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Preventive Ethics and Alleviating Care Providers’ Stress

In the lead article in this issue, “Preventive Ethics: Expanding the Horizons of Clinical Ethics,” Lachlan Forrow, Robert M. Arnold, and Lisa S. Parker call for care providers to practice preventive ethics. Such a preventive approach theoretically has few limits, since one can consider ways to avoid future problems after virtually any ethical dilemma arises. For example, to prevent the conflict that Jay E. Kantor and Iffath Abbasi Hoskins describe in “Brain Death in Pregnant Women,” care providers could ask all pregnant women whether they would want their vital functions maintained for the sake of their fetuses in the event that they experienced brain death. However, as Jacqueline J. Glover states in “Incubators and Organ Donors,” her response to Kantor and Hoskins, carrying preventive ethics to this extreme may be inadvisable. She states: “It is difficult to talk routinely about death with women who are receiving care for a normal process. . . . [Thus,] it seems farfetched that professional caregivers . . . will raise [this question].” The predominant difficulty posed by Forrow’s challenge to practice preventive ethics is not deciding which preventive-ethics interventions could be carried out, but which ones should be. The complexity of this question is exemplified in efforts to prevent a dilemma that is probably as wrenching as any: when the parents of a child whose condition is futile want all treatments carried out--despite the fact that the burdens of treatment are greater than the benefits--because they are hoping for a miracle. The law tends to rule in favor of such parents, regardless of their child’s circumstances. This trend can be seen in a case reported by Dena S. Davis in “Legal Trends in Bioethics,” in which a federal judge ruled to maintain the life of