Michael Welker | Eva Winkler | John Witte, Jr. | Stephen Pickard (Eds.): The Impact of Health Care (Leseprobe)

14 Eva C. Winkler and Michael Welker
tensions between their mission toensure their patients’ welfare, on one hand,
and their responsibility for cost-conscious decisions, on the other. Finally, she
illuminates the limitations of “appeals to individual ethos” and personal responsibility,
and she discusses the necessary embedding of the individual in institutional
ethics and the importance of decision-making above the patient-physician
level. She then proposes potentialguardrails for ethical decision-making in view
of cost considerations.
Günter Thomas begins with reflections onthe theological-historical background
of an ethos ofcaring for the sick in Christianity and beyond. This ethos
has often been considered in frameworks of person-to-person relations. This orientation,
however, has to be re-investigated today with respect to the social distribution
of values in health-care organizations. Thomas names the complexnetwork
of medical institutions, health insurers, public or government funding of
health care, the ethos of human actors and clinical staff, and the various expectations
of patients. How to orchestrate this complex network with its differing
value systems of orientation and the associated expectations? How to deal with
the problem that “organizedcommunities of solidarity must always be inclusive
and exclusive at the same time in order to function effectively”?
Thomas concludes with considerations on “orientational distress.” He asks
for religious, academic, and civil-societal contexts in which broader visions of a
good, fulfilled, and successful life can be discussed “without damaging the latent
protection in the health-care organization itself.” He argues for intensified discourses
between those who deal with religiously and ethically based value orientation
and those who deal with the ethical and practical challenges ofhealth
care in order to reduce orientational distress and prevent eventual burnout.
ChristineThomas specifies such challengeswith respect to the medical treatment
of elderly patients. She describes conflicts over apatient’s sovereignty of
interpretation and decision-making, conflicts between patients and their relatives
or younger generations, and conflicts also between patients and families,
on one hand, and medical and therapeutic practitioners, on the other. Abroad
spectrum of potential problems arises, from unrealistic demands for maximum
therapy to aresigned “nihilism” of frail patients or alaissez-faire attitude on the
part of the patient or relatives, but also from limitations in hospital financing
and mental and physical capacities of the medical and nursing staff.
She pleads to uphold the demands of ethical responsibility and acommunity
of solidarity, to “return to the principle of no harm” in medical practice and to
“initiatives such as ‘choosing wisely’” between overmedication and underuse.
She also argues for “targeted face-to-facecommunication between treatment providers
and patients” and the eventual “moderation of an ethics adviser.”
Part Two of this book turns to ethical challenges that come with advancing
medical research and techniques.