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282. autonomy as a problem for clinical ethicsIn Thomas Nys, Yvonne Denier & Toon Vandevelde (eds.), Autonomy & paternalism: reflections on the theory and practice of health care, Peeters. pp. 5--71. 2007.
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5Responsibility in Health CareSpringer. 2011.Medicine is a complex social institution which includes biomedical research, clinical practice, and the administration and organization of health care delivery. As such, it is amenable to analysis from a number of disciplines and directions. The present volume is composed of revised papers on the theme of "Responsibility in Health Care" presented at the Eleventh Trans Disciplinary Symposium on Philosophy and Medicine, which was held in Springfield, illinois on March 16-18, 1981. The collective f…Read more
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110Autonomy and Long-Term CareOxford University Press. 1993.The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis of the…Read more
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36How Nurses and physicians face ethical dilemmas — the Croatian experienceNursing Ethics 18 (3): 341-355. 2011.The aim of this study was to assess nurses’ and physicians’ ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N = 364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life…Read more
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55Physical restraint elimination in the acute care setting: Ethical considerations (review)HEC Forum 10 (3-4): 244-262. 1998.
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73On Values in Recent American Psychiatric ClassificationJournal of Medicine and Philosophy 19 (3): 261-277. 1994.The DSM-IV, like its predecessors, will be a major influence on American psychiatry. As a consequence, continuing analysis of its assumptions is essential. Review of the manuals as well as conceptually-oriented literature on DSM-III, DSM-III-R, and DSM-IV reveals that the authors of these classifications have paid little attention to the explicit and implicit value commitments made by the classifications. The response to DSM criticisms and controversy has often been to incorporate more scientifi…Read more
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31Research on clinical ethics and consultation. Introduction to the themeMedicine, Health Care and Philosophy 11 (1): 3-5. 2008.Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of e…Read more
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31Freitas on Disease in Nanomedicine: Implications for Ethics (review)NanoEthics 4 (3): 205-214. 2010.This paper critically examines the volitional normative model of disease and its underlying nanotechnologic vision of medicine both defended by Robert Freitas. Having provided an account of this vision, we explicate the highlight of the model, which is a concept of disease based on individual values and preferences. The model’s normative positions are then critiqued based on our argument that the epistemic basis of Freitas’s vision of nanotechnologic medicine and, by extension, of his volitional…Read more
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28Croatian physicians' and nurses' experience with ethical issues in clinical practiceJournal of Medical Ethics 34 (6): 450-455. 2008.Aim: To assess ethical issues in everyday clinical practice among physicians and nurses of the University Hospital Rijeka, Rijeka, Croatia.Subjects and methods: We surveyed the entire population of internal medicine, oncology and intensive care specialists and associated nurses employed at the University Hospital Rijeka, Rijeka, Croatia . An anonymous questionnaire was used to explore the type and frequency of ethical dilemmas, rank of their difficulty, access to and use of ethics support servic…Read more
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31Until they have faces: the ethics of facial allograft transplantationJournal of Medical Ethics 31 (12): 707-709. 2005.The ethical discussion of facial allograft transplantation for severe facial deformity, popularly known as facial transplantation, has been one sided and sensationalistic. It is based on film and fiction rather than science and clinical experience. Based on our experience in developing the first IRB approved protocol for FAT, we critically discuss the problems with this discussion, which overlooks the plight of individuals with severe facial deformities. We discuss why FAT for facial deformity i…Read more
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67Why Quality Is Addressed So Rarely in Clinical Ethics ConsultationCambridge Quarterly of Healthcare Ethics 18 (4): 339. 2009.In a practice like ethics consultation, quality and accountability are intertwined. Critics of ethics consultation have complained that clinical ethics consultants exercise power or influence in patient care without sufficient external oversight. Without oversight or external accountability, ethics consultation is seen as more sophistical than philosophical. Although there has been more discussion of accountability, concern for quality in ethics consultation is arguably more important, because i…Read more
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100Seeking the Everyday Meaning of Autonomy in Neurologic DisordersPhilosophy, Psychiatry, and Psychology 11 (4): 295-298. 2004.In lieu of an abstract, here is a brief excerpt of the content:Seeking the Everyday Meaning of Autonomy in Neurologic DisordersGeorge J. Agich (bio)The Socratic aphorism that the unexamined life is not worth living and dictums like "Know thyself" remind us of the centrality of self-understanding in the history of philosophical reflections on autonomy. These traditional concerns with autonomy may seem far removed from the neurologic impairments to which Joel Anderson and Warren Lux draw our atten…Read more
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21Response to “From Pittsburgh to Cleveland: NHBD Controversies and Bioethics” by George J. Agich (CQ Vol 8, No 3)Say It Ain't So: 60 Minutes on NHBD (review)Cambridge Quarterly of Healthcare Ethics 8 (4): 517-523. 1999.Frank Koughan and Walt Bogdanich's response to my article, “From Pittsburgh to Cleveland: NHBD Controversies and Bioethics,” reminds me of the Shakespearean line, “The lady protests too much, methinks.” My article was not about the specifics of the 60 Minutes April 13, 1997, story on NHBD at the Cleveland Clinic Foundation , even though the story formed the basis for the reflection. I did not attack the critics, though I do believe that bioethicists are accountable for their scholarly and public…Read more
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62Guest Editorial: Encouraging the DialogueCambridge Quarterly of Healthcare Ethics 18 (4): 333. 2009.Ethics consultation is the most engaged aspect of clinical ethics, a field focused on ethical issues, questions, and conflicts arising in the course of patient care and delivery of healthcare services. Despite the skepticism of some academic bioethicists and criticism expressed by social commentators, clinical ethics, which began in North America, has expanded to Europe and many other parts of the world with the proliferation of healthcare institution ethics and ethics consultation support servi…Read more
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73From Pittsburgh to Cleveland: NHBD Controversies and BioethicsCambridge Quarterly of Healthcare Ethics 8 (3): 269-274. 1999.In March 1997, 60 Minutes, a nationally syndicated news magazine program, featured a story in which it was claimed that The Cleveland Clinic Foundation had in place a non-heart-beating donor protocol that involved killing patients for their organs. These charges were brought by a philosopher from a local university. A student who worked at LifeBanc, the northeastern Ohio organ procurement agency where the organ donation protocol originated, was given the protocol by LifeBanc with the understandi…Read more
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79Conflicts of Interest and Management in Managed CareCambridge Quarterly of Healthcare Ethics 9 (2): 189-204. 2000.The bioethics literature on managed care has devoted significant attention to a broad range of conflicts that managed care is perceived to have introduced into the practice of medicine. In the first part of this paper we discuss three kinds of conflict of interest: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts with the fiduciary character of the physician–patient relationship. We argue that the conflicts are either not as serious as they are often…Read more
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4Stroke patients’ preferences and values about emergency researchJournal of Medical Ethics 31 (10): 608-611. 2005.Background: In the USA, the Food and Drug Administration waiver of informed consent permits certain emergency research only if community consultation occurs. However, uncertainty exists regarding how to define the community or their representatives.Objective: To collect data on the actual preferences and values of a group—those at risk for stroke—most directly affected by the waiver of informed consent for emergency research.Design: Face to face focused interviews were conducted with 12 patients…Read more
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143Who shall be allowed to give? Living organ donors and the concept of autonomyTheoretical Medicine and Bioethics 22 (4): 351-368. 2001.Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy in…Read more
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103The Logical Status of Brain Death CriteriaJournal of Medicine and Philosophy 10 (4): 387-396. 1985.This article is an attempt to clarify a confusion in the brain death literature between logical sufficiency/necessity and natural sufficiency/necessity. We focus on arguments that draw conclusions regarding empirical matters of fact from conceptual or ontological definitions. Specifically, we critically analyze arguments by Tom Tomlinson and Michael B. Green and Daniel Wikler. which, respectively, confuse logical and natural sufficiency and logical and natural necessity. Our own conclusion is th…Read more
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51When consent is unbearable: an alternative case analysisJournal of Medical Ethics 5 (1): 26-28. 1979.Dr Agich takes up a previous difficult case related by Dr Kottow in an earlier issue of the Journal. He analyses the three ethical problems as presented in the case and offers his own opinion of it as well as his own conclusions with regard to the medical ethical aspects of it. Unlike Dr Kottow, Dr Agich's reading of the case indicates that the application of the principle of informed consent does not rule out ethical decisions for the physician, but emphasizes the relevance of ethical analysis …Read more
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18Why Quality is so Rarely Addressed in Clinical Ethics ConsultationCambridge Quarterly of Healthcare Ethics 18 (4): 339-346. 2009.
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167What kind of doing is clinical ethics?Theoretical Medicine and Bioethics 26 (1): 7-24. 2004.This paper discusses the importance of Richard M. Zaners work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that …Read more
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8What Kind of Doing is Clinical Ethics?Theoretical Medicine and Bioethics 26 (1): 7-24. 2005.This paper discusses the importance of Richard M. Zaner’s work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that…Read more
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82The foundation of medical ethicsTheoretical Medicine and Bioethics 2 (1): 31-34. 1981.Thomasma and Pellegrino''s [3] focus on the healing relationship as the way to give medical ethics a philosophical foundation contains a number of difficulties. Most importantly, their approach focuses philosophical analysis on an idealized view of the healing relationship in which the ideal of health is seen as an uncontroversial norm in the individual case. medical ethics is then characterized as an intrinsic part of the medical act itself. Philosophical inquiry seems limited to a description …Read more
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28The importance of management for understanding managed careJournal of Medicine and Philosophy 24 (5): 518-534. 1999.
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49The question of method in ethics consultationAmerican Journal of Bioethics 1 (4). 2001.This paper offers an exposition of what the question of method in ethics consultation involves under two conditions: when ethics consultation is regarded as a practice and when the question of method is treated systematically. It discusses the concept of the practice and the importance of rules in constituting the actions, cognition, and perceptions of practitioners. The main body of the paper focuses on three elements of the question of method: canon, discipline, and history, which are treated …Read more
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23Truth in Advertising: Reasonable Versus Unreasonable Claims About Improving Ethics ConsultationAmerican Journal of Bioethics 16 (3): 25-26. 2016.