Understanding Ethical Issues: The Clinical Ethics Model

Michael McCabe
Issue 3, April 2001

"Clinical ethics is a practical discipline that provides a structured approach to decision making that can assist physicians and family members to identify, analyse, and resolve ethical issues in clinical medicine."

—Jonsen, Siegler & Winslade

Healthcare professionals frequently contact The Nathaniel Centre asking for advice on a particular issue in clinical practice, or an issue concerning treatment options for a family member. We thought it would be helpful, therefore, to provide a brief outline of a model to assist these readers understanding of some of the ethical issues in healthcare practice. This particular model comes from Jonsen, Siegler & Winslade's book, "Clinical Ethics".

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Informed Choice and Consent

Sharron Cole
Issue 3, April 2001

"The voluntary consent of the human subject is absolutely essential". In the practice of human experimentation, this is the first of the basic principles to satisfy moral, ethical and legal concepts, as laid down in the Nuremburg Code 1947. The Code is the concluding statement of the judgment in the trial of the Nazi doctors who were accused of crimes against humanity by conducting criminal scientific and medical experiments on concentration camp prisoners. The Nuremburg Code has become part of international law and it serves as the basis for many formulations of the ethics of research with human subjects.

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The Complexities of Cloning

Anne Dickinson
Issue 3, April 2001

The lack of legislation in New Zealand relating to human cloning has been highlighted recently by the announcement that a team of scientists from Italy, Israel and the United States is seeking to use cloning to create human embryos, as a means of assisting infertile couples to have children.

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Striking a Balance in Truth Telling

Michael McCabe
Issue 4, August 2001

The obligation of veracity is the obligation to tell the truth and not to lie or deceive others. Even though veracity is an essential part of the relationship between healthcare professionals and their patients, and an indispensable feature in establishing goals of care at the end of life, many codes of medical ethics frequently ignore rules of veracity and have little or nothing to say about deception and when or whether it is ever justified. The Hippocratic Oath, for example, does not mention this principle. [1] Ethicist, Sissela Bok, in her germinal book, "Lying; Moral Choice in Public and Private Life" suggests the reason why little is said about truth telling in codes of ethics is because, "reasons to lie occur to most people quite often. Not many stop to examine the choices confronting them; existing deceptive practices and competitive stresses can make it difficult not to conform. Guidance is hard to come by, and few are encouraged to consider such choices in schools and colleges or in their working life." [2] The principle of veracity and its allied virtue of truthfulness are expressions of the fundamental obligations contained in the primary principles of bioethics - respect for autonomy, justice, beneficence (to do the good) and non-maleficence (first do no harm).

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