Nagpal et al. The religiosity of a caregiver for an individual with Dementia may affect the perception of QoL of the individual they are looking after. Emotions, confidence, self-esteem, physical health Instrument: Heart disease specific QOL questionnaire Prayer or meditation, consequential religiosity for coping with personal problems, theological belief system, experiential religiosity pertaining to feeling of religious comfort. The distress following a cardiac event may require support from religious behaviour and spiritual beliefs. However, if there is no such support, as shown in the results, the authors argue that lower perceptions of QoL may trigger negative forms of religious coping and put the couples at risk of spiritual distress.
Responses to the item were combined to create a dichotomous variable reflecting the prayer and other five complementary therapies recognized by the US National Center of Complementary and Alternative Medicine NCCAM , including alternative medical systems i. However, this position may change over time since it is not necessarily associated to QoL. Ai et al. Psychological functioning behaviour coping, cognitive coping, levels of distress, anger coping, avoidant coping, depression , physical functioning fatigue symptoms , social relationships perceived social support.
Physical health and overall QoL i. Psychological well-being, meaning in life, positive affect, self-esteem. Instrument: Items were adapted from existing scales to assess self-esteem Rosenberg Self-Esteem Scale , meaning in life using two items, e. This is because the negative emotion experienced on 1 day is likely to predict increases in spirituality on the next day.
Physical health, psychological health, social relationships, environmental health. Spirituality or religious coping in the form of community prayer services and devotion to God is an important factor that may have a major impact on the treatment of patients of African-American origin with Schizophrenia. Psychological Well-Being Instrument: three measures of psychological well-being: self-esteem, optimism, and life satisfaction Attachment to God through prayer Instruments: Attachment to God Scale and frequency of prayer was based on a single item How often do you pray by yourself?
In addition, physical health was assessed using The EORTC breast cancer module BR , prostate cancer module PR , and colorectal cancer module CR which cover symptoms, self-image, sexuality, and specific complaints during the previous week.
Visual Ethics: An Integrative Approach to Ethical Practice in Visual Journalism
Physical health, psychological health. Using mind-body interventions e. Levin [ 73 ]. Physical health Instrument: Activities of Daily Living Scales and variables on indicators of physical health such as self-rated health, long-term health problems, activity limitation, diagnosed chronic diseases, physical symptoms. Frequency of prayer Instrument: Designed variables for synagogue activities e. Taken part in a religious organisation [church, synagogue, mosque, etc. Physical health, psychological health, social and environmental QoL.
Mental functioning, physical functioning, spiritual functioning. Krause et al. Rohani et al. Discussion Among the most important findings has been the fairly consistent positive correlation between RS and QoL. Conclusion The findings from this review have broad implications for the role of RS in relation to QoL in medical-health contexts. Availability of data and materials References of all data generated or analysed during this study are included in the reference list of this article.
Notes Ethics approval and consent to participate Not applicable. Competing interests The authors declare that they have no competing interests. Contributor Information Victor Counted, Email: ua. References 1. Barbarin OA. Coping with resilience: exploring the inner lives of African American children. J Black Psychol. Hefti R. Integrating religion and spirituality into mental health care, psychiatry and psychotherapy. Cambridge: Cambridge University Press; Assessing plurality in spirituality definitions. Spirituality and health: multidisciplinary explorations.
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There was a positive correlation between physical health and trust in God r. Results of the multiple hierarchical analyses reveal that negative religious coping was significantly related to low levels of QoL when adjusted for demographic and clinical variables. When adjusted for demographic risk factors, combat exposure, and severe PTSD symptoms in the structural equation modelling, results revealed that spirituality was significantly associated with forgiveness and QoL.
Results show evidence that faith was strongly associated with meaning and peace in uncontrolled analyses. Warren takes up this issue and concludes that while the fact that the human fetus is a potential person, which, on moral grounds, might entail that women ought not to wantonly have abortions, in the final analysis, whenever the question comes down to the right to life of the fetus as opposed to the right of a woman to have an abortion, the right of the woman must always supersede the claimed right on behalf of the fetus because the rights of actual persons always outweigh the rights of potential persons.
Don Marquis takes on the question of the morality of abortion in a way that is separate and apart from any considerations of whether a fetus can be a determined to be a person and even whether a fetus can be considered to be potentially a person. It is, says Marquis, this loss that makes the taking of a human life morally incorrect.
This argument against the taking of a human life would apply not only to adults but also to young children and babies who, arguably, also have a future of value concerning life experiences, activities, projects, and enjoyments to which to look forward. In the same way, a human fetus has a similar future such that, if aborted, would never be able to come to pass Marquis, At least since the Roe v. Wade U. Supreme Court decision, the spectrum of positions on the issue of the moral status of abortion has been represented by an extreme conservative position, namely, that, without any exception, abortions of human fetuses ought never to be allowed; by an extreme liberal position, namely, that abortions of human fetuses ought always to be allowed, and for any reason whatsoever; and by more moderate positions, like, for example, that abortions of human fetuses ought not to be allowed, in general, but ought to be allowed in cases in which the following circumstances serve as the exceptions: in cases in which pregnancies have occurred as a result of the act of rape or the act of incest, or in cases in which the life of the expectant mother is seriously jeopardized by the pregnancy itself.
Euthanasia is an intervention in the standard medical course of treatment of a patient who is reasonably considered to be terminally, or irreversibly, ill or injured for the express purpose of causing the imminent death of that patient, normally for reasons of mercy. This distinction between active and passive euthanasia has been, historically, the focal point of the most controversy concerning the practice of euthanasia. Traditionally, all health care-related professional codes of ethics find passive euthanasia to be morally allowable but active euthanasia to be tantamount to murder; the relevant laws in all of the legal jurisdictions in America follow suit.
James Rachels, in a famous article on this very question Rachels, , attempts to demonstrate that this controversy represents a distinction without a difference. For example, a cancer patient, with a prognosis of only a matter of days to live, continues on a regimen of the sedative lorazepam and the opioid morphine. With increasing frequency, the patient has complained of the worsening of the pain and has repeatedly requested ever-higher doses of the morphine drip.
In response to each of these requests, the physician has complied, knowing full well that there will be a threshold beyond which the dosage of morphine will be sufficient in conjunction with a myriad of other causal factors that are idiosyncratic to this patient to kill the patient. This, then, comes to pass. The key factor in the doctrine of double effect is the intention on the part of the medical professional in question. However, the most fundamental criticism of the application of the doctrine of double effect to such cases is that there is no relevant moral distinction between the action in question and an instance of active euthanasia.
Palliative sedation, as the monitored use of medications, including sedatives and opioids, among others, to provide relief from otherwise unmitigated and excruciating physiological, among other types of, pain or distress by inducing any of a number of degrees of unconsciousness, can be similarly problematic depending on whether and to what extent the pain or distress of the patient in question is managed appropriately.
If managed well, palliative sedation need not be a causal factor in hastening the death of the patient; however, if it is not managed well, in theory, palliative care can be such a causal factor. Jack Kevorkian who, throughout the final decade of the 20 th century, as a retired pathologist, offered to help fatally ill patients to end their lives prematurely. Prior to his fifth, and final, prosecution, which was for second degree murder, and for which he was convicted having avoided this fate the first four times , he claimed to have assisted approximately patients to end their lives, which he had claimed, throughout his entire medical career, that patients ought to have a right both morally and legally to do.
Despite the fact that all health care-related professional codes of ethics have consistently, and still do, condemn physician-assisted suicide, currently, at least five of the fifty states in America have legalized physician-assisted suicide. Among those European nations that had legalized both active euthanasia and physician-assisted suicide by the early 21 st century, the Netherlands has led the way Kevorkian, Theoretically, the most fundamental reason to conduct research involving human subjects is to add to our existing knowledge concerning the physiological and the psychological constitution of the human body and the human mind, respectively, in an effort to improve the quality of life of people as determined by the status of their bodily and mental health.
Thus, the principle of beneficence should lie at the heart of all research that is conducted with human subjects. The history of such research is one of major achievements, typically incremental and over time, each of which has played a part in the extension of not only the duration of human life but also the quality of the day-to-day existence of members of the human race, virtually all over the planet. However, many are the moral issues that have arisen due to the mistreatment to which many such human subjects have been subjected, and which have occurred in any of a number of important ways, from physiological abuse to mental and emotional abuse to the abuse of human rights.
The history of human subject research is replete with examples of such abuses. By the middle of the 20 th century, enough people in sufficiently important roles in Western societies began to codify what they took to be some of the most basic moral rights that would need to be respected in order for human subject research to be recognized as morally acceptable. Over many decades throughout the second half of the 20 th century, a variety of codes of ethics were developed for the protection of the rights of people who serve as human research subjects.
In virtually every case, those codes, that were of the most importance, were formulated in response to specific cases of human subject research during the course of which at least some of the people who served as participants had some of their fundamental rights abused. A few examples follow. The Nuremberg Code was formulated in response to experiments that were performed on people who were members of demographic groups that were targeted for extinction by Hitler in Nazi Germany and that were conducted by medical doctors and biomedical researchers some of whom had little to no expertise or experience in either the practice of medicine or the conducting of biomedical research.
Of the ten principles in the Code, the emphasis, in general, was on the need for biomedical researchers to obtain the voluntary informed consent of the prospective human subjects prior to the commencement of any such experimentation. Despite having no legal force, The Nuremberg Code has had profound effects on the ethics of human experimentation and has spawned a good number of other such codes since its formulation.
The participants in this study, begun during the throes of the Great Depression and in one of the economically poorest regions of America, were promised free food and free medical care for their participation. The Public Health Services Act established and mandated that every research facility in America that conducts either biomedical or behavioral research on human subjects have an Institutional Review Board IRB for the protection of the rights of human research subjects.
This requirement for each such research institution academic or otherwise to have IRB approval for each and every biomedical or behavioral research study was a result of many instances of research protocols that, for a variety of reasons, were thought, at least in retrospect, to have violated the human rights of their human participants.
As for biomedical research, the famous case of Henrietta Lacks and her HeLa cells allowed for at least dozens and dozens of medical breakthroughs in the curing of diseases in the latter half of the twentieth century, making large amounts of money for some people and some institutions in the research process, while most of her descendants, including some of her own children, lived their entire lives without health insurance, some of whom were, even if temporarily, homeless.
Only recently has attention been brought to her story, and to this situation, by her biographer Skloot, The composition of the membership of all Institutional Review Boards IRBs is mandated to be reflective of diversity with respect to gender, race, and culture or heritage as well as a diversity of social experiences and an appreciation for issues relevant to the research involving human subjects that reflect the standards and values of society, if not also of the local community.
Moreover, IRBs are obligated to ensure that all proper procedures are followed for the voluntary informed consent of all of the subjects of all research projects. The moral issues that have arisen, over decades, concerning human subjects in both biomedical and behavioral research are many and varied. In biomedical research, such issues include the exclusion of the members of specific demographic groups from even being considered to be eligible to become participants in such research. For example, until the latter part of the 20 th century in America, biomedical research on breast cancer was almost nonexistent.
Not until women, in decent numbers, had entered the field of medicine and the field of biomedical research did research proposals into various aspects of breast cancer begin to compete for funding with research proposals into various aspects of prostate cancer. Furthermore, even biomedical research into, for example, the correlative, if not causal, factors involved in heart disease solicited only Caucasian males as prospective research participants.
Examples of appropriate exclusionary practices would be biomedical research into testicular cancer, which would properly exclude women, just as biomedical research into sickle-cell anemia would properly exclude Caucasians. One of the most popularly known moral issues concerning both biomedical and behavioral research is the use of placebos.
The classic case of the use of placebos is the clinical drug trial, in which researchers are attempting to determine, first, the effectiveness of the experimental drug, and second, the extent to which potential adverse side-effects of the experimental drug are significant, if not fatal. In order to attempt to ensure credibility concerning the use of a placebo, the participants in both groups are intentionally deceived as to which group of participants is receiving the experimental drug and which is receiving the placebo. The main reason for a blind study is to attempt to avoid any possibility of what we might refer to as suggestive bias on the part of the participant concerning the possible effectiveness of the experimental drug.
The main reason for a double-blind study is to attempt to avoid any possibility of what we might call expectation bias on the part of the researchers themselves concerning either the effectiveness, or the lack thereof, of the experimental drug. The use of placebos in biomedical or behavioral research does raise questions concerning the ethical principle of beneficence in addition to the moral right to be told the truth. First, in theory, the participants in many, if not most, clinical trials, including drug trials, have reasonable expectations of benefitting in any of a number of ways from their participation in such research.
At least in cases in which such a participant is, simultaneously, a patient with a terminal illness who ends up in the placebo designated group, it would appear that the right to beneficent treatment is being thwarted. Second, to the extent to which participants in human subject research are being deceived, knowingly and intentionally by the researchers, which is a necessary part of any research study involving the use of placebos, a case can be made that the moral right to be told the truth, on the part of the research participant, has been violated regardless of whether such participants are also, simultaneously, patients who are receiving medical treatment.
Of course, the response to either of these criticisms of research protocols that make use of placebos is that the participants agree to the use of placebos and know, full well and in advance, that they have an equal opportunity to be members of the group who receive the placebo or members of the group who do not. By the nature of the case, there are some groups of people in society who are especially susceptible to abuse, concerning their rights, whenever they are the subjects of human research.
Of particular concern in the recruitment of human research subjects, especially in cases involving prospective participants who are known to be vulnerable in any important and relevant respect s , is the issue of coercion, whether explicit or implicit. Notwithstanding the initial one, people in every category, above-enumerated, as groups of people who represent vulnerable populations, would be susceptible, for a variety of reasons, to the influence of coercion by recruiters for human subject research. Whenever possible, biomedical and behavioral researchers should refrain from even attempting to recruit, as a prospective participant, anyone who is reasonably identifiable as a member of any vulnerable population.
In such a situation, the researcher is morally obligated to engage in supererogatory efforts to attempt to minimize, as best one can, the effects of the coercion involved. Throughout the history of the practice of health care, the acquisition of knowledge and the innovation of medical technologies have brought with them new moral issues. Beginning in the last quarter of the 20 th century and continuing into the 21 st century, advancements in knowledge and technologies concerning human reproduction and human genetics have spawned whole new types of moral questions and moral issues, many of which involve even more complexities than the previous ones.
The last quarter of the 20 th century brought with it major advances in biological knowledge and in biological technology that allowed, for the first time in human history, for the birth of human offspring to result from biological interventions in the birthing process. For those whose ability to procreate was biologically compromised, new scientific methods were developed to facilitate success in the birthing process.
Artificial insemination is the process by which the sperm is manually inserted inside of the uterus during ovulation. In vitro fertilization is the process of uniting the sperm with the egg in a petri dish rather than allowing this process to take place in utero , that is, in the uterus.
To increase the probability of success, multiple embryos are transferred to the uterus. As a result, multiple pregnancies are not uncommon. These multiple pregnancies increase the probability of premature births, which usually result in low-birth weight, under-developed organs, and other health issues. As to the embryos that are not chosen for transfer, the normal practice is to freeze them for possible future use because the success rate for any given round of IVF is only approximately 1 in 3.
Many opponents of IVF focus on the probability of the resultant health issues; in other words, to bring into the world, in a contrived way, children who stand a reasonable chance of suffering any of a number of health problems is unfair to such children Cohen, , if not also to the society into which they are born.
Others disagree and argue that to be the recipient of the gift of life would more than outweigh the usual health issues that might result from IVF Robertson, Some commentators argue that reproductive technologies, such as AI and IVF, allow women the opportunity to realize their potential for autonomous decision-making when it comes to their own reproductive preferences Robertson, and Warren, Another criticism is the likelihood that the children, so produced, will be viewed as, somehow, inferior to children who are born as a result of the traditional process of procreation. There are also moral issues concerning frozen embryos.
First, the longer that an embryo is maintained in a frozen state, the more likely it is that it will become degraded to the extent that either it is no longer capable of being used for its intended purpose or it is no longer alive. Second, there are serious questions as to what the fate of these frozen embryos should be when, for example, because of the splitting up of the relationship of the biological parents or the death of one, or both, of these parents, such embryos are left in a state of limbo.
Should they be used for scientific research, should they be offered to other people, whose compromised procreative abilities dictate a need for such embryos to be brought to fruition through the process of IVF, or should such embryos merely be discarded? Surrogate motherhood is the process by which one woman carries to term a fetus for someone else typically a couple. Not only in the former case in which the surrogate mother is also the genetic mother but also in the latter case in which the surrogate mother is not the genetic mother , one of the most important moral, if not also legal, issues has always been whether the surrogate mother has any proprietary rights to the newborn baby, regardless of whether a legal contract applies and regardless of whether any money changes hands.
Another fundamental moral issue occurs in cases in which there is a contractual relationship as a legal guarantee for a financial agreement. Such cases raise the moral issue of whether fetuses and newborn babies should be treated as commodities, and indeed, whether the womb of the surrogate mother should be rented out as a service for someone else, that is, also treated as a mere commodity Anderson, However, not all commentators on this subject agree that surrogate motherhood can, of necessity, be reduced to the crass practice of baby selling or that women who serve as surrogate mothers are, necessarily, exploited.
On the contrary, it can be argued that women who serve as surrogate mothers are willing to forgo any parental right that they might have to begin, much less to maintain, an inter-personal relationship with the babies they deliver. In the same way in which this forgoing of any parental right to engage in any type of inter-personal relationship with the baby appears to not be offensive in cases of surrogate motherhood, when engaged in for altruistic reasons, consistency would seem to demand that no such offense should enter into the situation just because an exchange of money is involved; in other words, the motive is not relevant to the moral assessment of the process of surrogate motherhood Purdy, Cloning is the asexual reproduction of an organism from another that serves as its progenitor but that is genetically identical to its progenitor.
Cloning has always been a natural process of reproduction for many bacteria, plants, and even some insects, and it has been used as an intervention in the reproduction of plants for hundreds of years. However, since the successful cloning of a sheep named Dolly in , major moral concerns have been voiced concerning the ability of scientists to clone, not only other animals, but also human beings. Despite some claims to the contrary, none of which has ever been verified, the cloning of human beings is not yet feasible.
The purpose of therapeutic cloning is to create an embryo, the stem cells of which are identical to its donor cell and are able to be used in scientific research in order to better understand some diseases, from which can be derived treatments for such diseases. The same moral issues concerning the use and ultimate fate of human embryos, as aforementioned, apply to these cloned human embryos. The purpose of reproductive cloning is to create an embryo, which if brought to fruition will become a member of the animal kingdom. In the successful attempts to clone a variety of animals to date, a consistent problem has been health issues related to significant defects in major organs, including the heart and the brain; in addition, the duration of the lives of these cloned animals has been, on average, only half of the number of years of the normal life expectancy of such species.
Moreover, each successful attempt to clone these animals has been preceded by literally dozens, if not hundreds, of unsuccessful attempts. These same problems would represent major moral concerns in any attempt to clone human beings. However, were any such attempt to be successful and were the resultant cloned human being to be of sufficiently good health to lead anything like a normal existence, new moral issues would arise.
Would such cloned human beings be viewed as second class members of the human race? Would cloned human beings have been robbed of the exact same uniqueness in terms of their physiology, their personality characteristics, and their character traits that every human being in the history of humankind has hitherto enjoyed? Just because a cloned human being would be identical, genetically, to its progenitor does not mean, by virtue of its idiosyncratic experiences in utero and in life in a large number and variety of ways, that it would, of necessity, have exactly the same life as its progenitor National Academy of Sciences, This last point notwithstanding, would cloned human beings be denied rights to their own identity Brock, ?
Since the discovery of the molecular structure of deoxyribonucleic acid DNA , the molecule that contains the genetic instructions that are necessary for all living organisms to develop and to reproduce, in , and since the completion of the mapping of the human genome, popularly known as the Human Genome Project, that is, the identification of the complete and exact sequencing of the billions of elements that make up the DNA code of the human body, some fifty years later, a vast amount of research has been conducted in the area of disease-causing mutations as causes of many human genetic disorders.
This research has also allowed for the creation of literally thousands of genetic tests, the purpose of which is to detect, both in the case of prospective parents and at the fetal stage of the development of human offspring, those genetic mutations that are responsible, in part or in whole, for many non-fatal and fatal conditions and diseases. Furthermore, this research has allowed for the editing of human genes, in an effort to proactively disable some genetic mutations, in the case of adults, children, and newborns as well as in the fetal stage of development.
The information derived from genetic testing, more often than not, is anything but definitive; in other words, the results of the vast majority of genetic tests are predictive of the probability that the disease or condition for which the testing was done will actually bear out. Whether such probabilities are low, moderate, or high, many other factors, especially environmental ones, can also be contributing factors.
Further, while many genetic tests are available for the detection of conditions and diseases for which there is, at present, a cure, many other genetic tests are able to be conducted for conditions and diseases for which there are no cures. This fact raises the obvious question of whether specific individuals do or do not want to know that there is a probability, to whatever degree, that they will fall victim to a particular condition or disease for which there is no cure.
Each of the advances in genetic knowledge, genetic technologies, and biomedical capabilities concerning genetics brings in its train its own set of moral concerns. However, one who inherits the mutated gene might or might not fall victim to the ravages of the disease. It is conceivable that an individual, who has begun to exhibit some of the early symptoms of ALS, might choose to be tested for any of the four gene mutations that are thought to be causal.
If such testing reveals the presence of one or more such mutations, and if this individual has children, the moral issue of whether any such children should be informed, immediately, and if they are so informed, the moral issue of whether such children should choose, themselves, to be tested, both become of paramount importance, if only because, depending on the outcome of the genetic testing of these children, the fate of any of their children already in existence or as future possibilities would be a concern.
Another moral issue that continues to arise in the context of genetic testing is when an adult or a child is tested for one condition or disease and a mutated gene is discovered for another potentially fatal condition or disease. This situation can occur because much genetic testing, at present, is sufficiently broad in its application as to include a variety of different genes. So, it sometimes happens that genetic testing for a toddler, for example, for one, or more, genetic mutations which are suspected due to the presence of specific relevant symptoms might reveal one or more other genetic mutations for conditions, diseases, or even specific cancers, or for young adult-onset cardiomyopathy, about which neither the researcher nor the pediatrician was even concerned.
And, what about the toddler: from the perspective of the pediatrician or the parents, at what age should the toddler be so informed Wachbroit, ? In addition to therapeutic reasons for genetics research and its application to health care, there are non-therapeutic reasons for such research and applications, for example, genetic enhancement, that is, the application of genetic knowledge and technologies to improve any of a number of physiological, mental, or emotional human characteristics. Some commentators argue that genetic enhancement, as compared to genetic therapy, is morally objectionable for a number of reasons, not the least of which is that, in a free-market economic system in which genetic enhancement is not provided to each citizen who might choose it by the state, those who could afford to pay for it would have a decided advantage over those who could not Glannon, He does make clear that, consistent with the moral requirement to make selections in favor of the child who can be expected to have the best life, those individuals who are making such selections may be subjected to persuasion but ought not to be subjected to any coercion Savulescu, Stoller contends that Savulescu fails to make his case because the examples that he offers to be, ostensibly, analogous to pre-implantation genetic diagnosis PGD , a procedure that is used to screen IVF-created embryos for genetic disorders or diseases prior to their implantation, are different in ways that are morally relevant and consequently fail to justify his theory Stoller, Stem cell research, since its inception, has been the subject of much controversy.
Hence, many of the same reasons, as above-mentioned, that constitute moral issues whenever embryos are used for research purposes apply to the use of embryonic stem cells. As genetic research progresses to the point at which gene therapy is able to make use of not only somatic-cell therapy that is, the modification of genes in the cells of any of a number of human body parts for therapeutic reasons but also germ-line therapy that is, the alteration of egg cells, sperm cells, and zygotes for therapeutic reasons , the health care applications are expected to increase in number in an exponential way.
However, the most important moral concern that the prospect of being able and willing to eventually engage in germ-line therapy is that this type of gene modification, by its very nature, will affect an unknown number of people in the future as they inherit these genetic changes. By contrast, somatic-cell therapy can only affect the person whose genes are so modified. Health care resources have never been unlimited in any society, regardless of the type of health care system that was employed.
At least for the foreseeable future, this fact is unlikely to change, but it is this fact that necessitates some form of what is normally referred to as the rationing of health care resources. Health care resources include not only the availability of in-patient hospital and other medical facility beds, emergency room beds, surgical units, specialized surgical units, specialized treatment centers, diagnostic technology, and more, but also personnel resources, that is, health care professionals of every description.
Whenever the availability of health care resources is exceeded by the demand for health care resources, the financial costs of such resources will rise; to the extent that, historically, there has been a consistent progression of the demand for such resources exceeding their availability, the financial costs of health care have also, consistently, risen. Because there are many other causal factors for this financial phenomenon, the rise in the financial costs of health care has been consistently exponential, in many countries, since the latter part of the 20 th century.
By the nature of the case, this occurs to a greater extent, and at a more rapid pace, in any country the politicians and public policy makers for which decide to employ a health care system that does not provide universal coverage. The procurement of human organs for transplantation in order to save the lives of those who otherwise would not survive represents what many consider to be a modern medical miracle, which became possible only in the latter half of the 20 th century.
However, like all such advances in medical knowledge and in medical technologies, human organ transplantation raises some fundamental moral issues. Throughout the brief history of human organ transplantation, a problem that is expected to continue is the fact that there are many, many more people who need organ transplants in order to survive than there are human organs available to be transplanted. Consequently, the available organs, at any point in time, must be rationed, which raises the question of determining the relevant factors to be considered in deciding who receives transplanted organs and who does not.
To harvest human organs that are necessary for human life, for example, hearts, lungs, or livers, and in order to be able to transplant them into the bodies of people who will not survive without such a transplant, is to harvest them from the bodies of people who are only recently deceased. However, a single kidney or bone marrow, for example, are usually harvested from the body of a donor who is alive and, presumably, well. In either case, in most countries, permission is required to be granted, legally and arguably also morally, in order for the harvesting to take place.
One of the most important moral issues concerning the recipients of human organs is the issue of the criteria that are used for the selection of human organ recipients. It should come as no surprise that one of the major factors to determine which prospective organ recipients are given priority on the waiting list is the age of the prospective recipient. With only rare exception, a young adult, as a prospective heart transplant recipient, will rank higher on the heart transplant waiting list than will an elderly adult, if the latter is deemed to even be eligible.
If the former two criteria do not seem to raise any moral concerns, each of the latter three, almost certainly, do. While each of the first two of these criteria could be reflective of egalitarian principles of justice, according to which each candidate, as a person, is viewed as having equal value, each of the latter three of these criteria could be seen as beneficial to the best interests of society, that is, as promoting social utility. As such, egalitarian principles of justice do not necessarily promote what is in the best interests of society any more than social utility considerations necessarily promote what is in the best interests of the individual.
However, the application of either of these two criteria is far less controversial than is the application of any one of the latter three criteria. It might be reasonable for people to disagree as to whether a person who is otherwise a good candidate for an organ transplant should be rejected solely because this person cannot afford to pay for the procedure and has no access to health insurance. Finally, it might be reasonable for people to disagree as to whether a candidate for an organ transplant, who happens to be a cancer biomedical researcher, is any more deserving of such a transplant than is another medically qualified candidate, who happens to be a high school custodian.
Adding to the dissatisfaction that some people express concerning the rationing of human organs for transplantation, in America and in other countries, is the deference that is sometimes offered to people of social prominence. Publicly documented in America are cases in which, for example, a prominent former professional sports figure, who had cirrhosis of the liver due to decades of alcohol abuse, was offered a liver transplant despite being, at that time, far down on the waiting list, and a governor of an East Coast state, who was offered and received both a heart and a lung transplant, again despite being, at the time in question, far down on the waiting list due, at least in part, to his age and his health status.
In fact, he died less than a year later. Another moral issue that is endemic to the human organ transplant industry is the buying and selling of human organs for the purpose of transplantation. In some Central American and some South American countries as well as in some Mideast countries, for the past several decades, there has been a thriving illegal market for human organs. More recently, this practice has spread to some European countries and even to America, when financially impoverished people find themselves in need of money for their own sustenance. Typically, such individuals are promised the equivalent of thousands of dollars for a kidney or bone marrow but find themselves at the mercy of the organ dealer for payment after the fact.
Worse, too many times, such medical procedures are performed in non-clinical environments and sometimes by non-clinically trained harvesters. In the former case, questions arise concerning the moral propriety of bringing a child into the world for the express purpose of harvesting some of its body parts.
Depending on which specific organs might be harvested, the death of this newborn might be inevitable. Any such case introduces questions concerning any of the following moral issues: Is it ever morally allowable to keep the body of an otherwise brain dead person alive for the sole purpose of harvesting some of its organs? Even if the answer to these questions is in the negative, because this individual might be deemed to have the same physiological, and thereby moral, status as one who has died, does proper respect for the body of the dead dictate that this practice is morally improper?
Both the retail sale of human organs and the farming of human organs continue to raise the moral issue of whether, and to what extent, human organs should be treated as commodities to be bought and sold in the marketplace legally or not and grown for the express purpose of harvesting for transplantation. To the extent that these prospects become realities, many of the moral issues that are raised by the procurement and the transplantation of human organs will become moot. The question of who, in a given society, should be eligible to receive health care is one of the most important ethical issues concerning the provision of health care in the 21 st century.
This is because of the stark contrasts that exist concerning the distribution of health care when comparing America to other nations. America is the only one of the thirty or more wealthiest nations on the planet to continue to prohibit universal health care. Universal health care, by the nature of the case, leaves out of its financing equation private health care insurance providers. By contrast, in America, these private health care insurance providers are the primary drivers of the health care system, determining who is eligible for health care insurance coverage; what particular health care services they choose to finance, and for whom, including not only diagnostic procedures but also surgical and other invasive medical procedures; the lengths of stays in hospitals or other medical facilities, for both surgical and non-surgical patients; the cost of health insurance premiums as well as financial deductibles and co-payments to be paid by their customers; the fees for services for physicians, surgeons, and other health care professionals, and the percentage of such fees that they will pay; the particular prescription medications that they deem eligible for payment by themselves and how much, in co-payments, that their customers have to pay; and many additional factors that affect both the health and the finances of those who maintain such insurance coverage.
In fact, there is a direct relationship, due to the effects of this type of health care system, between the health care and the finances of all members of society both those with health insurance and those without. Added to these issues is the fact that not all health insurance plans are the same concerning which services and procedures that they cover and which they do not, the practical effect of which is that many families with working parents do not have health insurance coverage for many important and significant health care services and procedures, or even prescription medications.
Worse, a large percentage of wage earners, and some salaried employees, cannot, reasonably, afford to pay the costs of health insurance premiums, and so, have no health insurance coverage at all. All of these facts concerning the health care system in America as compared to the health care systems in virtually every other reasonably wealthy nation in the world raise the following questions of a moral nature. Does each and every citizen of any society have a moral right to health care?
If so, does the government of any society have a moral obligation to provide each and every one of its citizens with health care? These questions, by their very nature, raise the issue of the extent to which the ethical principle of justice can be realized in any given society. At the societal level, the ethical principle of justice is applicable, fundamentally, to the ways in which goods and services as well as rights, liberties, opportunities for social and economic advancement, duties, responsibilities, and many other entities both tangible and intangible are distributed to citizens.
The application of the ethical principle of justice to these questions concerning health care provides a benchmark for the determination of which types of health care systems are more, or less, just than others. While any of the methods of moral decision-making, as delineated above, could be applied in fruitful ways to such questions, it might be more instructive to apply two public policy perspectives: libertarianism and egalitarianism. Those politicians and public policy makers who are responsible, over many decades, for the health care system in America, have, for the most part, done so based on libertarian principles of justice, while those politicians and public policy makers who are responsible, again, over many decades, for the health care systems in those countries with universal health care coverage, have, by and large, done so based on egalitarian principles of justice.
According to libertarian principles of justice, citizens might or might not have any kind of right to health care, but even if they do, it should not result in the placing of financial burdens on wealthier citizens to fund, in part or in whole, the health care of their less financially well-off counterparts. Rather, health care, like food, clothing, the cost of shelter, and the costs of all other goods and services available in society, should be distributed by the dictates of a free-market economic system. Those who are wealthier, and who are able to buy more expensive goods and services of superior quality, will also be able to afford to buy not only health care services and procedures themselves, but also a superior quality of such health care commodities.
Those who are less wealthy, and who are able to buy less expensive goods and services of comparatively inferior quality, will be able to afford health care services and procedures, but only of a comparatively inferior quality. Finally, those who are financially impoverished will not be able to afford health care services or procedures at all.
Under the public policy dictates of this type of health care system, the ethical principle of the autonomy of citizens to make their own choices, as citizens in society, takes precedence over the ethical principle of beneficence. According to egalitarian principles of justice, each citizen in society has an equal right to health care services and procedures because each citizen in society has equal value as a person.
Unlike most of the goods and services the distribution of which is dictated by a free-market economic system, health care is essential to the well-being of every citizen. Of course, the politicians and public policy makers, in accordance with this type of health care system, would have to adjudicate the question of whether all health care services and procedures would be available to all of the members of society, in equal measure, or the ways in which, and the degrees to which, such services and procedures would be made available to the members of society.
Under the public policy dictates of this type of health care system, the ethical principle of beneficence supersedes, in importance, the ethical principle of the autonomy of its citizens to make their own choices. The Joint Commission is the comprehensive accrediting agency for health care programs and organizations, of all types, throughout America, and has, for some time, mandated the inclusion of ethics committees as an accreditation requirement.
The purpose of any health care organization ethics committee is to develop, to engage in an on-going process of the review of, and to ensure the proper application of the medical ethics policies of the health care organization in question. Such policies would normally include such significant issues in health care ethics as informed consent, confidentiality, euthanasia, assisted suicide, the withholding and withdrawing of medical treatment, the harvesting and transplantation of human organs, and many others depending on the specific type of health care organization. While there is a wide latitude concerning the membership composition of health care ethics committees, typically, the following professions are represented: physicians, nurses, social workers, senior administrators, risk managers, chaplains, and ethicists, in addition to lay people from the local community, among others.
Health care ethics is a multi-faceted and fundamentally important issue for the citizens of any society because the provision of health care is essential to the well-being of each person, and the ways in which people are treated, concerning their health care, bears importantly on their health status. The many moral issues that arise out of the provision of health care—from those that are inherent in the relationship between the health care professional and the patient to those associated with abortion and euthanasia, from those to be encountered in biomedical or behavioral human subject research to those that have come about as a result of reproductive and genetic knowledge and technologies, and from those concerning the harvesting and transplantation of human organs to those that stem from public policy decisions as determinative of the allocation of health care services and procedures—are perennial issues.
To attempt to clarify these moral issues by use of the philosophical analysis of the language and the concepts that underlie them is, at least in theory, to provide a framework in accordance with which to make better quality decisions concerning them. Stephen C. Taylor Email: staylor desu. Health Care Ethics Health care ethics is the field of applied ethics that is concerned with the vast array of moral decision-making situations that arise in the practice of medicine in addition to the procedures and the policies that are designed to guide such practice.
Methods of Moral Decision-Making Methods of moral decision-making are concerned, in a variety of ways, not only with moral decision-making but also with the people who make such decisions. Utilitarian Theories: Mill The preeminent proponent of utilitarianism as an ethical theory in the 19 th century was John Stuart Mill. Deontological Theories: Kant A deontological normative ethical theory is one according to which human actions are evaluated in accordance with principles of obligation, or duty.
The Ethics of Care Yet another method of moral decision-making, which is sometimes thought of as a sub-field of feminist ethics but in the early 21 st century has come to be seen in its own right as a methodology and was given birth by feminist ethics, is usually referred to as the ethics of care. Ethical Principles In addition to the application of a variety of methods of moral decision-making to the practice of health care, ethical principles are also so applicable, but not procedurally in the same way as in the method of moral decision-making identified above as principlism.
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Justice In the clinical context, the ethical principle of justice dictates the extent to which the delivery of health care is provided in an equitable fashion. The Health Care Professional-Patient Relationship Any ethical issues that can arise within the clinical relationship between the health care professional and the patient are of the utmost importance if only because this relationship represents the front line of the provision of health care.
Confidentiality There is a moral obligation to protect from dissemination any and all personal information, of any type, that has been obtained on the patient by any and all health care professionals at any medical facility. The Question of a Right to Life Of all of the ethical issues that can be encountered in the practice of health care, none has been more controversial than those of abortion, euthanasia, and physician-assisted suicide. Human Life: Abortion At least since the time of the Oath of Hippocrates , with its explicit prohibition against abortion, there have been admonishments against the practice of the aborting of a human fetus together with arguments on both sides of this issue.
Human Death: Euthanasia and Physician-Assisted Suicide Euthanasia is an intervention in the standard medical course of treatment of a patient who is reasonably considered to be terminally, or irreversibly, ill or injured for the express purpose of causing the imminent death of that patient, normally for reasons of mercy. Human Subject Research Theoretically, the most fundamental reason to conduct research involving human subjects is to add to our existing knowledge concerning the physiological and the psychological constitution of the human body and the human mind, respectively, in an effort to improve the quality of life of people as determined by the status of their bodily and mental health.
The Rights of Subjects Over many decades throughout the second half of the 20 th century, a variety of codes of ethics were developed for the protection of the rights of people who serve as human research subjects. Vulnerable Populations By the nature of the case, there are some groups of people in society who are especially susceptible to abuse, concerning their rights, whenever they are the subjects of human research. Reproductive and Genetic Technologies Throughout the history of the practice of health care, the acquisition of knowledge and the innovation of medical technologies have brought with them new moral issues.
Reproductive Opportunities for Choice The last quarter of the 20 th century brought with it major advances in biological knowledge and in biological technology that allowed, for the first time in human history, for the birth of human offspring to result from biological interventions in the birthing process. Genetic Opportunities for Choice Since the discovery of the molecular structure of deoxyribonucleic acid DNA , the molecule that contains the genetic instructions that are necessary for all living organisms to develop and to reproduce, in , and since the completion of the mapping of the human genome, popularly known as the Human Genome Project, that is, the identification of the complete and exact sequencing of the billions of elements that make up the DNA code of the human body, some fifty years later, a vast amount of research has been conducted in the area of disease-causing mutations as causes of many human genetic disorders.
The Allocation of Health Care Resources Health care resources have never been unlimited in any society, regardless of the type of health care system that was employed. Organ Procurement and Transplantation The procurement of human organs for transplantation in order to save the lives of those who otherwise would not survive represents what many consider to be a modern medical miracle, which became possible only in the latter half of the 20 th century.
The Question of Eligibility in Health Care The question of who, in a given society, should be eligible to receive health care is one of the most important ethical issues concerning the provision of health care in the 21 st century. Health Care Organization Ethics Committees The Joint Commission is the comprehensive accrediting agency for health care programs and organizations, of all types, throughout America, and has, for some time, mandated the inclusion of ethics committees as an accreditation requirement.
Conclusion Health care ethics is a multi-faceted and fundamentally important issue for the citizens of any society because the provision of health care is essential to the well-being of each person, and the ways in which people are treated, concerning their health care, bears importantly on their health status. References and Further Reading Anderson, E. Aristotle Nicomachean Ethics , trans. Beauchamp, T. Boylan, M. Reprinted in Boylan, M. Brandt, A.