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"The moment one gives close attention to anything, even a blade of grass, it becomes a mysterious, awesome, indescribably magnificent world in itself."
-Henry Miller
Medical Ethics
Aware medicine can not be practiced without ethics being involved. However, "ethics" is not an easy term to define. What is Ethics? from The Markkula Center at Santa Clara University is a useful article to review. The American Medical Association outlines nine principles of medical ethics in physician practice which can be broadly applied to other healers as well.
As outlined nicely in Wikipedia, six values commonly arise in medical ethics: These are (as quoted from the website):
1. Beneficence - a practitioner should act in the best interest of the patient.
2. Non-maleficence - "first, do no harm."
3. Autonomy - the patient has the right to refuse or choose their treatment.
4. Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
5. Dignity - the patient (and the person treating the patient) have the right to dignity.
6. Truthfulness and honesty - the concept of informed consent has increased in importance...
Everyday Ethics
One engaging way of looking at ethics on a daily basis comes from and article on the Santa Clara University Ethics Web site (a great general resource to explore). The author, SJ Shanks, suggests that one ask the following five questions at the end of each day, and these can easily be applied to the context of healing:
"Did I practice any virtues today? In The Book of Virtues, William Bennett notes that virtues are "habits of the heart" we learn through models… They are the best parts of ourselves. Ask yourself, Did I cross a line today that gave up one of those parts? Or was I, at least some of the time, a person who showed integrity, trustworthiness, honesty, compassion, or any of the other virtues I was taught as a child?
Did I do more good than harm today? Or did I try to? Consider the short term and long-term consequences of your actions.
Did I treat people with dignity and respect today? All human beings should be treated with dignity simply because they are human. People have moral rights, especially the fundamental right to be treated as free and equal human beings, not as things to be manipulated, controlled, or cast away. How did my actions today respect the moral rights and the dignified treatment to which every person is entitled?
Was I fair and just today? Did I treat each person the same unless there was some relevant moral reason to treat him or her differently? Justice requires that we be fair in the way we distribute benefits and burdens. Whom did I benefit and whom did I burden? How did I decide?
Was my community better because I was in it? Was I better because I was in my community?
Consider your primary community, however you define it--neighborhood, apartment building, family, company, church, etc. Now ask yourself, Was I able to get beyond my own interests to make that community stronger? Was I able to draw on my community's strengths to help me in my own process of becoming more human?"
See Halberstam, Joshua. Everyday Ethics: Inspired Solutions to Real-Life Dilemmas. New York: Penguin Books, 1993 for more information
Some Useful Links
(Note that many of these also include case studies)
http://www.scu.edu/ethics/practicing/focusareas/medical/ - Markkula Center for Applied Ethics at Santa Clara University.
- http://www.scu.edu/ethics/practicing/focusareas/cases.cfm?fam=HEALTH - medical ethics cases from the SCU site
- http://www.scu.edu/ethics/practicing/decision/homepage.html - Guidelines for ethical decision making
American Medical Association Virtual Mentor
- http://virtualmentor.ama-assn.org/2005/06/toc-0506.html - Family Medicine and Ethics resources
- http://virtualmentor.ama-assn.org/site/cases.html - AMA Virtual Mentor Ethics Cases
http://www.medicalethics.ca/ - Medical Ethics Canada. Source of a number of excellent articles. Check out their "Ethics Articles" section. The "Bioethics for Clinicians" articles, available in PDF format, are quite good, as is the "Ethics Matters" website, from the Centre for Bioethics.
http://www.mic.ki.se/Diseases/K01.316.html - Karolinska Institutet. Nice array of PDF files and websites pertaining to medical ethics topics.
American Academy of Family Physicians
- http://fmignet.aafp.org/PreBuilt/Medical_Ethics.pdf - outline of medical ethics curriculum for residents
- http://www.learnwell.org/allethics.htm - Free online ethics courses.
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Photo by Josh Rindfleisch
"Ethics cannot be based upon our obligations toward [people], but they are complete and natural only when we feel this Reverence for Life and the desire to have compassion for and to help all creatures insofar as it is in our power. I think that this ethic will become more and more recognized because of its great naturalness and because it is the foundation of a true humanism toward which we must strive if our culture is to become truly ethical."
-Albert Schweitzer
"How is one to live a moral and compassionate existence when one is fully aware of the blood, the horror inherent in life, when one finds darkness not only in one's culture but within oneself? If there is a stage at which an individual life becomes truly adult, it must be when one grasps the irony in its unfolding and accepts responsibility for a life lived in the midst of such paradox. One must live in the middle of contradiction, because if all contradiction were eliminated at once life would collapse. There are simply no answers to some of the great pressing questions. You continue to live them out, making your life a worthy expression of leaning into the light."
-Barry Lopez, Arctic Dreams
"I have learned two lessons in my life: first, there are no sufficient literary, psychological, or historical answers to human tragedy, only moral ones. Second, just as despair can come to one another only from other human beings, hope, too, can be given to one only by other human beings."
-Elie Wiesel