[The physician's conscience, conscience clauses, and religious belief: A Catholic perspective]. / La Conciencia el Médico, Cláusulas de Conciencia y Creencia Religiosa: Una Perspectiva Católica.

This Essay explores how physicians may handle conflicts or conscience facing Roman Catholic Health practitioners regarding "human life" issues, especially through conscience clauses. In five parts, the author examines "first, why conscientious objection is so important in our day; second, the moral grounding for freedom in the exercise of conscience; third, the components of the physician's conscience; fourth, specific conflicts of conscience for Catholic physicians and institutions; and fifth, competing models of conflict resolution".

La conciencia del médico, cláusulas de conciencia y creencia religiosa: una perspectiva católica / No disponible

Este ensayo explora cómo los médicos pueden manejar los conflictos de conciencia a que se enfrentan los profesionales sanitarios católicos, respecto a las cuestiones de la "vida humana", especialmente a través de las cláusulas de conciencia. En cinco apartados, el autor examina en primer lugar por qué la objeción de conciencia es tan importante en nuestros días; en segundo lugar, la base moral de la libertad en el ejercicio de la conciencia; en tercer lugar, los componentes de la conciencia del médico; en cuarto, los conflictos de conciencia específicos de los médicos e instituciones católicas; y en quinto lugar, los modelos que compiten en la resolución de los conflictos

This Essay explores how physicians may handle conflicts or conscience facing Roman Catholic Health practitioners regarding "human life" issues, especially through conscience clauses. In five parts, the author examines "first, why conscientious objection is so important in our day; second, the moral grounding for freedom in the exercise of conscience; third, the components of the physician’s conscience; fourth, specific conflicts of conscience for Catholic physicians and institutions; and fifth, competing models of conflict resolution"

Medical ethics in an era of bioethics: resetting the medical profession's compass.

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, 2010).

Holistic Care in the US Military I-The Epidaurus Project: An Initiative in Holistic Medicine for the Military Health System, 2001-2012.

This article describes the history and findings of the Epidaurus Project, a Uniformed Services University-affiliated project to bring holistic care and evidence-based design into the Military Health System (MHS). A distinguished group of civilian thought leaders contributed. The 2005 Base Realignment and Closure process offered a chance to implement the Epidaurus agenda. A new integrated healthcare delivery system, centered around the Walter Reed National Military Medical Center at Bethesda, Maryland, was the result. These facilities will be templates for a new generation of MHS "healing environments" and a model for innovative systems of healthcare nationwide. The Epidaurus Project represents a significant collaboration between civilian medicine and the military in times of war.

Este artículo describe la historia y los hallazgos del Proyecto Epidaurus, un proyecto en colaboración con la Uniformed Services University (Universidad de Servicios Uniformados), para incorporar la medicina holística y el diseño basado en la evidencia en el Military Health System (Sistema de Salud Militar). A ello contribuyó un grupo distinguido de líderes intelectuales civiles. El proceso de Realineamiento y Cierre de Bases del 2005 ofreció una oportunidad para implementar el programa Epidaurus. El resultado fue un sistema nuevo e integrado de asistencia sanitaria, centrado alrededor del Walter Reed National Military Medical Center de Bethesda. Estas instalaciones serán el modelo para una nueva generación de "entornos de salud" MHS y para sistemas de asistencia sanitaria innovadores a nivel nacional. El Proyecto Epidaurus representa una colaboración destacada entre la medicina civil y los militares en tiempos de guerra.

The Catholic Physician in an Era of Secular Bioethics.

This essay examines how commitment to the Roman Catholic moral and ethical traditions shapes the process, and content of bioethics and clinical decisions. An essential element of the vocation of Roman Catholic health professionals is to give genuine witness to that tradition in their daily clinical practices. Three questions will be addressed: 1) What is the justification for introducing religious commitments in clinical bioethics in a morally pluralist society? 2) What specifically does the Catholic medical tradition contribute to today's clinical decisions? 3) How are faith and reason to be balanced in clinical ethics? 4) Why are these questions relevant to papal calls for re-evangelization, or "re-proposal" of the faith, especially in the life of the physician?

Perioperative guidelines for elective surgery in the human immunodeficiency virus-positive patient.

BACKGROUND: Human immunodeficiency virus (HIV)-positive patients with changes in body morphology can be challenging for the plastic surgeon. Uncertainty about the advisability of elective procedures for these patients and fears of infection transmission may cause trepidation. Plastic surgeons are likely to encounter these patients in increasing numbers. The authors provide an overview of HIV lipodystrophy and treatment options. Clinical parameters are established that must be met before elective procedures on HIV-positive patients. In addition, ethical and legal considerations are discussed. METHODS: A literature review was conducted to identify articles reporting specific, identifiable factors influencing operative risk in HIV-positive patients. Legal and ethical experts were consulted. RESULTS: Specific risk factors influencing operative morbidity include an absolute CD4 count of less than 200 cells/cc3 or viral load greater than 10,000 copies/ml. Patients with CD4 counts greater than 200 cells/cc3 and a low viral load have a risk of postoperative complications similar to that of the general population and should therefore be evaluated on established preoperative parameters (e.g., American Society of Anesthesiologists class, nutrition, and age). CONCLUSIONS: Patients with HIV-associated body morphology changes can be safely treated by the plastic surgeon, provided that a thorough preoperative workup is performed. There is minimal risk of disease transmission. There is an ethical and legal obligation to treat these patients if the patient is suitable and the procedure in question falls under the expertise of the consulting surgeon.

Toward a reconstruction of medical morality.

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive--together with the physician--at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.

Some things ought never be done: moral absolutes in clinical ethics.

Moral absolutes have little or no moral standing in our morally diverse modern society. Moral relativism is far more palatable for most ethicists and to the public at large. Yet, when pressed, every moral relativist will finally admit that there are some things which ought never be done. It is the rarest of moral relativists that will take rape, murder, theft, child sacrifice as morally neutral choices. In general ethics, the list of those things that must never be done will vary from person to person. In clinical ethics, however, the nature of the physician-patient relationship is such that certain moral absolutes are essential to the attainment of the good of the patient - the end of the relationship itself. These are all derivatives of the first moral absolute of all morality: Do good and avoid evil. In the clinical encounter, this absolute entails several subsidiary absolutes - act for the good of the patient, do not kill, keep promises, protect the dignity of the patient, do not lie, avoid complicity with evil. Each absolute is intrinsic to the healing and helping ends of the clinical encounter.

Professionalism, profession and the virtues of the good physician.

The putative loss of professionalism in medicine has of late become of serious concern to practitioners, educators, ethicists and the public. Impassioned pleas for its restitution abound. Serious ethical obligations are linked to the idea of a profession. Yet, most of the definitions have been socio-historical, political or legal. Important as these aspects may be, there is need for a firmly grounded ethical derivation of the moral dimensions of professionalism. This essay undertakes to provide a philosophical grounding for ethically responsible professionalism in the phenomena of clinical medicine, in the character of the professional, and in virtue theory.