Dubious premises--evil conclusions: moral reasoning at the Nuremberg trials

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform 'medical activities,' what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts - acts directed towards their patients' health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Professionalism under fire: Conflict, war and epidemics

Today's medical students (tomorrow's doctors) will be entering a world of conflict, war and regular outbreaks of infectious diseases. Despite numerous international declarations and treaties protecting human rights, the last few decades has been fraught with reports of "lapses" in medical professionalism involving torture and force-feeding of detainees (e.g. captured during the War on Terror) and health care professionals refusing to treat infected patients (e.g. HIV and Ebola). This paper provides some historical background to the changing status of a physician's duty to treat and how medical practitioners came to be involved in the inhumane treatment of detainees during the War on Terror, culminating in reports of "lapses" in professionalism. The Theory of Planned Behavior, which takes into account the individual, the environment and the social context, is used to explain the factors that might influence an individual's behavior in challenging situations. The paper concludes with some recommendations for medical and health professions education. The recommendations include selecting students who, as a minimum, can provide evidence of "basic" professionalism, engaging them in exploring the history of the medical profession, exposing them to contexts of uncertainty and moral dilemmas and challenging them to reflect on their responses.

Moral distress: the state of the science

Moral distress, a complex human experience, has lacked a clear, complete definition. Intuitively, clinicians know that moral distress might be occurring for patients with increasing frequency due to technological advances that alter the natural order of life and death. Yet clinicians have not been able to evaluate the presence or extent of moral distress. To date, moral distress has been investigated mainly as an occupational issue using Jameton's (1984) definition, which has been problematic for several reasons. Without an adequate definition, moral distress can be unrecognized, yet have a silent, clinically significant impact on health. The literature is discussed from several perspectives to show the current state of the science in this topical area, and its potential future.