Academic journal article The Hastings Center Report

Commentary

Academic journal article The Hastings Center Report

Commentary

Article excerpt

Janet's actions are understandable in the face of a very frustrating and painful situation. While I do not believe Janet's actions can be morally justified, I do not think she should bear the onus of moral blame. The terrible situation in which she found herself, made possible only by grave institutional failure, is the place to look for moral blame.

Contemporary medicine is practiced within institutional contexts: hospitals, insurers, government, and health care professionals. Choices cannot be seen as if they take place in isolation from these contexts; indeed, the parameters of many choices are structured by the settings. When physicians and patients meet, even if they are alone in an examination room, there are many other parties present. Hospitals, insurers, legal regulators, family members are all part of the fabric of that encounter. Health care, as we know it, is delivered through complex institutional mechanisms.

In this case there seem to have been no good, or at least effective, institutional structures to help Mrs. Jordan's situation. Yet one can easily imagine how institutions might meet their moral responsibilities toward such patients. The culture of health care institutions must include an explicit commitment to respect patient's wishes insofar as possible. …

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