The Rapid Ethical Decisionmaking Model: Critical Medical Interventions in Resource-Poor Environments

Applying bioethical principles can be difficult in resource-poor environments, particularly for Western doctors unfamiliar with these limitations. The challenges become even greater when clinicians must make rapid critical decisions. As the following case in Zambia illustrates, the Rapid Ethical Decisionmaking Model, long used in emergency medicine, is a useful tool in such circumstances.

Regulation and Ethics in Business: The Israeli Bank-Share Case

This article analyzes the early-1980s Israeli bank-share crash at different points of its development to demonstrate the vital contribution of managers' professional and personal ethical norms to a fruitful collaboration between government authorities and the business sector. After presenting the case and discussing pertinent problems of external versus internal business regulation, this article provides a phase model of ethical decisionmaking in business that reconstructs the moral problems faced by the major players and probes appropriate responses to these problems. The application of the model to the bank-share affair shows how different stages in the evolution of the crisis introduce different ethical problems, inviting different moral considerations and calling for different solutions.

Changing Economics and Clinical Ethical Decisionmaking: A View from the Trenches

There is good news, and there is bad news. The good news is that in my experience, younger physicians generally are much more concerned about the cost of clinical tests and treatments, and about justly distributing finite medical resources, than were those who practiced medicine in the fee-for-service era. The bad news has at least three components. First, with respect to medically nonbeneficial treatment in the ICU, managed care has not yet given evidence of wanting to put the brakes on unrealistic family demands for aggressive medical interventions. Second, managed care is frustrating many healthcare professionals as well as patients. And third, managed care has no apparent interest in addressing, and may even have contributed to, the problem of medical indigence. Let me develop these propositions more fully.