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Ethical issues that arise in the care of pregnant women are challenging to physicians, especially in critical care situations. By familiarizing themselves with the concepts of medical ethics in obstetrics, physicians will become more capable of approaching complex ethical situations with a clear and structured framework. This review discusses ethical approaches regarding 3 specific scenarios: (1) the life of the fetus versus the life of the mother and situations of questionable maternal decision making; (2) withdrawal of care in a brain-dead pregnant patient; and (3) domestic violence and the pregnant patient.

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Although the use of cochlear implants as a treatment designed to help deaf individuals hear has a relatively brief history, the use of this therapy has given rise to a number of ethical conflicts. This article identifies ethical conflicts in cochlear implantation therapy and shows how ethical principles that are commonly accepted in health care ethics may guide decision making in resolving these issues. Furthermore, clinicians are often confronted with particular cases in which ethical conflicts arise. A useful paradigm for the clinical context, the 4-box method, is offered as a means of organizing the facts of a "case" so that the important facts are considered, and a principled approach to decision making can be used in working toward a resolution.

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Chaplains serving in the health care context provide a ministry to dying patients of inestimable worth as they comfort patients in the last chapter of the journey by being present, listening, and caring. Chaplains also play another important role, helping patients clarify ways in which their beliefs and values might influence health care decisions. This paper reviewed the current trends of spiritual diversity alongside the aging of a large Baby Boomer cohort. Chaplains may be challenged as they participate in the decision-making process, or as they support familes who make decisions about the care of loved ones nearing the end of life. Many of those who seek health care and comfort as the end of life approaches will bring a startling diversity of nonbelief, beliefs, and diverse religious and spiritual practices. This pattern of diversity will profoundly affect patients' decision-making around end-of-life issues. Case studies are used to illustrate possibilities for the chaplain's role at the bedside in the face of such diversity. The dimensional information of a new scale is presented for chaplains to assess diverse afterlife beliefs. As chaplains renew their studies of the worlds living religions, they will be better equipped to serve the needs of this large and spiritually diverse population.

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CONTEXT: There is evidence of significant career dissatisfaction among practicing physicians and those considering medicine as a profession. Most research on career satisfaction has examined practicing physicians. This study was undertaken to look at determinants of satisfaction in those at the earliest stage of their medical careers - medical students. METHODS: As part of a larger study, students comprising one class at the University of Washington School of Medicine were surveyed three times over the course of their medical education. For the present study we examined measures specifically related to determinants of career satisfaction. FINDINGS: Over time, students' sense of the importance of most measured determinants of satisfaction showed significant change, the majority of which were in the direction of decreased importance. However, most of the change was relative. That is, factors that students considered to be most important at the start of medical school continued to be most important throughout the educational experience and those factors students considered to be least important at Year 1 continued to be least important at Years 2 and 4. DISCUSSION: These findings have implications for medical education, a time when students are forming expectations that will impact their career satisfaction. In addition to information on career satisfaction, students should understand the professional values of medicine, their own values and expectations, current practice patterns, economics, and the role of advocacy.

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A 3-day-old infant unexpectedly developed cardiopulmonary arrest at home. A resuscitation process was initiated and the infant was transported to a nearby community hospital where a highly respected senior pediatrician assumed responsibility for the prolonged resuscitation. Following cessation of aggressive support measures, the infant resumed gasping/respiratory efforts. The pediatrician admitted to occluding the infant's nose and mouth just before death. Several of the important medical issues and ethical distinctions are discussed.

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