A 75-year-old woman has type 2 diabetes mellitus, peripheral vascular disease, and a gangrenous ulcer of her left foot. A below-the-knee amputation is recommended, but she declines, saying that she has lived long enough and wants to die with her body intact. Her internist is concerned about her increasing confusion over the past year and notes that she appears to be depressed. How should her physician determine whether her decision is competent?

https://www.bumc.bu.edu/im-residency/files/2013/03/Capacity.pdf

Assessment of Patients' Competence to Consent to Treatment

For forty years, successive editions of Ethical Theory and Business have helped to define the field of business ethics. The 10th edition reflects the current, multidisciplinary nature of the field by explicitly embracing a variety of perspectives on business ethics, including philosophy, management, and legal studies. Chapters integrate theoretical readings, case studies, and summaries of key legal cases to guide students to a rich understanding of business ethics, corporate responsibility, and sustainability. The 10th edition has been entirely updated, ensuring that students are exposed to key ethical questions in the current business environment. New chapters cover the ethics of IT, ethical markets, and ethical management and leadership. Coverage includes climate change, sustainability, international business ethics, sexual harassment, diversity, and LGBTQ discrimination. New case studies draw students directly into recent business ethics controversies, such as sexual harassment at Fox News, consumer fraud at Wells Fargo, and business practices at Uber.

Ethical Theory and Business

The authors describe the rationale for implementing evidence-based practices in routine mental health service settings. Evidence-based practices are interventions for which there is scientific evidence consistently showing that they improve client outcomes. Despite extensive evidence and agreement on effective mental health practices for persons with severe mental illness, research shows that routine mental health programs do not provide evidence-based practices to the great majority of their clients with these illnesses. The authors define the differences between evidence-based practices and related concepts, such as guidelines and algorithms. They discuss common concerns about the use of evidence-based practices, such as whether ethical values have a role in shaping such practices and how to deal with clinical situations for which no scientific evidence exists.

https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.52.2.179

Implementing evidence-based practices in routine mental health service settings.

To date, analyses of differences between adolescents' and adults' judgment have emphasized age differences in cognitive factors presumed to affect decision making. In contrast, this article examines research and theory on threepsychosocial aspects of maturity of judgment: responsibility, temperance, and perspective. For several psychosocial dimensions of maturity that are likely to affect judgment, the existing pvidence, while indirect and imperfect, indicates that the greatest differences are found in comparisons between early adolescents versus middle and late adolescents. Developmental research on maturity that focuses specifically on mid-and late adolescence, that simultaneously examines both cognitive and noncognitive factors, and that investigates the relation between these factors and the ability to make good decisions is greatly needed.

https://psycnet.apa.org/journals/lhb/20/3/249.pdf

Maturity of judgment in adolescence: Psychosocial factors in adolescent decision making.

Buarachanan A. E. & Brock D. W. (Cambridge University Press, New York, NY, 1990), 368 pages, $49.50 hardback; $16.95 paperback.

Deciding for others: The ethics of surrogate decision‐making

The permanent cessation of functioning of the organism as a whole is the definition underlying the traditional understanding of death We suggest the total and irreversible loss of functioning of the whole brain as the sole criterion of death; this has always been an implicit criterion of death If artificial ventilation is present, only completely validated brain dysfunction tests should be used to show that this criterion of death is satisfied In most cases without artificial ventilation, permanent loss of cardiopulmonary function is sufficient We propose a statutory definition of death based on the criterion of total and irreversible cessation of whole brain functions but allowing physicians to declare death according to their customary practices in most cases

On the Definition and Criterion of Death

1. Introduction 2. Morality 3. Application 4. Principalism 5. Malady 6. Competence 7. Consent 8. Confidentiality 9. Paternalism 10. Justification 11. Death 12. Euthanasia

Bioethics: A Return to Fundamentals

Formal teaching of ethics in the medical school curriculum has increased greatly during the past 15 years. Yet, schools vary in how much attention they give the subject, and even those that do offe...

Basic curricular goals in medical ethics.

1. Introduction 2. Morality 3. Moral disagreement 4. Particular Moral Rules and Special Duties 5. Principlism 6. Malady 7. Mental Maladies 8. What Doctors Must Know about Medical Practice 9. Adequate Information, Competence and Coercion 10. Paternalism and Its Justification 11. Death 12. Euthanasia

Charles M. Culver

Papers

On the Definition and Criterion of Death

Bioethics: A Return to Fundamentals

Basic curricular goals in medical ethics.

Bioethics: A Systematic Approach

Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry