Framing issues in health care: do American ideals demand basic health care and other social necessities for all?

This paper argues for the necessity of universal health care (as well as universal free education) using a different argument than most that have been made heretofore. It is not meant to conflict with but to strengthen the arguments previously made by others. Using the second paragraph of the Declaration of Independence and the Preamble to the Constitution we argue that universal health care in this day and age has become a necessary condition if the ideals of life, liberty and the pursuit of happiness are to be more than an empty promise and if the discussion of "promoting of general welfare" in the preamble is to have any meaning.

Healthcare and the hospital chaplain.

Many chaplains and most chaplaincy programs in the United States--with encouragement from their accrediting organization, the Association for Clinical Pastoral Education (ACPE)--have begun to assume a more proactive stance toward patients, healthcare professionals, and healthcare facilities. Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to proposing that they be permitted to do "spiritual assessments" on patients--in some instances whether these patients have been explicitly informed and have agreed to this beforehand. Moreover, many chaplains and chaplaincy programs have begun to assume that chaplains are full-fledged members of the healthcare team, complete with access to patients' medical records both to gather information and to make notations of their own.

Ageisms.

In this paper some very fundamental attitudes we have and assumptions we make in the US about persons, what they owe and what they are owed, are scrutinized and found to be indefensibly ageist. It is argued that these assumptions and the attitudes they engender are supported by logically and ethically suspect methods and conclusions. These errors are summarized and some remedial steps by which we might better protect against such illicit and unwarranted methods and conclusions in the future are suggested.

Use and abuse of bioethics: integrity and professional standing.

This paper sets out to examine the integrity and professional standing of "Bioethics." It argues that professions have certain responsibilities that start with setting criteria for and credentialing those that have met the criteria and goes on to ultimately have social responsibilities to the community. As it now stands we claim that Bioethics--while it certainly has achieved some progress in the way medicine has developed--has failed to become a profession and has to a large extent failed in its social responsibility.

Hastening death by selective disclosure of treatment options--beneficence or "euthanasia by deception"?

In this paper I make a radical claim regarding selective non-disclosure of treatment options that have some hope of prolonging a patient's life. I suggest that selective non-disclosure under such circumstances is tantamount to what might be called "euthanasia by deception." I offer a case to test the validity of my claim and to demonstrate how the failure to offer or, at least, to discuss renal dialysis in this case (and, by inference, any other form of treatment which has some hope of prolonging a patient's life) qualifies as paternalism in its most egregious form.

Written advance directives: Theuth's blessing... or... curse?

Advance directives are discussed from a philosophical standpoint and with reference to their relationship to informed consent. The necessity of an advance directive being truly informed is stressed. The author suggests that the validity of these instruments is made quite difficult when the particular context in which they find themselves is one which neither patient nor physician anticipated.

Honouring the age-old commitment to "the patient's good": the promise--and peril--of hospice.

In this article, the rise of hospice in the United States is examined and some of its important strengths and weaknesses are described. It is suggested that, despite the tendency to believe otherwise, hospice is not immune to a kind of alienation between patients and clinicians based on the absorption of doctors with biomedical conditions and their possible technological remedies, thus overlooking or ignoring the patient's good. To protect the age-old fiduciary or "trust" relationship between patients and clinicians requires a re-adjustment of current attitudes and practices--not just in the current cure-oriented health care of conventional medicine, but in the palliation-oriented health care of hospice as well.