Extremely premature birth and the choice of neonatal intensive care versus palliative comfort care: an 18-year single-center experience.

Objective: Review all live births 22 0/7 through 26 6/7 weeks gestation born 1996 through 2013 at our institution to describe the decision process and immediate outcomes of palliative comfort care (PCC) versus neonatal intensive care (NICU) and whether any significant family complaints or quality assurance concerns arose.

Study Design: Retrospective chart review, physician and ethicist interview process and database review focused upon our established periviability counseling guidelines that are directive of PCC at 22 weeks gestation and NICU at 26 weeks but supportive of informed family choice of either option at 23, 24 and 25 weeks.

Result: At 22 weeks--all 54 infants had PCC; at 23 weeks--29/78 (37%) chose NICU care, 6/29 (21%) infants survived; at 24 weeks--79/108 (73%) chose NICU care, 47/79 (59%) survived; at 25 weeks--147/153 (96%) chose NICU care, 115/147 (78%) survived; and at 26 weeks--all infants had NICU care, 176/203 (87%) survived.

Ethics consultation in Portland. Providence Health's Oregon Region has created an ethics consult service.

In response to the need for a more structured approach toward the enhancement of and preparation for case consultation, the Portland Service Area (PSA) of the Providence Health System Oregon Region implemented a "special team" system. These teams--an extension of the ethics committees already in place--underwent training in areas such as an overview of ethics, patient decision making, professionalism, organizational ethics, and palliative and end-of-life care. Moving ethics consultation away from the purview of ethics committees generally, and into the realm of these trained special teams, has improved PSA's ability to respond to ethics needs in the region.

Sterilization, Catholic health care, and the legitimate autonomy of culture.

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine.

Covenant model of corporate compliance. "Corporate integrity" program meets mission, not just legal, requirements.

Catholic healthcare should establish comprehensive compliance strategies, beyond following Medicare reimbursement laws, that reflect mission and ethics. A covenant model of business ethics--rather than a self-interest emphasis on contracts--can help organizations develop a creed to focus on obligations and trust in their relationships. The corporate integrity program (CIP) of Mercy Health System Oklahoma promotes its mission and interests, educates and motivates its employees, provides assurance of systemwide commitment, and enforces CIP policies and procedures.

Fifteen years after "Animal Liberation": has the animal rights movement achieved philosophical legitimacy?

Fifteen years ago, Peter Singer published Animal Liberation: A New Ethics for Our Treatment of Animals. In it, he proposed to end "the tyranny of humans over nonhuman animals" by "thinking through, carefully, and consistently, the question of how we ought to treat animals" (p. ix).

Terminal care and the pregnant woman: ethical reflections on In Re: A.C.

In June 1987, a Washington, DC, court, stating that it had an interest in protecting viable fetal life, ordered a 27-year-old woman dying of cancer to undergo a cesarean section to deliver a 26 1/2-week fetus. The child died within hours, and the woman within days, of the surgery. The ruling was appealed.

Balancing benefit and burden. Merely avoiding harm does not carry out the intent of the Hippocratic Oath.

Healthcare providers often seek to benefit their patients through the avoidance of harm. This approach to benefit is rooted in the common understanding of the Hippocratic oath as primum non nocere--first, do no harm. A need exists in medical-ethical decision making to rediscover the principle of benefit per se, independent of the principle of avoiding harm.

The effect of a relaxation technique on coronary risk factors.

This study examined the effect of a relaxation technique on plasma lipids, weight, blood pressure, and blood glucose. Sixteen outpatient males were randomly assigned to control or experimental groups. The experimental group was taught a relaxation technique that they used throughout the study.