THE OBAMA ADMINISTRATION AND THE CATHOLIC Church are in conflict over the implementation of provi... more THE OBAMA ADMINISTRATION AND THE CATHOLIC Church are in conflict over the implementation of provisions of the Patient Protection and Affordable Care Act (HR 3590) requiring that all US Food and Drug Administration–approved contraceptive agents, not including abortifacients but including so-called morning after pills and sterilization procedures, be offered free of charge by all institutional insurance health plans, with no exception for institutions having religious objections. However, the Administration has compromised its initial directives, suggesting that insurers would have to offer free contraceptive coverage to individuals otherwise covered by such objecting institutions. These proposals are not of benefit to institutions that self-insure and do not exempt employers who have no clear association with religious institutions. Jost has discussed the purely legal disagreements between the Obama Administration and the Catholic Church; however, there has been little comment from a medical standpoint. As faculty members at the Creighton University School of Medicine—one of 4 Catholic medical schools in the United States—we question whether the public health benefits of mandated contraception coverage in the United States are so substantial that individuals and institutions should be forced to take actions that violate their collective moral conscience, thereby doing unnecessary harm to the principle of religious freedom. Because there are 629 Catholic hospitals—which account for more than 15% of patient admissions—in the United States, and there are 4 US medical schools and dozens of other health sciences schools affiliated with Catholic universities, this fundamental difference of opinion affects many patients and health care professionals, and resolving this controversy has important implications for health care in the United States. The Catholic Church offers all of its programs to the general public irrespective of religious belief, but because the Church’s health care ministry originates from its primary spiritual mission, the services provided must be consistent with Catholic ethical tenets. The Church opposes artificial means of birth control based on the belief that each and every marital sexual act must be open to the possibility of the transmission of life. This tenet is part of Church teachings wherein sexuality is incorporated as only one aspect of a framework for understanding the sanctity of the relationship between a man and a woman. A similar system of beliefs is shared, in part, by other faiths, including Orthodox Judaism and certain other Christian churches. Proponents of birth control procedures hold that women have a right to participate in sexual acts without the anxiety, burden, and medical risks of undesired pregnancy, and couples should be able to plan their families using artificial means as they choose, consistent with their life interests as well as their personal resources. The US government has taken the position that such control of reproduction is an essential health service and has mandated that it be offered by all health plans, including those sponsored and paid for by Catholic-affiliated institutions. So, for example, employees of a Catholic university would receive contraceptives, including postcoital agents and sterilization procedures, free of charge. Student health insurance policies at Catholic schools would cover these same measures, directly contradicting efforts to teach students the moral tenets of the Church. A number of preventive health services, including immunizations, mammography, osteoporosis testing, and screening for gestational diabetes, have received such free coverage based on unequivocal evidence of a health benefit to the US population. However, provision of contraceptive services should not be elevated to that same level as a public health priority. It is not clear that birth control is a truly “preventive service” in the sense of avoidance of disease or disability. Whether pregnancy may be undesirable for some women, it is not an illness. Moreover, the risk of venous thromboembolism, with a community incidence exceeding 1 per 1000, is increased 10-fold by the use of oral contraceptives. This
In dental education, students spend much of their time treating patients' oral health care needs.... more In dental education, students spend much of their time treating patients' oral health care needs. Many dental schools still require students to complete a specified number of treatments of various kinds before they can graduate. It often happens that students need to do a particular treatment in order to complete school requirements, when this treatment is not what the patient truly needs, or is not the only treatment indicated for the patient's condition. Consequently, students will be tempted to talk the patient into accepting the procedure. Likewise, educational requirements may tempt the student to postpone certain treatments or forgo non-credit-bearing interventions altogether. We argue that this conflict of interest is inevitable (even though the educational system adopted by the school may mitigate the problem) and analogous to that found in therapeutical experimentation. Hence, we advocate the same ethical solution as has long been adopted for conflicts arising in biomedical experimentation: informed consent.
Nitrous oxide (N(2)O) as a behavioral management intervention in children has attained an excelle... more Nitrous oxide (N(2)O) as a behavioral management intervention in children has attained an excellent safety record and is, therefore, used widely. As is true of any diagnostic or therapeutic dental intervention, however, its usage merits periodic review, even if-or particularly when-it is routinely applied. For example, when N(2)O is used in combination with other sedatives, such polypharmacy can produce potentially serious side effects. There are also bioenvironmental risks to patients and staff if ambient air is not properly monitored. Using historical publications, current empirical articles, professional usage policies, and educational textbooks, the purpose of this article was to review indications and contraindications of N(2)O and discuss various factors that should or should not be considered about its use in the United States. Even though today's parents may be more accepting of pharmacologic approaches such as N(2)O, the choice to use it should always be made with the child's best interest in mind.
The standard ethical arguments that prescribe dentistry&a... more The standard ethical arguments that prescribe dentistry's involvement in improving access to oral health care are based on the ethical principle of social justice. The authors underwrite this principle but argue that, as with other ethical principles, this principle alone will fail to have a practical impact. The authors show that the issue of access is a symptom of a more systemic problem in dentistry, namely the lack of connectedness that dentists feel between themselves and their profession, their community, and society at large. The second half of the article develops a plan for boosting "connectedness." Successful implementation should help resolve many of the systemic problems that dentistry currently faces, including the issue of disparities in oral health.
In 2 earlier articles a definition of professionalism was developed, and several specific profess... more In 2 earlier articles a definition of professionalism was developed, and several specific professional responsibilities were deduced. This third and final article in the series examines whether dentistry qualifies as a profession. On various levels, the professionalism of dentistry is found wanting. However, attaining the status of a profession is a work in progress, which means that each profession will always have some deficiencies. The author concludes that dentistry qualifies as a profession but that it is also exhibiting a trend toward once again becoming a business (as it was before the 19th century). For the sake of honesty with the public, dentistry must make a choice between these 2 models.
Individual dentists and organized dentistry alike invariably claim to be (members of) a professio... more Individual dentists and organized dentistry alike invariably claim to be (members of) a profession. This label is cherished because it suggests special social, moral and political status. However, almost every self-respecting occupation nowadays claims to be a profession. Hence, the question arises as to what exactly is meant when dentists claim to be professionals and, more important, whether they can justifiably lay claim to this label. Rather than reviewing the manifold and divergent discussions in the literature about professionalism, the author proposes--in this first of 3 consecutive articles--a definition of the term "profession" that is based on the literal origins of the word. Next, it is argued that a profession arises out of a social contract between the public and a service occupation that professes to give priority to the existential needs of the people served. In the second article, the author deduces several professional responsibilities. The third and final article examines whether and to what extent dentistry fulfills these responsibilities and outlines some future challenges.
Page 1. perspective Why Physicians? Reflections on The Netherlands' New Euthanasia Law BY JO... more Page 1. perspective Why Physicians? Reflections on The Netherlands' New Euthanasia Law BY JOS VM WELIE inally, euthanasia is legal in The Netherlands. The bill that was passed by the Lower House of Parlia-ment on ...
Assisted suicide is a highly controversial practice and illegal in most jurisdictions around the ... more Assisted suicide is a highly controversial practice and illegal in most jurisdictions around the world, although the number of countries that have decriminalized it is increasing. Public debates as well as legislative proposals and court judgments are often confounded by a failure to carefully distinguish assisted suicide from other end-of-life practices. Hence, this contribution will first seek to clarify the concept of assisted suicide. Next, the practice itself is briefly discussed, followed by a summary of current laws and regulations, and a cursory review of various sociocultural traditions and religious tenets in different countries around the world that appear to influence the ongoing practices and public opinions. In the last two sections, the ethics of assisted suicide is analyzed. Four sets of arguments (focused on pragmatics, consistency, rights, and benefits) favoring this practice are discussed first. In the final section, three sets of arguments against legalization (focused on pragmatics, the role of physicians, and the sanctity or inviolability of human life) are reviewed
This article provides a summary overview of the ideas on medical anthropology and anthropological... more This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883-1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel's warning against a dehumanization of medicine when the "person" of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.
THE OBAMA ADMINISTRATION AND THE CATHOLIC Church are in conflict over the implementation of provi... more THE OBAMA ADMINISTRATION AND THE CATHOLIC Church are in conflict over the implementation of provisions of the Patient Protection and Affordable Care Act (HR 3590) requiring that all US Food and Drug Administration–approved contraceptive agents, not including abortifacients but including so-called morning after pills and sterilization procedures, be offered free of charge by all institutional insurance health plans, with no exception for institutions having religious objections. However, the Administration has compromised its initial directives, suggesting that insurers would have to offer free contraceptive coverage to individuals otherwise covered by such objecting institutions. These proposals are not of benefit to institutions that self-insure and do not exempt employers who have no clear association with religious institutions. Jost has discussed the purely legal disagreements between the Obama Administration and the Catholic Church; however, there has been little comment from a medical standpoint. As faculty members at the Creighton University School of Medicine—one of 4 Catholic medical schools in the United States—we question whether the public health benefits of mandated contraception coverage in the United States are so substantial that individuals and institutions should be forced to take actions that violate their collective moral conscience, thereby doing unnecessary harm to the principle of religious freedom. Because there are 629 Catholic hospitals—which account for more than 15% of patient admissions—in the United States, and there are 4 US medical schools and dozens of other health sciences schools affiliated with Catholic universities, this fundamental difference of opinion affects many patients and health care professionals, and resolving this controversy has important implications for health care in the United States. The Catholic Church offers all of its programs to the general public irrespective of religious belief, but because the Church’s health care ministry originates from its primary spiritual mission, the services provided must be consistent with Catholic ethical tenets. The Church opposes artificial means of birth control based on the belief that each and every marital sexual act must be open to the possibility of the transmission of life. This tenet is part of Church teachings wherein sexuality is incorporated as only one aspect of a framework for understanding the sanctity of the relationship between a man and a woman. A similar system of beliefs is shared, in part, by other faiths, including Orthodox Judaism and certain other Christian churches. Proponents of birth control procedures hold that women have a right to participate in sexual acts without the anxiety, burden, and medical risks of undesired pregnancy, and couples should be able to plan their families using artificial means as they choose, consistent with their life interests as well as their personal resources. The US government has taken the position that such control of reproduction is an essential health service and has mandated that it be offered by all health plans, including those sponsored and paid for by Catholic-affiliated institutions. So, for example, employees of a Catholic university would receive contraceptives, including postcoital agents and sterilization procedures, free of charge. Student health insurance policies at Catholic schools would cover these same measures, directly contradicting efforts to teach students the moral tenets of the Church. A number of preventive health services, including immunizations, mammography, osteoporosis testing, and screening for gestational diabetes, have received such free coverage based on unequivocal evidence of a health benefit to the US population. However, provision of contraceptive services should not be elevated to that same level as a public health priority. It is not clear that birth control is a truly “preventive service” in the sense of avoidance of disease or disability. Whether pregnancy may be undesirable for some women, it is not an illness. Moreover, the risk of venous thromboembolism, with a community incidence exceeding 1 per 1000, is increased 10-fold by the use of oral contraceptives. This
In dental education, students spend much of their time treating patients' oral health care needs.... more In dental education, students spend much of their time treating patients' oral health care needs. Many dental schools still require students to complete a specified number of treatments of various kinds before they can graduate. It often happens that students need to do a particular treatment in order to complete school requirements, when this treatment is not what the patient truly needs, or is not the only treatment indicated for the patient's condition. Consequently, students will be tempted to talk the patient into accepting the procedure. Likewise, educational requirements may tempt the student to postpone certain treatments or forgo non-credit-bearing interventions altogether. We argue that this conflict of interest is inevitable (even though the educational system adopted by the school may mitigate the problem) and analogous to that found in therapeutical experimentation. Hence, we advocate the same ethical solution as has long been adopted for conflicts arising in biomedical experimentation: informed consent.
Nitrous oxide (N(2)O) as a behavioral management intervention in children has attained an excelle... more Nitrous oxide (N(2)O) as a behavioral management intervention in children has attained an excellent safety record and is, therefore, used widely. As is true of any diagnostic or therapeutic dental intervention, however, its usage merits periodic review, even if-or particularly when-it is routinely applied. For example, when N(2)O is used in combination with other sedatives, such polypharmacy can produce potentially serious side effects. There are also bioenvironmental risks to patients and staff if ambient air is not properly monitored. Using historical publications, current empirical articles, professional usage policies, and educational textbooks, the purpose of this article was to review indications and contraindications of N(2)O and discuss various factors that should or should not be considered about its use in the United States. Even though today's parents may be more accepting of pharmacologic approaches such as N(2)O, the choice to use it should always be made with the child's best interest in mind.
The standard ethical arguments that prescribe dentistry&a... more The standard ethical arguments that prescribe dentistry's involvement in improving access to oral health care are based on the ethical principle of social justice. The authors underwrite this principle but argue that, as with other ethical principles, this principle alone will fail to have a practical impact. The authors show that the issue of access is a symptom of a more systemic problem in dentistry, namely the lack of connectedness that dentists feel between themselves and their profession, their community, and society at large. The second half of the article develops a plan for boosting "connectedness." Successful implementation should help resolve many of the systemic problems that dentistry currently faces, including the issue of disparities in oral health.
In 2 earlier articles a definition of professionalism was developed, and several specific profess... more In 2 earlier articles a definition of professionalism was developed, and several specific professional responsibilities were deduced. This third and final article in the series examines whether dentistry qualifies as a profession. On various levels, the professionalism of dentistry is found wanting. However, attaining the status of a profession is a work in progress, which means that each profession will always have some deficiencies. The author concludes that dentistry qualifies as a profession but that it is also exhibiting a trend toward once again becoming a business (as it was before the 19th century). For the sake of honesty with the public, dentistry must make a choice between these 2 models.
Individual dentists and organized dentistry alike invariably claim to be (members of) a professio... more Individual dentists and organized dentistry alike invariably claim to be (members of) a profession. This label is cherished because it suggests special social, moral and political status. However, almost every self-respecting occupation nowadays claims to be a profession. Hence, the question arises as to what exactly is meant when dentists claim to be professionals and, more important, whether they can justifiably lay claim to this label. Rather than reviewing the manifold and divergent discussions in the literature about professionalism, the author proposes--in this first of 3 consecutive articles--a definition of the term "profession" that is based on the literal origins of the word. Next, it is argued that a profession arises out of a social contract between the public and a service occupation that professes to give priority to the existential needs of the people served. In the second article, the author deduces several professional responsibilities. The third and final article examines whether and to what extent dentistry fulfills these responsibilities and outlines some future challenges.
Page 1. perspective Why Physicians? Reflections on The Netherlands' New Euthanasia Law BY JO... more Page 1. perspective Why Physicians? Reflections on The Netherlands' New Euthanasia Law BY JOS VM WELIE inally, euthanasia is legal in The Netherlands. The bill that was passed by the Lower House of Parlia-ment on ...
Assisted suicide is a highly controversial practice and illegal in most jurisdictions around the ... more Assisted suicide is a highly controversial practice and illegal in most jurisdictions around the world, although the number of countries that have decriminalized it is increasing. Public debates as well as legislative proposals and court judgments are often confounded by a failure to carefully distinguish assisted suicide from other end-of-life practices. Hence, this contribution will first seek to clarify the concept of assisted suicide. Next, the practice itself is briefly discussed, followed by a summary of current laws and regulations, and a cursory review of various sociocultural traditions and religious tenets in different countries around the world that appear to influence the ongoing practices and public opinions. In the last two sections, the ethics of assisted suicide is analyzed. Four sets of arguments (focused on pragmatics, consistency, rights, and benefits) favoring this practice are discussed first. In the final section, three sets of arguments against legalization (focused on pragmatics, the role of physicians, and the sanctity or inviolability of human life) are reviewed
This article provides a summary overview of the ideas on medical anthropology and anthropological... more This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883-1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel's warning against a dehumanization of medicine when the "person" of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.
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