can be set, tested or - as the case may be - rejected. …

Allocating Health Care Resources To The Elderly, George P. Smith Ii

Scholarly Articles

Health is not an absolute condition, but is assessed by reference to age and other factors. Therefore, a relative scale is necessary to determine whether an elderly person’s right to health care is being satisfied. Today, older Americans are increasingly affected by the growing need to regulate health care delivery. Since 1900, those over the age of 85 years have become twenty-one times as numerous in society, with an eightfold increase in the number of people over the age of 65. Given the need to curb rising health care costs — particularly the expenses related to caring for older individuals …

Setting Limits: Medical Technology And The Law, George P. Smith Ii

Scholarly Articles

The allocation and rationing of health care resources is, no doubt, one of the most pressing issues confronting contemporary society. These issues considered from a micro and a macro level of economic analysis are linked inextricably to utilitarianism which, in turn, relies upon a cost-benefit analysis which balances reasonable individual needs against the availability of medical resources within the larger community. From an ethical viewpoint, the cost-benefit approach to the distribution of health care resources is impractical because it seeks to reduce (or convert) all health benefits to dollar amounts, thereby seeking very awkwardly to convert quality of life benefits …

Genetic Enhancement Technologies And The New Society, George P. Smith Ii

Scholarly Articles

So long as procreation continues to remain a central driving force in a marital relationship, and the family the very core of progressive society, efforts will be undertaken to expand the period of fecundity and combat infertility. Genetic planning and eugenic programming are more rational and humane alternatives to population regulation than death by famine and war.

Genetic enhancement technologies and the scientific research undertaken to advance them should be viewed as not only aiding (or, sometimes resolving) the tragedy of infertility in family planning, but as a tool for enhancing the health of a Nation's citizens by engineering man's …

Euphemistic Codes And Tell-Tale Hearts: Human Assistance In End-Of-Life Cases, George P. Smith Ii

Scholarly Articles

A euphemism is defined as the substitution of an agreeable or inoffensive word or expression for one that is harsh, indelicate, or otherwise unpleasant taboo; allusion to an offensive thing by an inoffensive expression. This article deals with medical euphemisms used commonly through medical codes in hospitals for end-of-life patient care. It examines the extent to which fear shapes decision making in critical care units - fear of medical failure, and fear of litigation if not "everything" is done to prolong life, no matter how agonizing. Furthermore, being trained to save lives, health care providers often lack the courage to …

The Elderly And Patient Dumping, George P. Smith Ii

Scholarly Articles

No abstract provided.

Complexities In Biomedical Decision-Making, George P. Smith Ii

Scholarly Articles

Within the contemporary debate over medical ethics, without question the most striking weakness found is the lack of a basic yardstick against which either the "rightness" or "wrongness" of a physician's actions may be measured. No general agreement is to be found among physicians or ethicists acknowledging what ethical determinant the physician should or should not follow in a particular case. Yet, despite this conflict of uncertainties, a framework for principled decisionmaking does exist and can be found within the rubric of medical ethics.

Patient Dumping: Implications For The Elderly, George P. Smith Ii

Scholarly Articles

Before 1986, the Common Law provided that physicians and hospitals had no duty to admit or treat persons who sought their care except in limited circumstances. Congress enacted The Emergency Medical Treatment and Active Labor Act (EMTALA) to curb this so-called patient-dumping problem. EMTALA provides, essentially, that Medicare-participating hospitals must treat all patients who arrive in emergency conditions.

This article first discusses the patient-dumping problem and how EMTALA has provoked many hospitals to curtail their emergency facilities in order to avoid treating indigent and uninsured patients. The Article then proceeds to analyze the specifics of EMTALA’s main statutory provision, Section …

Harnessing The Human Genome Through Legislative Restraint, George P. Smith Ii

Scholarly Articles

The awesome predictive power of genetic medicine promises great advancements in not only the treatment of identifiable conditions but the prevention of their pathological manifestations. At the same time, the release and dissemination of this genetic or medical information poses a distinct risk of loss of privacy and stigmatization to carriers of genetic disorders. In order to safeguard the individual right of autonomy, privacy, confidentiality and informed consent-yet accommodate the legitimate interests of employers and insurers to obtain medical information relevant to their professional needs and economic responsibilities a balance must be struck legislatively at the federal and state levels …

Terminal Sedation As Palliative Care: Revalidating A Right To A Good Death, George P. Smith Ii

Scholarly Articles

Not everyone finds a “salvific meaning” in suffering. Indeed, even those who do subscribe to this interpretation recognize the responsibility of each individual to show not only sensitivity and compassion but render assistance to those in distress. Pharmacologic hypnosis, morphine intoxication, and terminal sedation provide their own type of medical “salvation” to the terminally ill patient suffering unremitting pain. More and more states are enacting legislation that recognizes this need of the dying to receive relief through regulated administration of controlled substances. Wider legislative recognition of this need would go far toward allowing physicians, in the exercise of their reasonable …