Between meaning and duty - leaders' uses and misuses of ethical arguments in generating engagement.

PubMed

Bøgeskov, Benjamin Olivares; Rasmussen, Lise Dam; Weinreich, Elvi

2017-03-01

To identify, record and determine from the perspective of an argumentation theory whether and how nurse leaders use or possibly misuse ethical arguments to motivate and engage their staff when daily practice is affected by reforms. In some cases, health reforms based on New Public Management theories have met resistance, especially when perceived as contrary to nurses' professional and personal ethical values, creating a motivational challenge for nurse leaders. Qualitative thematic analysis and argumentation analysis based on personal interviews, focus group interviews and observations of nurse leaders and nurses in two different wards in a Danish hospital that has undergone structural and management reforms. Nurse leaders use ethical arguments to engage their staff, either by trying to make the reforms ethically meaningful or by appealing to duty when no meaning can be found. Occasionally, these ethical arguments are fallacious and inconclusive from an argumentation theory perspective. Using ethical arguments can motivate and engage staff, but it may also escalate conflicts. Managers and leaders must be aware that, if the argument is flawed, appealing to higher ethical values is not always beneficial. © 2016 John Wiley & Sons Ltd.

Toward an ethical eugenics: the case for mandatory preimplantation genetic selection.

PubMed

Appel, Jacob M

2012-01-01

Preimplantation genetic diagnosis offers the possibility of screening and terminating embryos with severe and life-threatening disabilities. This article argues that under certain conditions, the use of this technology is not merely desirable as a means to reduce human suffering but also an ethically required duty of a parent to a potential child.

Balancing the Duty to Treat Patients with Ebola Virus Disease with the Risks to Dialysis Personnel

PubMed Central

2015-01-01

In 2014, the author was invited to present at the American Society for Nephrology’s annual conference in Philadelphia on the ethics of treating patients with Ebola virus disease. The argument was made that the status of health care workers, including nephrologists, was the dominant ethical standard that generated both the duty to treat and the conflicts between this commitment and other ethical commitments that arise in public health emergencies. Conflicts between duty to treat and personal safety, duty to community, and duty to colleagues were illustrated, and suggestions for designing ethics into medical practice were given. This article is a summary of that presentation. PMID:26251324

Ionising radiation risk disclosure: When should radiographers assume a duty to inform?

PubMed

Younger, C W E; Douglas, C; Warren-Forward, H

2018-05-01

Autonomy is a fundamental patient right for ethical practice, and informed consent is the mechanism by which health care professionals ensure this right has been respected. The ethical notion of informed consent has evolved alongside legal developments. Under Australian law, a provider who fails to disclose risk may be found to be in breach of a duty of disclosure, potentially facing legal consequences if the patient experiences harm that is attributable to an undisclosed risk. These consequences may include the common law tort of negligence. Ionising radiation, in the form of a medical imaging examination, has the potential to cause harm. However, stochastic effects cannot be attributable to a specific ionising radiation event. What then is the role of the Australian medical imaging service provider in disclosing ionising radiation risk? The ethical and legal principles of informed consent, and the duty of information provision to the patient are investigated. These general principles are then applied to the specific and unusual case of ionising radiation, and what responsibilities apply to the medical imaging provider. Finally, the legal, professional and ethical duties of the radiographer to disclose information to their patients are investigated. Australian law is unclear as to whether a radiographer has a common law responsibility to disclose radiation risk. There is ambiguity as to whether stochastic ionising radiation risk could be considered a legal disclosure responsibility. While it is unlikely that not disclosing risk will have medicolegal consequences, doing so represents sound ethical practice. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Balancing the Duty to Treat Patients with Ebola Virus Disease with the Risks to Dialysis Personnel.

PubMed

Evans, Nicholas G

2015-12-07

In 2014, the author was invited to present at the American Society for Nephrology's annual conference in Philadelphia on the ethics of treating patients with Ebola virus disease. The argument was made that the status of health care workers, including nephrologists, was the dominant ethical standard that generated both the duty to treat and the conflicts between this commitment and other ethical commitments that arise in public health emergencies. Conflicts between duty to treat and personal safety, duty to community, and duty to colleagues were illustrated, and suggestions for designing ethics into medical practice were given. This article is a summary of that presentation. Copyright © 2015 by the American Society of Nephrology.

Ethical behavior of nurses in decision-making in Iran

PubMed Central

Ebrahimi, Hossein; Nikravesh, Mansoure; Oskouie, Fatemeh; Ahmadi, Fazlollah

2015-01-01

Background: Ethical caring is an essential in nursing practice. Nurses are confronted with complex situations in which they are expected to autonomously make decisions in delivering good care to patients. Although a wide range of studies have examined ethical behavior of nurses, there are still many issues requiring further investigation. The aim of this article is to describe the ethical behavior of nurses in decision-making in patients’ care in Iran. Materials and Methods: This study was conducted through grounded theory method. Participants were 17 Iranian nurses, employed in Tabriz University of Medical Sciences hospitals. Unstructured, semi-structured, and in-depth interviews were used for data gathering. Interviews were transcribed and coded according to Strauss and Corbin method in open, axial, and selective coding. Results: Nurses showed three major approaches in ethical behavior: Beyond the legal duty and protection of the patients, which includes dedication and full availability to nurses’ job and the client, spending time for the patients and delayed exit from the workplace, and arbitrary practice; legal duty and the protection of patients and nurses, which includes caretaking for the patient, responding to the client, and implementing the physician's prescription; and below the legal duty and the protection of one's self, that is, finding evidence and having witness in case of false documentation, and shortcoming, negligence, and mistake. Conclusions: Because of the importance of the ethical behavior of nurses in decision-making, it is necessary to find ways to promote moral reasoning and moral development of nurses. Empowerment of nurses, nurse educators, and nursing students to acquire knowledge and develop ethical behavior skills is important. PMID:25709704

The patient's duty to adhere to prescribed treatment: an ethical analysis.

PubMed

Resnik, David B

2005-04-01

This article examines the ethical basis for the patient's duty to adhere to the physician's treatment prescriptions. The article argues that patients have a moral duty to adhere to the physician's treatment prescriptions, once they have accepted treatment. Since patients still retain the right to refuse medical treatment, their duty to adhere to treatment prescriptions is a prima facie duty, which can be overridden by their other ethical duties. However, patients do not have the right to refuse to adhere to treatment prescriptions if their non-adherence poses a significant threat to other people. This paper also discusses the use of written agreements between physicians and patients as a strategy for promoting patient adherence.

Ethics in independent nurse consulting: strategies for avoiding ethical quicksand.

PubMed

Creel, Eileen L; Robinson, Jennifer C

2010-11-01

Changes in health care have created a variety of new roles and opportunities for nurses in advanced practice. One of these changes is the increasing number of advanced practice nurses carrying out independent consultation. Differences in goals between business and health care may create ethical dilemmas for nurse consultants. The purpose of this article is to describe possible ethical pitfalls that nurse consultants may encounter and strategies to prevent or solve these dilemmas. Three themes related to nursing codes of ethics will be discussed: the duty to uphold human rights, the duty to fulfill commitments, and the duty to practice the profession competently.

Overview of psychiatric ethics V: utilitarianism and the ethics of duty.

PubMed

Robertson, Michael; Morris, Kirsty; Walter, Garry

2007-10-01

The aim of this paper is to describe the ethical theories of utilitarianism and the ethics of duty (Kant's ethics) and to evaluate their value as theoretical bases of psychiatric ethics. Utilitarianism is a well-established moral philosophy and has significant instrumental value in dealing with common ethical problems faced by psychiatrists. Despite its capacity to generate solutions to ethical problems, utilitarianism requires a process of what Rawls described as 'reflective equilibrium' to avoid morally repugnant choices, based on utility. The criticisms of utilitarianism, such as the problems of quantifying utility and the responsibility for consequences, are very relevant for psychiatry. Singer's model of utilitarian thinking is particularly problematic for our profession. Kant's ethics provides the pretext for duty bound codes of ethics for psychiatrists, but suffers from problems of flawed claims to the universalizability prescribed by Kant's 'categorical imperative'. Kant's valorization of reason as the core of the autonomy of persons is a valuable insight in understanding psychiatrists' ethical obligations to their patients.

Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective.

PubMed

Pandit, M S; Pandit, Shobha

2009-07-01

A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses to bring relief to his medical problem. The relationship takes the shape of a contract retaining the essential elements of tort. A doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. The doctor has a duty to obtain prior informed consent from the patient before carrying out diagnostic tests and therapeutic management. The services of the doctors are covered under the provisions of the Consumer Protection Act, 1986 and a patient can seek redressal of grievances from the Consumer Courts. Case laws are an important source of law in adjudicating various issues of negligence arising out of medical treatment.

The case of H.S.: the ethics of reporting alcohol dependence in a bus driver.

PubMed

Karol, David E; Schuermeyer, Isabel N; Brooker, Craig A

2007-01-01

The physician's duty to preserve patient confidentiality is challenged when doing so may endanger third parties. We present the case of a bus driver whose alcohol dependence raised concerns of a risk not only to his own health and safety, but to public safety as well. We first examine the legal and ethical obligations to report his alcohol use to his employer and then stress the importance of weighing the potential harm of violating patient-physician confidentiality against the severity of risk to the general public.

Clinical negligence and duty of candour.

PubMed

Shekar, Vinita; Singh, Mark; Shekar, Kishore; Brennan, Peter

2011-12-01

The Department of Health is considering imposing a legal duty of candour on health care providers to ensure that an apology and explanation are given to patients when errors occur during medical treatment. This aims to improve quality of care and reduce adverse events during medical treatment. We present the current system of clinical negligence and the future of medical ethics. We discuss relevant cases with regard to duty of candour, and highlight the existence of serious imbalances in which patients' rights and corresponding ethical duties of professionals predominate over the responsibilities of patients themselves. It is known that most adverse events arise because of multiple factors for which no individual should be blamed. To improve healthcare services there is a need for a system in which lessons can be learnt from mistakes, and services can be improved in the interest of patient safety, and for transparency in the broad principles on which the decisions are based within which clinical performance is supervised and monitored. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

F141. DUTY TO WARN FOR POTENTIAL RISK OF PSYCHOLOGICAL HARM: A CASE REPORT

PubMed Central

Zhand, Naista; Attwood, David

2018-01-01

Abstract Background Under the current ethical and legal standards physicians are expected to breach confidentiality when a third party is at risk. However, the law has mainly focused on risk of bodily harm and there is no legal guidance on physicians’ responsibilty when it comes to risk of psychological harm to a potential targeted victim Methods This case report illustrates a clinical dilemma on duty to warn for mental health professionals. Results N/A Discussion This case report illustrates an unconventional perspective on a psychiatrist’s duty to warn: consideration of risk of psychological harm to the potential target of their patient. Psychological trauma can have a potential negative impact on victims, affecting their mental health and well being as well as their physical health. The ethicolegal dilemma discussed in this case has implications for policies related to the care of psychiatric patients.

A Kantian ethics approach to moral bioenhancement.

PubMed

Carter, Sarah

2017-11-01

It seems, at first glance, that a Kantian ethics approach to moral enhancement would tend towards the position that there could be no place for emotional modulation in any understanding of the endeavour, owing to the typically understood view that Kantian ethics does not allow any role for emotion in morality as a whole. It seems then that any account of moral bioenhancement which places emotion at its centre would therefore be rejected. This article argues, however, that this assumption is incorrect. Given later writings by Kant on the role of sympathy, and taking into account other concerns in Kantian ethics (such as bodily integrity), it may in fact be the case that Kantian ethics would allow for an account of moral bioenhancement through emotional modulation, and that in some (rare) cases such an intervention might even be considered to be a duty. © 2017 The Authors Bioethics Published by John Wiley & Sons Ltd.

A Kantian ethics approach to moral bioenhancement

PubMed Central

2017-01-01

Abstract It seems, at first glance, that a Kantian ethics approach to moral enhancement would tend towards the position that there could be no place for emotional modulation in any understanding of the endeavour, owing to the typically understood view that Kantian ethics does not allow any role for emotion in morality as a whole. It seems then that any account of moral bioenhancement which places emotion at its centre would therefore be rejected. This article argues, however, that this assumption is incorrect. Given later writings by Kant on the role of sympathy, and taking into account other concerns in Kantian ethics (such as bodily integrity), it may in fact be the case that Kantian ethics would allow for an account of moral bioenhancement through emotional modulation, and that in some (rare) cases such an intervention might even be considered to be a duty. PMID:28873235

Is the patient's right to die evolving into a duty to die?: Medical decision making and ethical evaluations in health care.

PubMed

Sprung, C L; Eidelman, L A; Steinberg, A

1997-02-01

When patient or family requests for continued life-sustaining treatments conflict with doctor recommendations, different conclusions as to what is beneficial for the patient may arise. Past practices usually accepted patient or family requests based on the principle of autonomy or that the doctor's primary responsibility is to the individual patient. Many patients die in intensive care units after doctors forego life-prolonging interventions. Health care changes and cost containment have led to a change in the classical ethical model of the patient-doctor relationship such that concerns for societal requirements increasingly overrule those for individual patient needs. The ability to keep patients alive with little likelihood of recovery and the recognition of escalating health costs have led to calls for the needs of society and distributive justice to be taken into account. A tendency to justify a duty to die for these patients has arisen. Recent legal decisions in cases with conflicts between families and health care providers and institutions over foregoing life-sustaining therapies have decided for the families against doctors and hospitals, compelling institutions and their staff to act contrary to their ethical views. Value judgments of doctors are sometimes confused with medical indications for therapy. Doctors have defined therapies as futile or non-beneficial based on their own values and even withdrawn life-sustaining treatments without patient or family input. In some cases, the right to die is leading to the duty to die even against patient or surrogate wishes. Such observations indicate the need for rigorous analyses of medical decision making in this context and for ethical evaluations in health care in general.

Are Military and Medical Ethics Necessarily Incompatible? A Canadian Case Study.

PubMed

Rochon, Christiane; Williams-Jones, Bryn

2016-12-01

Military physicians are often perceived to be in a position of 'dual loyalty' because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics (i.e., medical and military), each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different.

Ethical proceedings against dentists in Espírito Santo for infringements to the code of dental ethics.

PubMed

Santos Pacheco, Karina Tonini dos; Silva Junior, Manoelito Ferreira; Meireles, Naiara Ribeiro

2014-01-01

Just like any other profession, dentistry requires ethical and moral responsibilities that must be fulfilled, and the duty of every professional is to meet his obligations under the law. In light of the Código de Ética Odontológica (CEO-Code of Dental Ethics), this research aims to expound on the ethical violations committed by dentists in their practice, according to the ethical review process proposed by the Conselho Regional de Odontologia do Estado do Espírito Santo (CRO/ES-Regional Council of Dentistry of the State of Espírito Santo). The study is both retrospective and descriptive, using a quantitative approach. Data collection comprised all the ethical proceedings filed at the CRO/ES, between the years 2000 and 2011. Considering the 529 cases examined, the most frequent reason for infringement was illicit advertising (39.7%), followed by technical error (18.7%), irregular registration (16.8%), patient/professional relationship (11.3%) tax lien foreclosure (6.6%), professional/professional relationship (4.0%), irregular/illegal cover up practice (0.9%), consumer relations (0.8%), failure to provide care (0.6%), false certification (0.4%), and disrespect for authority and colleagues (0.2%). Most (59.2%) of the dental surgeons (DSs) involved were male, 35.5% were between 31 and 40 years of age, 85.8% had graduated over five (5) years prior, and 73.2% were general practitioners. Only 22 (4.2%) cases went to trial, resulting in 8 (36.4%) acquittals and 14 (63.6%) convictions. The most commonly applied penalties were private warning+pecuniary penalty (8 or 57.1%). It was concluded that the CEO must be followed with more discipline, and that professionals should seek information about their duties and obligations under the law, on behalf of patient welfare.

Ethical challenges in everyday practice for healthcare lawyers.

PubMed

Taylor, L D; Pomerance, P L

2001-01-01

A lawyer representing healthcare clients confronts numerous ethical issues in day-to-day practice. The authors, practicing healthcare attorneys, first give a quick overview of the history of today's rules of legal ethics, and then turn to hypothetical (but realistic) scenarios to examine counsel's duties under various circumstances. The Article concludes with an examination of the overriding duties of confidentiality and privilege, which guide the analysis of ethical concerns in all areas.

On pandemics and the duty to care: whose duty? who cares?

PubMed Central

Ruderman, Carly; Tracy, C Shawn; Bensimon, Cécile M; Bernstein, Mark; Hawryluck, Laura; Shaul, Randi Zlotnik; Upshur, Ross EG

2006-01-01

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. PMID:16626488

Ethical issues in field research: balancing competing values.

PubMed

O'Neill, P

1990-04-01

An ethical issue becomes a dilemma when the psychologist is pulled in different directions by competing values. This paper will focus on the conflict between experimental and ethical values inherent in field research. The problem has special significance in community psychology, which gives priority to studying, in natural settings, those affected by social problems. An example is given of research that required observation of family interaction in the homes of convicted child abusers. The case demonstrates that the value of ecological validity often conflicts with the need to protect privacy and obtain uncoerced consent. Other ethical constraints, including the duty to report lawbreaking and to protect the public from harm, may threaten research validity.

Patient experience in the emergency department: inconsistencies in the ethic and duty of care.

PubMed

Moss, Cheryle; Nelson, Katherine; Connor, Margaret; Wensley, Cynthia; McKinlay, Eileen; Boulton, Amohia

2015-01-01

To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Qualitative description of interview data (stage 3 of a multimethod study). The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Findings carry implications for emergency department care of people who present on multiple occasions and for emergency department health professionals to increase awareness of their moral comportment in care. © 2014 John Wiley & Sons Ltd.

The emergence of an ethical duty to disclose genetic research results: international perspectives.

PubMed

Knoppers, Bartha Maria; Joly, Yann; Simard, Jacques; Durocher, Francine

2006-11-01

The last decade has witnessed the emergence of international ethics guidelines discussing the importance of disclosing global and also, in certain circumstances, individual genetic research results to participants. This discussion is all the more important considering the advent of pharmacogenomics and the increasing incidence of 'translational' genetic research in the post-genomic era. We surveyed both the literature and the ethical guidelines using selective keywords. We then analyzed our data using a qualitative method approach and singled out countries or policies that were representative of certain positions. From our findings, we conclude that at the international level, there now exists an ethical duty to return individual genetic research results subject to the existence of proof of validity, significance and benefit. Even where these criteria are met, the right of the research participant not to know also has to be taken into consideration. The existence of an ethical duty to return individual genetic research results begs several other questions: Who should have the responsibility of disclosing such results and when? To whom should the results be disclosed? How? Finally, will this ethical 'imperative' become a legally recognized duty as well?

Ethical principles and concepts in medicine.

PubMed

Taylor, Robert M

2013-01-01

Clinical ethics is the application of ethical theories, principles, rules, and guidelines to clinical situations in medicine. Therefore, clinical ethics is analogous to clinical medicine in that general principles and concepts must be applied intelligently and thoughtfully to unique clinical circumstances. The three major ethical theories are consequentialism, whereby the consequences of an action determine whether it is ethical; deontology, whereby to be ethical is to do one's duty, and virtue ethics, whereby ethics is a matter of cultivating appropriate virtues. In the real world of medicine, most people find that all three perspectives offer useful insights and are complementary rather than contradictory. The most common approach to clinical ethical analysis is principlism. According to principlism, the medical practitioner must attempt to uphold four important principles: respect for patient autonomy, beneficence, nonmaleficence, and justice. When these principles conflict, resolving them depends on the details of the case. Alternative approaches to medical ethics, including the primacy of beneficence, care-based ethics, feminist ethics, and narrative ethics, help to define the limitations of principlism and provide a broader perspective on medical ethics. © 2013 Elsevier B.V. All rights reserved.

Ethics and high-value care.

PubMed

DeCamp, Matthew; Tilburt, Jon C

2017-05-01

High-value care (HVC) is en vogue, but the ethics of physicians' roles in the growing number of HVC recommendations demands further attention. In this brief report, we argue that, from the standpoint of individual physicians' primary commitments and duties to individual patients, not all HVC is ethically equal. Our analysis suggests that the ethical case for HVC may be both stronger and weaker than is ordinarily supposed. In some cases, HVC is not merely a 'good thing to do' but is actually ethically obligatory. In others, it is merely permissible-or even ethically suspect. More importantly, we suggest further that understanding HVC as ethically 'obligatory, permissible, or suspect' has implications for the design and implementation of strategies that promote HVC. For example, it questions the use of adherence to certain HVC recommendations as a physician performance metric, which may already be occurring in some contexts. Properly construed, ethics does not threaten HVC but can instead help shape HVC in ways that preserve the fundamental values of the medical profession. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Whither Utility and Duty? A Case for Virtue in Community College Administration

ERIC Educational Resources Information Center

Propheter, Geoffrey; Jez, Su Jin

2012-01-01

Recent improprieties by community college administrators have scarred the public trust. Efforts to secure against maladministration are firmly rooted in utilitarian and deontological ethics. In this article, the authors argue that these common approaches cannot remedy maladministration in the community college because utilitarianism and deontology…

The pre-employment medical--ethical dilemmas for GPs.

PubMed

Thuraisingham, Chandramani; Nalliah, Sivalingam

2013-04-01

In many workplaces, employment is conditional on a successful pre-employment medical examination. This examination is usually conducted by a general practitioner on the employers' panel of approved clinics or by an in-house company doctor. This article uses a case study to illustrate some of the ethical dilemmas that may be faced by GPs in the course of performing a pre-employment medical examination. Ethical issues discussed in this article include: Is it ethical for employers (based on physicians' reports) to select workers based on 'absence of illness' rather than 'fitness for work'? Should physicians divulge the illness of potential workers to third parties? What are the boundaries of a clinician's duty of care in the pre-employment medical examination setting?

Legal, ethical and professional aspects of duty of care for nurses.

PubMed

Dowie, Iwan

2017-12-13

Duty of care is a fundamental aspect of nursing, and many nurses consider this to be an important part of their professional duties as a nurse. However, the legal underpinnings of duty of care are often overlooked, and, as such, nurses may be unsure about when to act if they encounter emergency situations or serious incidents, especially when they are off duty. This article examines the legal, ethical and professional aspects of duty of care, what these mean for nurses in practice, and how duty of care is intrinsically linked with standards of care and negligence. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Morality, ethics, and law: introductory concepts.

PubMed

Horner, Jennifer

2003-11-01

The purpose of this article is to differentiate morality, ethics, and law. Morality refers to a set of deeply held, widely shared, and relatively stable values within a community. Ethics as a philosophical enterprise involves the study of values, and the justification for right and good actions, as represented by the classic works of Aristotle (virtue ethics), Kant (duty-based ethics), and Bentham and Mill (utilitarian and consequentialist ethics). Applied ethics, in contrast, is the use of ethics principles (e.g., respect for autonomy, beneficence, and nonmaleficence, justice) in actual situations, such as in professional and clinical life. Finally, law is comprised of concrete duties established by governments that are necessary for maintaining social order and resolving disputes, as well as for distributing social resources according to what people need or deserve.

Legal Briefing: Mandated Reporters and Compulsory Reporting Duties.

PubMed

Pope, Thaddeus Mason

2016-01-01

This issue's "Legal Briefing" column, one product of a Greenwall Foundation grant, reviews recent developments concerning compulsory reporting duties. Most licensed clinicians in the United States are "mandated reporters." When these clinicians discover certain threats to the safety of patients or the public, they are legally required to report that information to specified government officials. Over the past year, several states have legislatively expanded the scope of these reporting duties. In other states, new court cases illustrate the vigorous enforcement of already existing duties. I have organized all these legal developments into the following eight categories: 1. Overview of Mandatory Reporting Duties 2. Controversy over the Benefits of Mandatory Reporting 3. New and Expanded Duties to Report 4. Criminal Penalties for Failing to Report 5. Civil Liability for Failing to Report 6. Disciplinary Penalties for Failing to Report 7. Legal Immunity for Good-Faith Reporting 8. Protection against Employers' Retaliation. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Ethics and the Military Profession. The Professional Ethic

DTIC Science & Technology

1978-08-01

told to turn out his men for a patrol that will probably be the last duty for most or a11 of them must comply. While definitions differ, most... Duty , by Brlg&dler General Scholtes; Honor, by Colonel Capps; The County’s Expectations, by Professor Gurland; You and the Profession of Arms, by...volunteer to assist in this instruction by notifying their Executive Officers« This duty allows cadets to see tactical officers participating in an

Lay people's interpretation of ethical values related to mass vaccination; the case of A(H1N1) vaccination campaign in the province of Quebec (French Canada).

PubMed

Massé, Raymond; Désy, Michel

2014-12-01

Pandemic influenza ethics frameworks are based on respect of values and principles such as regard for autonomy, responsibility, transparency, solidarity and social justice. However, very few studies have addressed the way in which the general population views these moral norms. (i) To analyse the receptiveness of the population of French-speaking Quebecers to certain ethical principles promoted by public health authorities during the AH1N1 vaccination campaign. (ii) To add to the limited number of empirical studies that examine the population's perception of ethical values. Eight months after the end of the AH1N1 vaccination campaign in the Province of Quebec (Canada), 100 French-speaking Quebecers were assembled in ten focus groups. Discussions focussed on the level of respect shown by public health authorities for individual autonomy, the limits of appeals for solidarity, the balance between vaccination efficiency and social justice towards non-prioritized subpopulations, vaccination as a demonstration of civic duty and social responsibility. The population acknowledged a high level of individual responsibility towards family members and agreed to vaccination to protect children and ageing parents. However, the concepts of civic duty and solidarity did not elucidate unanimous support, despite the fact that social justice stood out as a dominant value of public morals. The ethical principles promoted in influenza pandemic ethics frameworks are subject to reinterpretation by the population. An ethic of public health must consider their understanding of the fundamental values that legitimize mass vaccination. © 2012 John Wiley & Sons Ltd.

Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care.

PubMed

Grigorovich, Alisa; Kontos, Pia

2018-03-19

Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.

Should a psychiatrist report a bus driver's alcohol and drug abuse? An ethical dilemma.

PubMed

Leeman, C P; Cohen, M A; Parkas, V

2001-01-01

Denial of alcohol or drug abuse, and of its possible consequences, can complicate medical and psychiatric care. We present the case of an HIV-positive bus driver with substance abuse who initially denied ongoing use of alcohol and of other drugs, but later admitted to both. The psychiatrist's duty to protect the patient's confidentiality, coupled with concerns about public safety, created an ethical dilemma. In discussing this dilemma we stress the importance of preserving confidentiality, both to facilitate treatment and also to further the safety of others.

An analytic approach to resolving problems in medical ethics.

PubMed Central

Candee, D; Puka, B

1984-01-01

Education in ethics among practising professionals should provide a systematic procedure for resolving moral problems. A method for such decision-making is outlined using the two classical orientations in moral philosophy, teleology and deontology. Teleological views such as utilitarianism resolve moral dilemmas by calculating the excess of good over harm expected to be produced by each feasible alternative for action. The deontological view focuses on rights, duties, and principles of justice. Both methods are used to resolve the 1971 Johns Hopkins case of a baby born with Down's syndrome and duodenal atresia. PMID:6234395

The man who claimed to be a paedophile

PubMed Central

Hill, S.

2000-01-01

A psychiatrist recounts a case of a man presenting with severe depression who claimed to have abused children and his pet dog. Clinical management of the case hinged on whether this claim was true, a lie or delusional. The uncertainty over this raised complex ethical dilemmas regarding confidentiality and protection of the public (and animals). Key Words: Paedophilia • confidentiality • duty to public • psychotic depression PMID:10786326

Kant's 'formula of humanity' and assisted reproductive technology: a case for duties to future children.

PubMed

Patrone, Tatiana

2017-11-01

The paper asks the question whether Kant's ethical theory can be applied to issues in assisted reproductive technology (ART). It argues against three objections to applying Kant's ethics to ART: (i) the non-identity objection, (ii) the gen-ethics objection, and (iii) the care-ethics objection. After showing that neither of the three objections is sufficiently persuasive the paper proposes a reading of Kant's 'formula of humanity,' and especially its negative clause (i.e., the 'merely as means' clause), that can be of some guidance in ART. The paper conclude that although Kant's 'formula of humanity' cannot be used as a simple litmus test for determining whether an ART practice is morally permissible or not, it nonetheless can supply us with some guidance in our moral deliberation.

Taking action on developmental toxicity: Scientists’ duties to protect children

PubMed Central

2012-01-01

Background Although adaptation and proper biological functioning require developmental programming, pollutant interference can cause developmental toxicity or DT. Objectives This commentary assesses whether it is ethical for citizens/physicians/scientists to allow avoidable DT. Methods Using conceptual, economic, ethical, and logical analysis, the commentary assesses what major ethical theories and objectors would say regarding the defensibility of allowing avoidable DT. Results The commentary argues that (1) none of the four major ethical theories (based, respectively, on virtue, natural law, utility, or equity) can consistently defend avoidable DT because it unjustifiably harms, respectively, individual human flourishing, human life, the greatest good, and equality. (2) Justice also requires leaving “as much and as good” biological resources for all, including future generations possibly harmed if epigenetic change is heritable. (3) Scientists/physicians have greater justice-based duties, than ordinary/average citizens, to help stop DT because they help cause it and have greater professional abilities/opportunities to help stop it. (4) Scientists/physicians likewise have greater justice-based duties, than ordinary/average citizens, to help stop DT because they benefit more from it, given their relatively greater education/consumption/income. The paper shows that major objections to (3)-(4) fail on logical, ethical, or scientific grounds, then closes with practical suggestions for implementing its proposals. Conclusions Because allowing avoidable DT is ethically indefensible, citizens---and especially physicians/scientists---have justice-based duties to help stop DT. PMID:22963689

Taking action on developmental toxicity: scientists' duties to protect children.

PubMed

Shrader-Frechette, Kristin

2012-09-10

Although adaptation and proper biological functioning require developmental programming, pollutant interference can cause developmental toxicity or DT. This commentary assesses whether it is ethical for citizens/physicians/scientists to allow avoidable DT. Using conceptual, economic, ethical, and logical analysis, the commentary assesses what major ethical theories and objectors would say regarding the defensibility of allowing avoidable DT. The commentary argues that (1) none of the four major ethical theories (based, respectively, on virtue, natural law, utility, or equity) can consistently defend avoidable DT because it unjustifiably harms, respectively, individual human flourishing, human life, the greatest good, and equality. (2) Justice also requires leaving "as much and as good" biological resources for all, including future generations possibly harmed if epigenetic change is heritable. (3) Scientists/physicians have greater justice-based duties, than ordinary/average citizens, to help stop DT because they help cause it and have greater professional abilities/opportunities to help stop it. (4) Scientists/physicians likewise have greater justice-based duties, than ordinary/average citizens, to help stop DT because they benefit more from it, given their relatively greater education/consumption/income. The paper shows that major objections to (3)-(4) fail on logical, ethical, or scientific grounds, then closes with practical suggestions for implementing its proposals. Because allowing avoidable DT is ethically indefensible, citizens---and especially physicians/scientists---have justice-based duties to help stop DT.

A case report of embryo donation: ethical and clinical implications for psychologists.

PubMed

Rizk, Marianne; Pawlak, Stacey

2016-10-01

Third-party reproduction is a growing field, and an increasing body of literature considers the ethics of embryo donation. Due to the psychosocial complexities that generally accompany the donation and/or use of donor embryos, psychologists can play a pivotal role in these specialised fertility cases. While laws in the USA are in place to regulate the medical procedures involved in embryo donation, only unenforceable guidelines exist for psychologists specialising in fertility cases. The presentation of this case study aims to: (1) clarify the ethical concerns that fertility psychologists should consider in similar situations by assessing whether American Society of Reproductive Medicine (ASRM) and the American Psychological Association (APA) guidelines compete or complement one another within this case of embryo donation and (2) consider the interests, obligations and rights of all parties involved. Several principles, standards and guidelines that must be considered are described. Overall, the APA Ethics Code and the ASRM Guidelines appear to complement one another for most aspects of this case. Fertility psychologists should consider the clinical implications of the interests, rights and duties of all involved parties, including themselves. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Linking biomedical engineering ethics case study approach and policy.

PubMed

Dibrell, William; Dobie, Elizabeth Ann

2007-01-01

In this paper we link bioengineering case study methods to the development of policy. The case study approach to ethics is an excellent way to show the complex nature of practical/moral reasoning. This approach can, however, lead to a kind of overwhelming complexity. The individual nature of each case makes it difficult to identify the most important information and difficult to see what moral considerations are most relevant. In order to make the overwhelming complexity less debilitating, we present a framework for moral decision making derived from suggestions made by W.D. Ross and Virginia Held. Ross articulates the multiple sources of morality and Held deepens the discussion by reminding us of the foundational importance of care and sympathy to our moral natures. We show how to use the notion of prima facie duty and discuss moral conflict. In doing this, we show how the framework, applied to cases, can be of assistance in helping us develop policies and codes of ethics with sufficient plasticity to be useful in the complex world of the bioengineer.

Law and ethics in conflict over confidentiality?

PubMed

Dickens, B M; Cook, R J

2000-09-01

Ethical principles that require the preservation of patients' confidential information are reinforced by principles found in several areas of law, such as law on contracts, negligence, defamation and fiduciary duty. However, laws sometimes compel disclosures of medical confidences, and more often may justify or excuse disclosures. Legally contentious issues concern patients' confidences regarding possible unlawful conduct, such as pregnancy termination, and the risk of spread of HIV and other infections. This article reviews the various legal bases of the duty of confidentiality, and legal challenges to the ethical obligation of non-disclosure. It addresses the justifications and limits of exchange of patients' health information among healthcare professionals and trainees, and considers legally recognized limits of confidential duties, and the scope of legitimate disclosure. An underlying theme is how to determine whether physicians are ethically justified in employing the discretion the law sometimes affords them to breach patients' expectations of confidentiality.

Pandemic influenza: human rights, ethics and duty to treat.

PubMed

Pahlman, I; Tohmo, H; Gylling, H

2010-01-01

The 2009 influenza A/H1N1 pandemic seems to be only moderately severe. In the future, a pandemic influenza with high lethality, such as the Spanish influenza in 1918-1919 or even worse, may emerge. In this kind of scenario, lethality rates ranging roughly from 2% to 30% have been proposed. Legal and ethical issues should be discussed before the incident. This article aims to highlight the legal, ethical and professional aspects that might be relevant to anaesthesiologists in the case of a high-lethality infectious disease such as a severe pandemic influenza. The epidemiology, the role of anaesthesiologists and possible threats to the profession and colleagueship within medical specialties relevant to anaesthesiologists are reviewed. During historical plague epidemics, some doctors have behaved like 'deserters'. However, during the Spanish influenza, physicians remained at their jobs, although many perished. In surveys, more than half of the health-care workers have reported their willingness to work in the case of severe pandemics. Physicians have the same human rights as all citizens: they have to be effectively protected against infectious disease. However, they have a duty to treat. Fair and responsible colleagueship among the diverse medical specialties should be promoted. Until disaster threatens humanity, volunteering to work during a pandemic might be the best way to ensure that physicians and other health-care workers stay at their workplace. Broad discussion in society is needed.

Exploring the potential duty of care in clinical genomics under UK law

PubMed Central

Mitchell, Colin; Ploem, Corrette; Chico, Victoria; Ormondroyd, Elizabeth; Hall, Alison; Wallace, Susan; Fay, Michael; Goodwin, Deirdre; Bell, Jessica; Phillips, Simon; Taylor, Jenny C.; Hennekam, Raoul; Kaye, Jane

2017-01-01

Genome-wide sequencing technologies are beginning to be used in projects that have both clinical diagnostic and research components. The clinical application of this technology, which generates a huge amount of information of varying diagnostic certainty, involves addressing a number of challenges to establish appropriate standards. In this article, we explore the way that UK law may respond to three of these key challenges and could establish new legal duties in relation to feedback of findings that are unrelated to the presenting condition (secondary, additional or incidental findings); duties towards genetic relatives as well as the patient and duties on the part of researchers and professionals who do not have direct contact with patients. When considering these issues, the courts will take account of European and international comparisons, developing guidance and relevant ethical, social and policy factors. The UK courts will also be strongly influenced by precedent set in case law. PMID:28943725

Exploring the potential duty of care in clinical genomics under UK law.

PubMed

Mitchell, Colin; Ploem, Corrette; Chico, Victoria; Ormondroyd, Elizabeth; Hall, Alison; Wallace, Susan; Fay, Michael; Goodwin, Deirdre; Bell, Jessica; Phillips, Simon; Taylor, Jenny C; Hennekam, Raoul; Kaye, Jane

2017-09-01

Genome-wide sequencing technologies are beginning to be used in projects that have both clinical diagnostic and research components. The clinical application of this technology, which generates a huge amount of information of varying diagnostic certainty, involves addressing a number of challenges to establish appropriate standards. In this article, we explore the way that UK law may respond to three of these key challenges and could establish new legal duties in relation to feedback of findings that are unrelated to the presenting condition (secondary, additional or incidental findings); duties towards genetic relatives as well as the patient and duties on the part of researchers and professionals who do not have direct contact with patients. When considering these issues, the courts will take account of European and international comparisons, developing guidance and relevant ethical, social and policy factors. The UK courts will also be strongly influenced by precedent set in case law.

The Ethic of Community

ERIC Educational Resources Information Center

Furman, Gail C.

2004-01-01

This article proposes the concept of an ethic of community to complement and extend other ethical frames used in education e.g. the ethics of justice, critique, and care. Proceeding from the traditional definition of ethics as the study of moral duty and obligation, ethic of community is defined as the moral responsibility to engage in communal…

The analysis and resolution of ethical dilemmas.

PubMed

Macauley, Robert C

2013-01-01

Perhaps no other field of medicine illustrates the ethical dilemmas occasioned by the explosion of technology more than neurology. Many dilemmas which at first appear to be ethical, however, are actually biotechnical, informational, or interpersonal in nature. For those which are, indeed, ethical, a review of existing information and acquisition of additional data can often serve to identify the proper response. When the optimal course of action remains unclear, the comprehensive, structured approach described in this chapter is both philosophically rigorous and clinically relevant. It takes into account a variety of critical considerations - including rights, duties, consequences, virtues, and similar cases - while utilizing both inductive and deductive methods. The end result is the "least bad" of available options, or, at the very least, a practical response which preserves future options and avoids crucial mistakes. © 2013 Elsevier B.V. All rights reserved.

Educational Effects of Practical Education Using a Debate Exercise on Engineering Ethics

NASA Astrophysics Data System (ADS)

Takanokura, Masato; Hayashi, Shigeo

The educational effects of practical education using a debate exercise are investigated using questionnaires. For the group-work composed of discussion and debate, students understand thoroughly various engineering ethical topics, such as factors preventing ethical decision-making. Students enhance their abilities to make a rational and logical decision by themselves such as a judgment based on correct information. Mutual evaluation by students through group interaction elevates positive educational effects. However, students answer fewer questions related to the understanding of professional duties and cooperate social responsibility because of the group-work using failure cases. Students also show less progress in their abilities to communicate with others and to express their opinions to audiences. A more suitable number of group members solves the latter problem.

Professions as the conscience of society.

PubMed

Sieghart, P

1985-09-01

Ethics is no less of a science than any other. It has its roots in conflicts of interest between human beings, and in their conflicting urges to behave either selfishly or altruistically. Resolving such conflicts leads to the specification of rules of conduct, often expressed in terms of rights and duties. In the special case of professional ethics, the paramount rule of conduct is altruism in the service of a 'noble' cause, and this distinguishes true professions from other trades or occupations. If professional ethics come into conflict with national laws, the professional today can test the legitimacy of such laws by reference to internationally agreed legal standards in the field of human rights, and so help to perform the role of 'professions as the conscience of society'.

Doctors and patients.

PubMed

Gillon, R

1986-02-15

Gillon outlines some prima facie moral duties of physicians to patients that have emerged from his previous articles in a series on philosophical medical ethics. These duties follow from four general ethical principles--respect for autonomy, beneficence, non-maleficence, and justice--plus the self-imposed supererogatory duty of medical beneficence. From these principles the author derives such duties as providing adequate information and advice on treatment options, encouraging patient participation leading to informed decisions, maintaining competence and exposing incompetence, admitting errors, disclosing personal medico-moral standards, and acknowledging that other interests may occasionally supersede those of the individual patient. Gillon concludes that, where self interest conflicts with medical beneficence, the claim of medicine as a profession requires that the patient's interests take priority.

Refusal of care: the physician-patient relationship and decisionmaking capacity.

PubMed

Simon, Jeremy R

2007-10-01

Problems of refusal of care, among the most common ethical dilemmas in the emergency department, are also often the most difficult to resolve, pitting 2 conflicting duties, that of helping patients and that of respecting their autonomy, against each other. Using a case presentation as a backdrop, this article offers a practical approach to patients who refuse treatment, including assessment of decisionmaking capacity but emphasizing the role of trust, communication, and compromise in these cases.

A Qualitative Study of Paramedic Duty to Treat During Disaster Response.

PubMed

Smith, Erin; Burkle, Frederick; Gebbie, Kristine; Ford, David; Bensimon, Cécile

2018-04-10

Disasters place unprecedented demands on emergency medical services and can test paramedics personal commitment as health care professionals. Despite this challenge, guidelines and codes of ethics are largely silent on the issue, providing little to no guidance on what is expected of paramedics or how they ought to approach their duty to treat in the face of risk. The objective of this research is to explore how paramedics view their duty to treat during disasters. The authors employed qualitative methods to gather Australian paramedic perspectives. Our findings suggest that paramedic decisions around duty to treat will largely depend on individual perception of risk and competing obligations. A code of ethics for paramedics would be useful, but ultimately each paramedic will interpret these suggested guidelines based on individual values and the situational context. Coming to an understanding of the legal issues involved and the ethical-social expectations in advance of a disaster may assist paramedics to respond willingly and appropriately. (Disaster Med Public Health Preparedness. 2018;page 1 of 6).

Teaching Ethics to Pediatric Residents: A Literature Analysis and Synthesis.

PubMed

Martakis, K; Czabanowska, K; Schröder-Bäck, P

2016-09-01

Ethics education rarely exists in pediatric resident curricula, although ethical conflicts are common in the clinical practice. Ethics education can prepare residents to successfully handle these conflicts. We searched for methods in teaching ethics to clinical and especially pediatric residents, and identified recurring barriers to ethics teaching and solutions to overcome them. Literature from 4 electronic databases with peer-reviewed articles was screened in 3 phases and analyzed. The literature included papers referring to applied methods or recommendations to teaching ethics to clinical residents, and on a second level focusing especially on pediatrics. An analysis and critical appraisal was conducted. 3 231 articles were identified. 96 papers were included. The applied learning theory, the reported teaching approaches, the barriers to teaching ethics and the provided solutions were studied and analyzed. We recommend case-based ethics education, including lectures, discussion, individual study; regular teaching sessions in groups, under supervision; affiliation to an ethics department, institutional and departmental support; ethics rounds and consultations not as core teaching activity; recurring problems to teaching ethics, primarily deriving from the complexity of residential duties to be addressed in advance; teaching ethics preferably in the first years of residency. We may be cautious generalizing the implementation of results on populations with different cultural backgrounds. © Georg Thieme Verlag KG Stuttgart · New York.

Ethics in Health Care. Syllabus #1006.2.

ERIC Educational Resources Information Center

Fullen, Jim; Coverdale, Edna

A 12-week course in health care ethics offered by Central Ohio Technical College is described. Following a list of objectives, a week by week outline charts the following topics covered in the course: ethics in health, an introduction to ethics, utilitarianism and egoism (goal-based ethical theories), divine command and social law (duty-based…

Individual rights versus societal duties.

PubMed

Vermeersch, E

1999-10-29

In 'bioethics', the rights to self-determination and to informed consent of the patient are prerequisites to every medical decision: paternalism is no longer a justifiable attitude. Hence, it seems that compulsory vaccination is an unacceptable praxis. Even John Stuart Mill. however, took into account other values: e.g. the duty not to harm others. This article is dedicated to the analysis of the historical development of these values and to their relevance for the ethics of vaccination. The acceptability of coercion is upheld, but no clear-cut answers are given in general: in every case the pros and cons of coercion are to be weighed carefully against each other.

Avian flu pandemic - flight of the healthcare worker?

PubMed

Shabanowitz, Robert B; Reardon, Judith E

2009-12-01

One of the ethical issues identified in response to a possible pandemic is healthcare workers' duty to provide care during a communicable disease outbreak. Healthcare employees may be subject to a variety of work obligations under such conditions. Questions of duty to treat remain controversial, and debate continues as to the ethical articulation of a duty to treat. This study aimed to investigate opinions from healthcare workers themselves on the perceived duty to treat, and how they might respond to a severe avian flu pandemic. Using system-wide e-mail, we surveyed employees at our rural tertiary/quaternary care health system regarding their knowledge of our institution's pandemic planning policy and their willingness to work in the event of a virulent avian pandemic. Results (N=908) show that employees felt a responsibility for"duty to care." Over 60% disagreed that it was ethical to abandon the workplace during a pandemic. However, opinions also stated that employees wanted autonomy to decide whether or not to work (65%). When asked about volunteering, 79% would agree to volunteer, given some incentives and protective options, the most salient being protective equipment (with relative training for use) and infectious disease training. Our research demonstrated that the healthcare workers a tour institution voiced an earnest willingness to work in the event of an avian flu pandemic, if provided with the necessary input, protections and tools, and education. The use of an electronic methodology for dissemination of surveys allowed the low-cost solicitation of information from a vast proportion of the workforce with ease, providing the institutional ethics committee with the empirical data needed to articulate more meaningful,thoughtful, and robust suggestions for ethical pandemic planning.

Peeling Onions: Some Tools and a Recipe for Solving Ethical Dilemmas.

ERIC Educational Resources Information Center

Gordon, Joan Claire

1993-01-01

Presents a process for solving ethical dilemmas: define the problem; identify facts; determine values; "slice" the problem different ways--duties, virtues, rights, and common good; rank ethical considerations; consult colleagues; and take action. (SK)

Ethical dilemmas in geosciences. We can ask, but, can we ans?

NASA Astrophysics Data System (ADS)

Marone, Eduardo

2016-04-01

Philosophy tries to provide rules and principles enabling us to solve the ethical dilemmas we face in a wide sense, and, also, in particular fields as (geo)sciences. One alleged goal of ethics is to figure out how to solve ethical dilemmas. But, is it possible to solve such dilemmas? And what can we do if we cannot? An ethical dilemma is a problem that offers an alternative between two or more solutions, none of which proves to be fully acceptable in practice. Dilemmas arise because of conflict between the rightness or wrongness of the actions/means and the goodness or badness of the consequences/ends. They involve an apparent conflict between moral imperatives, in which to follow one would result in violating another. Can a geoscientist answer those dilemmas that appear in the exercise of his/her profession? Always? In some cases? Not at all? What if we cannot? Have we? As geoscientists, we hold the knowledge (our scientific principles), not perfect, thus fallible, and always subject to changes and improvements. If we have to do what is right, based on our principles, despite potentially bad consequences, then we have to be sure that the principle is an absolute true. But, are our scientific principles such a true? Deontological theories may deny that consequences are of any concern, provided the intention was a good one. However, if our principles are not perfect (and we know that): can we answer in one or other direction to geoethical dilemmas in good faith? Although, if a geoscientist action does usually go for the best consequences, sometimes bad consequences may be accepted. But, who have to decide to accept the bad consequences? If ethical dilemmas with a conflict between means and ends cannot simply be solved by a geoscientist, where is our duty? If there is no real solution to the conflict of the right with the good, in the sense that a solution usually seems to be expected, what has to be our professional attitude? When we have duties of omission and when duties of commission? The task of examining ethical dilemmas is a relatively recent issue in the 3K years old philosophy and, off course, just a "baby" in geosciences. But the time has arrived to better examine and rethink the challenge of answering and how to approach geoethical dilemmas.

School Counselor Advocacy: When Law and Ethics May Collide

ERIC Educational Resources Information Center

Stone, Carolyn B.; Zirkel, Perry A.

2010-01-01

Legal rules establish basic duties akin to the floor for acceptable behavior, whereas ethical codes represent aspirational standards for best practice. For school counselors, fulfilling both legal requirements and ethical principles may pose challenges that warrant careful consideration. This article outlines a legal/ethical conflict in the case…

Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot.

PubMed

Kirschen, Matthew P; Friedlander, Joel A

2012-10-01

This article presents the case of a 41-year-old airline pilot with benign paroxysmal positional vertigo who requests that his diagnosis not be disclosed to his commercial airline employer or his aviation medical examiner because it may result in the suspension of medical certification. The legal and ethical requirements for physicians reporting impaired pilots are discussed as well as practical recommendations for handling such situations. The argument is made that a physician's obligation to honor patient confidentiality should not take precedence over his or her duty to protect the safety and well-being of the airplane passengers and the general public. If the patient chooses not to self-report, a physician has an ethical obligation to report the patient's medical condition to the Federal Aviation Administration.

Professions as the conscience of society.

PubMed Central

Sieghart, P

1985-01-01

Ethics is no less of a science than any other. It has its roots in conflicts of interest between human beings, and in their conflicting urges to behave either selfishly or altruistically. Resolving such conflicts leads to the specification of rules of conduct, often expressed in terms of rights and duties. In the special case of professional ethics, the paramount rule of conduct is altruism in the service of a 'noble' cause, and this distinguishes true professions from other trades or occupations. If professional ethics come into conflict with national laws, the professional today can test the legitimacy of such laws by reference to internationally agreed legal standards in the field of human rights, and so help to perform the role of 'professions as the conscience of society'. PMID:4057214

From environmental to ecological ethics: toward a practical ethics for ecologists and conservationists.

PubMed

Minteer, Ben A; Collins, James P

2008-12-01

Ecological research and conservation practice frequently raise difficult and varied ethical questions for scientific investigators and managers, including duties to public welfare, nonhuman individuals (i.e., animals and plants), populations, and ecosystems. The field of environmental ethics has contributed much to the understanding of general duties and values to nature, but it has not developed the resources to address the diverse and often unique practical concerns of ecological researchers and managers in the field, lab, and conservation facility. The emerging field of "ecological ethics" is a practical or scientific ethics that offers a superior approach to the ethical dilemmas of the ecologist and conservation manager. Even though ecological ethics necessarily draws from the principles and commitments of mainstream environmental ethics, it is normatively pluralistic, including as well the frameworks of animal, research, and professional ethics. It is also methodologically pragmatic, focused on the practical problems of researchers and managers and informed by these problems in turn. The ecological ethics model offers environmental scientists and practitioners a useful analytical tool for identifying, clarifying, and harmonizing values and positions in challenging ecological research and management situations. Just as bioethics provides a critical intellectual and problem-solving service to the biomedical community, ecological ethics can help inform and improve ethical decision making in the ecology and conservation communities.

The ethics of contacting family members of a subject in a genetic research study to return results for an autosomal dominant syndrome.

PubMed

Taylor, Holly A; Wilfond, Benjamin S

2013-01-01

This case explores the ethical landscape around recontacting a subject's relatives to return genetic research results when the informed consent form signed by the original cohort of subjects is silent on whether investigators may share new information with the research subject's family. As a result of rapid advances in genetic technology, methods to identify genetic markers can mature during the life course of a study. In this case, the investigators identified the genetic mutation responsible for the disorder after a number of their original subjects had died. The researchers now have the ability to inform relatives of the subject about their risk of developing the same disease. Mark Rothstein, JD, from the University of Louisville School of Medicine, provides an overview of the medical/scientific, legal, and ethical issues underlying this case. Lauren Milner, PhD, and colleagues at Stanford University explore how the relationship between researcher and subject affect this debate. Seema Shah, JD, and colleagues at the National Institutes of Health and University of California, Los Angeles (UCLA) discuss whether and how requirements of the duty to warn are applicable in this case.

Ethics, law, and pain management as a patient right.

PubMed

Hall, John K; Boswell, Mark V

2009-01-01

Ethical and legal considerations in pain management typically relate to 2 issues. The first refers to pain management as a human right. The second involves the nature of the patient-physician relationship as it relates to pain management. Although pain physicians often like to think of pain management as a human right, it remains difficult to support this position as a point of law or as a matter of ethics. Medical organizations generally do not define pain management as a specific duty of the physician, apart from the provision of competent medical care. To date, neither law nor ethics creates a duty of care outside of the traditional patient-physician relationship. Absent a universal duty, no universal right exists. Pursuing pain management as a fundamental human right, although laudable, may place the power of the government in the middle of the patient-physician relationship. Despite apparent altruistic motives, attempts to define pain management as a basic human right could have unintended consequences, such as nationalization of medicine to ensure provision of pain management for all patients.

AIDS: Balancing Confidentiality and the Duty to Protect.

ERIC Educational Resources Information Center

Lynch, Sherry K.

1993-01-01

Explores legal and ethical responsibilities of counselors working with human immunodeficiency virus-infected students and reviews guidelines for making critical decisions involving these students. Court decisions, Kitchner's (1985) five ethical principles, and ethical standards of several professional associations are considered. (Author/NB)

Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

PubMed Central

Hernandez, Elein; Fawcett, Anne; Brouwer, Emily; Rau, Jeff

2018-01-01

Simple Summary Veterinarians have an ethical obligation to provide good care for the animals that they see in practice. However, at times, there may be conflicts between the interests of animal caregivers or owners, the interests of veterinarians and the interests of animals. We provide an overview of why and how veterinary ethics is taught to veterinary students, as well as providing a context for thinking about veterinary ethical challenges and animal welfare issues. We argue that veterinarians are ethically obliged to speak up and ask questions when problems arise or are seen and provide a series of clinical case examples in which there is scope for veterinarians to improve animal welfare by ‘speaking up’. Abstract Although expectations for appropriate animal care are present in most developed countries, significant animal welfare challenges continue to be seen on a regular basis in all areas of veterinary practice. Veterinary ethics is a relatively new area of educational focus but is thought to be critically important in helping veterinarians formulate their approach to clinical case management and in determining the overall acceptability of practices towards animals. An overview is provided of how veterinary ethics are taught and how common ethical frameworks and approaches are employed—along with legislation, guidelines and codes of professional conduct—to address animal welfare issues. Insufficiently mature ethical reasoning or a lack of veterinary ethical sensitivity can lead to an inability or difficulty in speaking up about concerns with clients and ultimately, failure in their duty of care to animals, leading to poor animal welfare outcomes. A number of examples are provided to illustrate this point. Ensuring that robust ethical frameworks are employed will ultimately help veterinarians to “speak up” to address animal welfare concerns and prevent future harms. PMID:29361786

[End-of-life care and end-of-life medical decisions: the ITAELD study].

PubMed

Miccinesi, Guido; Puliti, Donella; Paci, Eugenio

2011-01-01

To describe the attitudes towards end of life care and the practice of end-of-life medical decisions with possible life-shortening effect among Italian physicians. Cross sectional study (last death among the assisted patients in the last 12 months was considered). In the year 2007, 5,710 GPs and 8,950 hospital physicians were invited all over Italy to participate in the ITAELDstudy through anonymous mail questionnaire. Proportion of agreement with statements on end-of-life care issues. Proportion of deaths with an end-of-life medical decision. The response rate was 19.2%. The 65% of respondents agreed with the duty to respect any non-treatment request of the competent patient, the 55% agreed with the same duty in case of advanced directives, the 39% in case of proxy's request. The 53% of respondents agreed with the ethical acceptability of active euthanasia in selected cases. Among 1,850 deaths the 57.7% did not receive any end-of-life medical decision. For a further 21.0% no decision was possible, being sudden and unexpected deaths. In the remaining 21.3% at least one end-of-life medical decision was reported: 0.8% was classified as physician assisted death, 20.5% as non-treatment decision. Among all deceased the 19.6% were reported to have been deeply sedated. Being favourable to the use of opioids in terminal patients was associated to non-treatment decisions with possible but non-intentional life shortening effect; agreeing with the duty to fully respect any actual non-treatment request of the competent patient was associated to end-of life medical decisions with intentional life-shortening effect (adjusted OR>10 in both cases). The life stance and ethical beliefs of physicians determine their behaviour at the end of life wherever specific statements of law are lacking. Therefore education and debate are needed on these issues.

Compelling truth: legal protection of the infosphere against big data spills.

PubMed

Schafer, Burkhard

2016-12-28

The paper explores whether legal and ethical concepts that have been used to protect the natural environment can also be leveraged to protect the 'infosphere', a neologism used by Luciano Floridi to characterize the totality of the informational environment. We focus, in particular, on the interaction between allocation of (intellectual) property rights and 'communication duties', in particular, data breach notification duties.This article is part of the themed issue 'The ethical impact of data science'. © 2016 The Author(s).

[Biological risk in health. Risk to third parties: medical-legal focus. Responsible behavior of the competent physician].

PubMed

Rodriguez, Daniele

2010-01-01

The responsibility of the occupational physician (OP) is discussed within the particular topic of biological risk generated by health care workers (HCW) versus third parties in health care settings. The present contribution offers keys of interpretation regarding current Italian legislation and passed sentences, taking into account principles of occupational medicine, the ICOH code of ethics for occupational health professionals, as well as duties and tasks of OP, employers and employees. Most of the responsibilities stand on employers, but OP has a primary duty of information and to judge fitness for work. It is underlined the difficult interpretation of the current legislation and indications. Behaviour of the OP could be censored in case of particular fitness for work or in case of inadequate information, as well as if the comprehension of information is not verified or when indication to minimize the risk are not controlled.

Perception of and attitude toward ethical issues among Korean occupational physicians.

PubMed

Choi, Junghye; Suh, Chunhui; Lee, Jong-Tae; Lee, Segyeong; Lee, Chae-Kwan; Lee, Gyeong-Jin; Kim, Taekjoong; Son, Byung-Chul; Kim, Jeong-Ho; Kim, Kunhyung; Kim, Dae Hwan; Ryu, Ji Young

2017-01-01

Occupational physicians (OPs) have complex relationships with employees, employers, and the general public. OPs may have simultaneous obligations towards third parties, which can lead to variable conflicts of interests. Among the various studies of ethical issues related to OPs, few have focused on the Korean OPs. The aim of the present survey was to investigate the ethical contexts, the practical resolutions, and the ethical principles for the Korean OPs. An email with a self-administered questionnaire was sent to members of the Korean Society of Occupational and Environmental Medicine, comprising 150 specialists and 130 residents. The questionnaire was also distributed to 52 specialists and 46 residents who attended the annual meeting of the Korean Association of Occupational and Environmental Clinics in October 2015, and to 240 specialists by uploading the questionnaire to the online community 'oem-doctors' in February 2016. The responses to each question (perception of general ethical conflicts, recognition of various ethical codes for OPs, core professional values in ethics of occupational medicine, and a mock case study) were compared between specialists and residents by the chi-squared test and Fisher's exact test. Responses were received from 80 specialists and 71 residents. Most participants had experienced ethical conflicts at work and felt the need for systematic education and training. OPs suffered the most ethical conflicts in decisions regarding occupational health examination and evaluation for work relatedness. Over 60% of total participants were unaware of the ethical codes of other countries. Participants thought 'consideration of worker's health and safety' (26.0%) and 'neutrality' (24.7%) as the prominent ethical values in professionality ofoccupational medicine. In mock cases, participants chose beneficence and justice for fitness for work and confidential information acquired while on duty, and beneficence and respect for autonomy in pre-placement examinations. This study evaluated the current perception of and attitude toward ethical issues among the Korean OPs. These findings will facilitate the development of a code of ethics and the ethical decision-making program forthe Korean OPs.

[Medical ethical aspects of culture in social interactions with Muslim patients].

PubMed

Ilkilic, I

2007-07-30

In today's world, the plurality of values is considered to be a constitutive feature of modern societies. In these societies, transcultural patient-physician relationships are a part of daily medical practice. Culturally determined value systems can be crucial for understanding the perception of notions such as "health" and "illness", leading to fundamental differences in assessing medical interventions and therapeutic objectives. Therefore, transcultural conflicts of interest are presenting medical ethical decision-making with new challenges. Time and again, medical practice demonstrates that cultural differences between physician and patient are correlated with the complexity of medical ethical conflicts, as can be seen in the relationship between Muslim patients and non-Muslim physicians in the German health care system. This paper discusses some of the central issues in these relationships like communication, sense of shame, religious duties, and medical end-of-life decisions, analyzing some concrete cases. Subsequently, a number of medical ethical theses relevant for multicultural societies will be discussed.

Ethical Perspective on Quality of Care: The Nature of Ethical Dilemmas Identified by New Graduate and Experienced Speech Pathologists

ERIC Educational Resources Information Center

Kenny, Belinda J.; Lincoln, Michelle; Blyth, Katrina; Balandin, Susan

2009-01-01

Background: Speech pathologists are confronted by ethical issues when they need to make decisions about client care, address team conflict, and fulfil the range of duties and responsibilities required of health professionals. However, there has been little research into the specific nature of ethical dilemmas experienced by speech pathologists and…

47 CFR 19.735-105 - Availability of ethics and other conduct related regulations and statutes.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Availability of ethics and other conduct... ethics and other conduct related regulations and statutes. (a)(1) The Commission shall furnish each new employee, at the time of his or her entrance on duty, with a copy of: (i) The Standards of Ethical Conduct...

49 CFR 1103.11 - Standards of ethical conduct in courts of the United States to be observed.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 8 2011-10-01 2011-10-01 false Standards of ethical conduct in courts of the... PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.11 Standards of ethical conduct in courts of the United States to be observed. These canons further the purpose...

49 CFR 1103.11 - Standards of ethical conduct in courts of the United States to be observed.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Standards of ethical conduct in courts of the... PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.11 Standards of ethical conduct in courts of the United States to be observed. These canons further the purpose...

47 CFR 19.735-105 - Availability of ethics and other conduct related regulations and statutes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Availability of ethics and other conduct... ethics and other conduct related regulations and statutes. (a)(1) The Commission shall furnish each new employee, at the time of his or her entrance on duty, with a copy of: (i) The Standards of Ethical Conduct...

49 CFR 1103.11 - Standards of ethical conduct in courts of the United States to be observed.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 8 2014-10-01 2014-10-01 false Standards of ethical conduct in courts of the... PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.11 Standards of ethical conduct in courts of the United States to be observed. These canons further the purpose...

47 CFR 19.735-105 - Availability of ethics and other conduct related regulations and statutes.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Availability of ethics and other conduct... ethics and other conduct related regulations and statutes. (a)(1) The Commission shall furnish each new employee, at the time of his or her entrance on duty, with a copy of: (i) The Standards of Ethical Conduct...

47 CFR 19.735-105 - Availability of ethics and other conduct related regulations and statutes.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Availability of ethics and other conduct... ethics and other conduct related regulations and statutes. (a)(1) The Commission shall furnish each new employee, at the time of his or her entrance on duty, with a copy of: (i) The Standards of Ethical Conduct...

47 CFR 19.735-105 - Availability of ethics and other conduct related regulations and statutes.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Availability of ethics and other conduct... ethics and other conduct related regulations and statutes. (a)(1) The Commission shall furnish each new employee, at the time of his or her entrance on duty, with a copy of: (i) The Standards of Ethical Conduct...

49 CFR 1103.11 - Standards of ethical conduct in courts of the United States to be observed.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 8 2013-10-01 2013-10-01 false Standards of ethical conduct in courts of the... PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.11 Standards of ethical conduct in courts of the United States to be observed. These canons further the purpose...

49 CFR 1103.11 - Standards of ethical conduct in courts of the United States to be observed.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 8 2012-10-01 2012-10-01 false Standards of ethical conduct in courts of the... PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.11 Standards of ethical conduct in courts of the United States to be observed. These canons further the purpose...

RESEARCH ON ENVIRONMENTAL HEALTH INTERVENTIONS: ETHICAL PROBLEMS AND SOLUTIONS

PubMed Central

RESNIK, DAVID B.; ZELDIN, DARRYL C.; SHARP, RICHARD R.

2014-01-01

This article reviews a variety of ethical issues one must consider when conducting research on environmental health interventions on human subjects. The paper uses the Kennedy Krieger Institute lead abatement study as well as a hypothetical asthma study to discuss questions concerning benefits and risks, risk minimization, safety monitoring, the duty to warn, the duty to report, the use of control groups, informed consent, equitable subject selection, privacy, conflicts of interest, and community consultation. Research on environmental health interventions can make an important contribution to our understanding of human health and disease prevention, provided it is conducted in a manner that meets prevailing scientific, ethical, and legal standards for research on human subjects. PMID:16220621

Incidental Findings in Neuroimaging: Ethical and Medicolegal Considerations

PubMed Central

Leung, Lawrence

2013-01-01

With the rapid advances in neurosciences in the last three decades, there has been an exponential increase in the use of neuroimaging both in basic sciences and clinical research involving human subjects. During routine neuroimaging, incidental findings that are not part of the protocol or scope of research agenda can occur and they often pose a challenge as to how they should be handled to abide by the medicolegal principles of research ethics. This paper reviews the issue from various ethical (do no harm, general duty to rescue, and mutual benefits and owing) and medicolegal perspectives (legal liability, fiduciary duties, Law of Tort, and Law of Contract) with a suggested protocol of approach. PMID:26317093

Incidental Findings in Neuroimaging: Ethical and Medicolegal Considerations.

PubMed

Leung, Lawrence

2013-01-01

With the rapid advances in neurosciences in the last three decades, there has been an exponential increase in the use of neuroimaging both in basic sciences and clinical research involving human subjects. During routine neuroimaging, incidental findings that are not part of the protocol or scope of research agenda can occur and they often pose a challenge as to how they should be handled to abide by the medicolegal principles of research ethics. This paper reviews the issue from various ethical (do no harm, general duty to rescue, and mutual benefits and owing) and medicolegal perspectives (legal liability, fiduciary duties, Law of Tort, and Law of Contract) with a suggested protocol of approach.

The patient perspective in health care networks.

PubMed

Raus, Kasper; Mortier, Eric; Eeckloo, Kristof

2018-06-05

Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because networks involve many risks. Due to their often amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down. We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics (justice, nonmaleficence, beneficence and autonomy) it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically. Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified.

The law of incidental findings in human subjects research: establishing researchers' duties.

PubMed

Wolf, Susan M; Paradise, Jordan; Caga-anan, Charlisse

2008-01-01

Research technologies can now produce so much information that there is significant potential for incidental findings (IFs). These are findings generated in research that are beyond the aims of the study. Current law and federal regulations offer no direct guidance on how to deal with IFs in research, nor is there adequate professional or institutional guidance. We advocate a defined set of researcher duties based on law and ethics and recommend a pathway to be followed in handling IFs in research. This article traces the underlying ethical and legal theories supporting researcher duties to manage IFs, including duties to develop a plan for management in the research protocol, to discuss the possibility of and management plan for IFs in the informed consent process, and to address, evaluate, and ultimately offer to disclose IFs of potential clinical or reproductive significance to research participants when they arise.

[Dissent in public health ethics. A guarantor for political credibility?].

PubMed

Michelsen, K

2009-05-01

Public health covers public activities linked with cure, prevention and health promotion directed to positively influence the health of populations. As far as these criteria are met, health policies are public health. Public health holds many ethical implications. Resources and health opportunities are redistributed, ends and means of public health as well as rights and duties have to be discussed, and conflicts exist between targets. Ethical policy counselling is an important complement to natural and social scientific policy counselling. However, ethical counselling cannot solve conflicts about values and norms nor does it claim to do so. There are different theories and approaches, recommended principles differ and are in conflict with each other. It must not be expected that a generally accepted frame for public health ethical policy counselling will be developed. Public health ethics can develop an ordering effect and enforce more clarity for actors about their values and norms, but in case of unresolvable dissent between experts it can also be misused to give support to the legitimation of political decisions. Orientation of consulting activities towards the "pragmatistic model" (Habermas) and a counselling of the civil society is promising to prevent such exploitation.

Medical confidentiality versus disclosure: Ethical and legal dilemmas.

PubMed

Agyapong, V I O; Kirrane, R; Bangaru, R

2009-02-01

A case is described of a fifty year old single man who made disclosures about criminal sexual practices during a psychiatric assessment. In common practice with other professional men, a doctor is under a duty not to disclose, without the consent of his patient, information which he has gained in his professional capacity other than in exceptional circumstances. We discuss the ethical and legal considerations surrounding issues of medical confidentiality and the dilemma that sometimes face clinicians, when they feel obliged, in the public interest, to disclose information they have gained in confidence. Breach of confidences can have deleterious consequences; particularly for the doctor-patient relationship, but failure to disclose in some situations could have serious implications for the well-being of the wider society. Doctors should be aware of the basic principles of confidentiality and the ethical and legal framework around which they are built.

The responsibilities of engineers.

PubMed

Smith, Justin; Gardoni, Paolo; Murphy, Colleen

2014-06-01

Knowledge of the responsibilities of engineers is the foundation for answering ethical questions about the work of engineers. This paper defines the responsibilities of engineers by considering what constitutes the nature of engineering as a particular form of activity. Specifically, this paper focuses on the ethical responsibilities of engineers qua engineers. Such responsibilities refer to the duties acquired in virtue of being a member of a group. We examine the practice of engineering, drawing on the idea of practices developed by philosopher Alasdair MacIntyre, and show how the idea of a practice is important for identifying and justifying the responsibilities of engineers. To demonstrate the contribution that knowledge of the responsibilities of engineers makes to engineering ethics, a case study from structural engineering is discussed. The discussion of the failure of the Sleipner A Platform off the coast of Norway in 1991 demonstrates how the responsibilities of engineers can be derived from knowledge of the nature of engineering and its context.

5 CFR 2638.203 - Duties of the designated agency ethics official.

Code of Federal Regulations, 2010 CFR

2010-01-01

... accordance with subpart G, Executive Agency Ethics Training Programs, of this part. (7) A counseling program... other audit groups is reviewed to determine whether such information discloses a need for revising...

Realizing Informed Consent in Times of Controversy: Lessons from the SUPPORT Study.

PubMed

Morse, Robert J; Wilson, Robin Fretwell

2016-09-01

This Essay examines the elegantly simple idea that consent to medical treatment or participation in human research must be "informed" to be valid. It does so by using as a case study the controversial clinical research trial known as the Surfactant, Positive Pressure, and Oxygenation Randomized Trial ("SUPPORT"). The Essay begins by charting, through case law and the adoption of the common rule, the evolution of duties to secure fully informed consent in both research and treatment. The Essay then utilizes the SUPPORT study, which sought to pinpoint the level of saturated oxygen that should be provided to extremely low birth weight infants to demonstrate modern complexities and shortcomings of the duty to secure informed consent. This Essay shows how the duty is measured by foreseeability of risks and benefits in human research and why federal regulators believed the trade-offs in risk and benefits from differing oxygen levels administered in the support study were foreseeable. It then explores the contours of the duty to secure informed consent when applied to researchers who also serve as treating physicians, highlighting how common law duties differ in jurisdictions that apply the professional standard and those that apply the patient-centered material risk standard. This Essay provides new insight into what the law must do to make real the notion that [e]very human being of adult years and sound mind has a right to determine what shall be done with his body." © 2016 American Society of Law, Medicine & Ethics.

Finding Fault? Exploring Legal Duties to Return Incidental Findings in Genomic Research

PubMed Central

Pike, Elizabeth R.; Rothenberg, Karen H.; Berkman, Benjamin E.

2014-01-01

The use of whole-genome sequencing in biomedical research is expected to produce dramatic advances in human health. The increasing use of this powerful, data-rich new technology in research, however, will inevitably give rise to incidental findings (IFs)—findings with individual health or reproductive significance that are beyond the aims of the particular research—and the related questions of whether and to what extent researchers have an ethical obligation to return IFs. Many have concluded that researchers have an ethical obligation to return some findings in some circumstances but have provided vague or context-dependent approaches to determining which IFs must be returned and when. As a result, researchers have started returning IFs inconsistently, giving rise to concerns about legal liability in circumstances in which notification could have potentially prevented injury. Although it is clear that ethical guidance should not be automatically codified as law and that crafting ethical obligations around legal duties can be inappropriate, the ethical debate should not proceed unaware of the potential legal ramifications of advancing and implementing an ethical obligation to return IFs. This Article assesses the legal claims that could be brought for a researcher’s failure to return IFs. The potential for researchers to be held liable in tort is still uncertain and turns largely on a number of factors—including customary practice and guidance documents—that are still in flux. Unlike medical care, which has a well-defined duty into which evolving scientific knowledge about genetics and genomics can readily be incorporated, a researcher’s duty to return IFs is less well defined, making it difficult to determine at the outset whether and when legal liability will attach. This Article advocates for a clearer, ethically sound standard of requiring that researchers disclose in the informed consent document which approach to offering IFs will be taken. This approach enables participants to know at the outset which findings, if any, will be returned, allows researchers to ascertain when their failure to appropriately return incidental findings will give rise to liability, and enables courts to make determinations that will produce more consistent legal guidance. PMID:25346543

Probing transplant and living donor candidates about their participation in organ vending.

PubMed

Bramstedt, Katrina A

2010-09-01

The selling of human organs for transplant is illegal in the United States and in most countries; however, such transactions still occur. Transplant hospitals and their personnel have multiple ethical duties, including (1) protecting the safety of their living donors and transplant recipients and (2) protecting the integrity of living donation and transplantation as clinical practices. To date, few psychosocial screening tools exist that pertain specifically to a person's risk or intent of pursuing organ vending (buying or selling). This article presents a series of transplant ethics case consultations that spawned the creation of a set of behavioral prompts for teams to probe with regard to organ vending when screening candidates about their suitability for participation as living donors or transplant recipients.

Just a Cog in the Machine? The Individual Responsibility of Researchers in Nanotechnology is a Duty to Collectivize.

PubMed

Spruit, Shannon L; Hoople, Gordon D; Rolfe, David A

2016-06-01

Responsible Research and Innovation (RRI) provides a framework for judging the ethical qualities of innovation processes, however guidance for researchers on how to implement such practices is limited. Exploring RRI in the context of nanotechnology, this paper examines how the dispersed and interdisciplinary nature of the nanotechnology field somewhat hampers the abilities of individual researchers to control the innovation process. The ad-hoc nature of the field of nanotechnology, with its fluid boundaries and elusive membership, has thus far failed to establish a strong collective agent, such as a professional organization, through which researchers could collectively steer technological development in light of social and environmental needs. In this case, individual researchers cannot innovate responsibly purely by themselves, but there is also no structural framework to ensure that responsible development of nanotechnologies takes place. We argue that, in such a case, individual researchers have a duty to collectivize. In short, researchers in situations where it is challenging for individual agents to achieve the goals of RRI are compelled to develop organizations to facilitate RRI. In this paper we establish and discuss the criteria under which individual researchers have this duty to collectivize.

Determining your duties.

PubMed

Summers, J

1989-04-01

This issue's discussion has two goals. First, we shall examine the reasons clinical personnel gravitate to the Kantian concept of duty. Second, we shall examine a technique used within Kantian theory that will help you decide when an ethical dilemma obligates you to act regardless of the consequences.

Ethics approval: responsibilities of journal editors, authors and research ethics committees.

PubMed

Bain, Luchuo Engelbert

2017-01-01

Meaningful progress of medicine depends on research that must ultimately involve human subjects. Obtaining ethical approval therefore, especially in medical sciences, should be a moral reflex for researchers. This unfortunately is not the case, with numerous researchers bypassing the ethics approval procedure, or simply unaware of its importance. Good research involves risks taken by research participants and uses tax payers' money in the process. These mandates the research endeavor to aim at attaining the highest degree of respect for the sacrifices made by others for science. Most researchers mistake scientific clearance or approval, for ethics approval. For a study to be ethical sound, it must be scientifically sound. This is only one of the activities carried out during protocol review. It is not uncommon for sensitive ethical concerns, especially in the social sciences to be overlooked and considered not to be accompanied by any serious risks for the research participants.The researcher has the responsibility of systematically consulting the competent ethics committee for advice and consequent approvals or ethical waivers. Journal editors and reviewers have the duty to systematically evaluate the ethical soundness of manuscripts submitted for review. Capacity building in research ethics and institutional support for Research Ethics Committees to speed up protocol review could reduce the incentive of carrying out research in human subjects without ethics approvals. It is hypocritical and idle to continue to expect optimal reviews on time and of good quality, from ethics committees functioning purely on altruistic grounds. Capacity building for researchers in research ethics, and institutional reforms and support for Research Ethics Committees appear not to have received the attention they truly deserve.

Clarifying conflict of interest.

PubMed

Brody, Howard

2011-01-01

As the debate over how to manage or discourage physicians' financial conflicts of interest with the drug and medical device industries has become more heated, critics have questioned or dismissed the concept of "conflict of interest" itself. A satisfactory definition relates conflict of interest to concerns about maintaining social trust and distinguishes between breaches of ethical duty and temptations to breach duty. Numerous objections to such a definition have been offered, none of which prevails on further analysis. Those concerned about conflicts of interest have contributed to misunderstandings, however, by failing to demonstrate when social arrangements leading to temptations to breach duties are in themselves morally blameworthy. Clarifying "conflict of interest" is important if we are eventually going to develop productive modes of engagement between medicine and for-profit industry that avoid the serious ethical pitfalls now in evidence.

Sexual harassment in the medical profession: legal and ethical responsibilities.

PubMed

Mathews, Ben; Bismark, Marie M

2015-08-17

Sexual harassment of women in medicine has become a subject of national debate after a senior female surgeon stated that if a woman complained of unwanted advances her career would be jeopardised, and subsequent reports suggest that sexual harassment is a serious problem in the medical profession. Sexual harassment of women in the medical profession by their colleagues presents substantial legal, ethical and cultural questions for the profession. Women have enforceable legal rights to gender equality and freedom from sexual harassment in the workplace. Both individual offenders and employers face significant legal consequences for sexual harassment in every Australian state and territory, and individual medical practitioners and employers need to understand their legal and ethical rights and responsibilities in this context. An individual offender may be personally liable for criminal offences, and for breaching anti-discrimination legislation, duties owed in civil law, professional standards and codes of conduct. An employer may be liable for breaching anti-discrimination legislation, workplace safety laws, duties owed in contract law, and a duty of care owed to the employee. Employers, professional colleges and associations, and regulators should use this national debate as an opportunity to improve gender equality and professional culture in medicine; individuals and employers have clear legal and ethical obligations to minimise sexual harassment to the greatest extent possible.

The pregnant woman and the good Samaritan: can a woman have a duty to undergo a caesarean section?

PubMed

Scott, R

2000-01-01

Although a pregnant woman can now refuse any medical treatment needed by the fetus, the Court of Appeal has acknowledged that ethical dilemmas remain, adverting to the inappropriateness of legal compulsion of presumed moral duties in this context. This leaves the impression of an uncomfortable split between the ethics and the law. The notion of a pregnant woman refusing medical treatment needed by the fetus is troubling and it helps little simply to assert that she has a legal right to do so. At the same time, the idea that a pregnant woman fails in her moral duty unless she accepts any recommended treatment or surgery--however great the burden--is also not without difficulty. This article seeks to find a way between these two somewhat polarized positions by arguing that, instead of being a question primarily about whether legally to enforce moral obligations, the 'maternal-fetal conflict' begins with previously unrecognized difficulties in determining when a woman's prima facie moral rights invoked in the treatment context should 'give way' to the interests of the fetus. This difficulty is mirrored within the law. Thus, how can we tell when a pregnant woman has the moral or legal duty to submit to a caesarean section? Seen in this way, the conflict is a problem which lies at the interface between moral and legal rights and duties, showing that there are important conceptual links between the ethics and the law. Against this background, this article explores the limits of a pregnant woman's right to bodily integrity by focusing upon the idea of her moral duty to aid the fetus through her body. Here we find difficulties in determining the existence and extent of this somewhat extraordinary duty. Such a duty is contrasted with both negative and positive duties toward others in the course of 'general conduct.' Attention to the social context of pregnancy and the refusal of treatment within this is also instructive. Overall, the purpose is to foster understanding and acceptance of the current legal position.

Legally protecting and compelling veterinarians in issues of animal abuse and domestic violence.

PubMed

Robertson, I A

2010-06-01

The majority of veterinarians recognise their important role and responsibility to society and animal welfare in the detection and reporting of suspected abuse of animals and humans. In spite of the existing moral, ethical, and legal duties applied to veterinarians, they face substantial barriers that prohibit them from fulfilling their professional role in handling cases of suspected abuse. With increasing public and legal attention on issues of animal welfare, the non-fulfillment of these duties places the profession and its members at considerable risk of public criticism and adverse legal accountability. The issue is raised here that the veterinary profession in New Zealand needs to provide a clear policy statement and take pro-active measures that provide practical enforceable solutions to these existing barriers and legal risks. Such an initiative will assist in ensuring that all registered members consistently fulfil their obligations, and are legally protected while doing so. Veterinary counterparts overseas already provide a legislative immunity for their veterinarians who report suspected abuse as part of a mandated duty to report. Implementation of such a duty has significant benefits for all veterinarians, including the requirement for education and effective support systems. In the absence of such a mandatory duty, intermediary measures can be introduced, demonstrating social responsibility and commitment by the profession to their existing duty of care.

Virulent Epidemics and Scope of Healthcare Workers' Duty of Care

PubMed Central

2006-01-01

The phrase "duty of care" is, at best, too vague and, at worst, ethically dangerous. The nature and scope of the duty need to be determined, and conflicting duties must be recognized and acknowledged. Duty of care is neither fixed nor absolute but heavily dependent on context. The normal risk level of the working environment, the healthcare worker's specialty, the likely harm and benefits of treatment, and the competing obligations deriving from the worker's multiple roles will all influence the limits of the duty of care. As experts anticipate the arrival of an avian influenza pandemic in humans, discussion of this matter is urgently needed. PMID:16965703

The moral experience of the patient with chronic pain: bridging the gap between first and third person ethics.

PubMed

Edwards, Ian; Jones, Mark; Thacker, Michael; Swisher, Laura Lee

2014-03-01

There has been a widespread call for an ethics in the management of patients with chronic pain which is patient centered and takes into account the lived experience of the patient. It has been argued in literature that current "duty" or principlist-based models of ethics (so-called 3rd person ethics) have not adequately addressed the needs of either patients or practitioners in this area. Two strands of literature within phenomenology were reviewed: the literature of interpretative phenomenological analysis and the study of the lived experience of the person with chronic pain; and the contribution of phenomenology in neo-Aristotelian virtue ethics (1st person ethics). Patients experience chronic pain in existential and moral terms in addition to their biomedical issues, facing dilemmas in understanding their own self-identity and in attempting to recover a sense of moral worth and agency. We outline a patient-centered ethics to underpin contemporary collaborative, multimodal approaches in the management of chronic pain. We firstly describe an agency-oriented, neo-Aristotelian 1st person ethics and then outline a hermeneutic relationship with extant "duty-based," 3rd person bioethics. The utility of the ethics model we propose (the ethical reasoning bridge) lies in its capacity for developing a sense of moral agency for both practitioner and patient, resonating with the current emphasis of seeking active engagement of patients in management. Wiley Periodicals, Inc.

Noddings's caring ethics theory applied in a paediatric setting.

PubMed

Lundqvist, Anita; Nilstun, Tore

2009-04-01

Since the 1990s, numerous studies on the relationship between parents and their children have been reported on in the literature and implemented as a philosophy of care in most paediatric units. The purpose of this article is to understand the process of nurses' care for children in a paediatric setting by using Noddings's caring ethics theory. Noddings's theory is in part described from a theoretical perspective outlining the basic idea of the theory followed by a critique of her work. Important conceptions in her theory are natural caring (reception, relation, engrossment, motivational displacement, reciprocity) and ethical caring (physical self, ethical self, and ethical ideal). As a nurse one holds a duty of care to patients and, in exercising this duty, the nurse must be able to develop a relationship with the patient including giving the patient total authenticity in a 'feeling with' the patient. Noddings's theory is analysed and described in three examples from the paediatrics. In the first example, the nurse cared for the patient in natural caring while in the second situation, the nurse strived for the ethical caring of the patient. In the third example, the nurse rejected the impulse to care and deliberately turned her back to ethics and abandoned her ethical caring. According to the Noddings's theory, caring for the patient enables the nurse to obtain ethical insights from the specific type of nursing care which forms an important contribution to an overall increase of an ethical consciousness in the nurse.

Ethical issues in ocular genetics.

PubMed

Mezer, Eedy; Wygnanski-Jaffe, Tamara

2009-09-01

To review some of the major issues in ophthalmic genetics ethics: predictive testing, prenatal testing and abortion, gene therapy, confidentiality, payment for genetic testing, the duty to recontact patients and convey new information. Patients and families may perceive benefits even though genetic testing may be associated with adverse psychosocial outcomes. Most patients were in favor of prenatal diagnosis but opposed abortion. Patient selection as candidates for gene therapy should be based on the different clinical characteristics of each hereditary disease. The balance between the right of the patient for confidentiality and the best interest of family members or society is an ethical challenge. Most insurance companies will pay for genetic testing if the condition is hereditary. The duty to recontact patients when new medical information becomes available is still ethically controversial. The field of ocular genetics is ever growing involving complex medical, technical, financial and social issues. As a result, ethical issues are expected to become more common. Properly prepared medical professionals as well as unique counseling for participants and families may enable improved decision-making taking into consideration the needs of each individual.

To pray or not to pray: a question of ethics.

PubMed

French, Charlotte; Narayanasamy, Aru

There is a widespread belief that nurses have a duty to provide spiritual care. However, many feel there is still a need for debate surrounding the ethical use of prayer in both nursing research and practice. By using critical reflections and evidence-based literature, this paper develops a discourse on the ethics of prayer as a spiritual intervention in nursing and health care practice. Several key ethical issues are highlighted. In regards to research, lack of informed consent is a major concern in both research and nursing practice. Key ethical issues in practice include questions around intention and authority, e.g. despite the religious beliefs of the nurse, intentions to proselytize must be avoided to protect patient autonomy and avoid abuse of the nurse's authority. Furthermore, prayer has unknown side effects and implications. This paper concludes that, in practice, nurses must reconcile their personal, spiritual beliefs with their professional duties, and while this may be a delicate balance, it is not yet appropriate to encourage or dissuade a patient from their beliefs until appropriate research evidence is produced.

John Gregory (1724-1773) and his lectures on the duties and qualifications of a physician establishing modern medical ethics on the base of the moral philosophy and the theory of science of the empiric British Enlightenment.

PubMed

Strätling, M

1997-01-01

In 1769/70 the Scottish physician and philosopher John Gregory (1724-1773) published Lectures On the Duties and Qualifications of a Physician. Gregory developed a truely ethical - in the sense of (moral) philosophically based - system of conduct in a physician. His concept of practising and teaching ethics in medicine and science is established on a very broad footing: combining Bacon's (1561-1626) general philosophy of nature and science with both, the general, likewise empirically based moral philosophy of his personal friend David Hume (1711-1776), and with the principles upheld by the so-called Common-Sense Philosophy. His Lectures had - particularly via the famous Code of Medical Ethics of Thomas Percival (1740-1804) - a decisive influence on our contemporary concepts of ethics in medicine and science. John Gregory is, without doubt, one of the most important and certainly the most comprehensive among the founders of what is known today as modern Bioethics.

Palliative sedation until death: an approach from Kant's ethics of virtue.

PubMed

Hasselaar, Jeroen G J

2008-01-01

This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does not destroy capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation--for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons.

The ethics of medical involvement in torture: commentary

PubMed Central

Hare, R M

1993-01-01

Torture does need to be defined if we are to know exactly what we are seeking to ban; but no single definition will do, because there are many possible ones, and we may want to treat different practices that might be called torture differently. Compare the case of homicide; we do not want to punish manslaughter as severely as murder, and may not want to punish killing in self-defence at all. There are degrees of torture as of murder. Unclarities simply play into the hands of would-be torturers. Downie is unsuccessful in deriving the duty of doctors not to be involved in torture from an analysis of the word `doctor'. It may be contrary to the role-duty of doctors to participate in torture; but there might be other duties which overrode this role-duty. The right approach is to ask what principles for the conduct of doctors have the highest acceptance-utility, or, as Kant might have equivalently put it, what the impartial furtherance of everyone's ends demands. This approach yields the result that torture (suitably defined) should be banned absolutely. It also yields prescriptions for the conduct of doctors where, in spite of them, torture is taking place. PMID:8230144

[How do first codes of medical ethics inspire contemporary physicians?].

PubMed

Paprocka-Lipińska, Anna; Basińska, Krystyna

2014-02-01

First codes of medical ethics appeared between 18th and 19th century. Their formation was inspired by changes that happened in medicine, positive in general but with some negative setbacks. Those negative consequences revealed the need to codify all those ethical duties, which were formerly passed from generation to generation by the word of mouth and individual example by master physicians. 210 years has passed since the publication of "Medical Ethics" by Thomas Percival, yet essential ethical guidelines remain the same. Similarly, ethical codes published in Poland in 19 century can still be an inspiration to modem physicians.

Beacons to the Future.

ERIC Educational Resources Information Center

Ohliger, John

From the point of view that broadcasting is turning toward social responsibility and social ethic, it becomes the duty of university departments preparing personnel for the broadcasting field to select students potentially qualified to contribute in addition to technical capability "that extra something" denoting real ethical quality.…

17 CFR 200.112 - Duties of recipient; notice to participants.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Duties of recipient; notice to participants. 200.112 Section 200.112 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION ORGANIZATION; CONDUCT AND ETHICS; AND INFORMATION AND REQUESTS Code of Behavior Governing Ex Parte...

17 CFR 200.112 - Duties of recipient; notice to participants.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Duties of recipient; notice to participants. 200.112 Section 200.112 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION ORGANIZATION; CONDUCT AND ETHICS; AND INFORMATION AND REQUESTS Code of Behavior Governing Ex Parte...

17 CFR 200.112 - Duties of recipient; notice to participants.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Duties of recipient; notice to participants. 200.112 Section 200.112 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION ORGANIZATION; CONDUCT AND ETHICS; AND INFORMATION AND REQUESTS Code of Behavior Governing Ex Parte...

17 CFR 200.112 - Duties of recipient; notice to participants.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Duties of recipient; notice to participants. 200.112 Section 200.112 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION ORGANIZATION; CONDUCT AND ETHICS; AND INFORMATION AND REQUESTS Code of Behavior Governing Ex Parte...

When Rights Just Won't Do: Ethical Considerations When Making Decisions for Severely Disabled Newborns.

PubMed

Hester, D Micah; Lew, Cheryl D; Swota, Alissa

2016-01-01

Children born with severe handicapping conditions, where survival and quality of survival is indeterminate, present special challenges for families and health-care professionals tasked with deciding the best courses of treatment and care. The case of Baby G presents an opportunity to compare the relative effectiveness of ethical versus rights theories in providing guidance about what obligations are owed to such children at bedside and how those obligations pertain to broader societal duties in a rights framework. We review common theories of determining the "best interests standard" of newborn decision-making and the priority of families to decide on behalf of their children. We then discuss what support the rights framework of the U.N. Convention on the Rights of the Child (CRC) might lend to the best implementation of clinical ethics decision-making. Finally, we conclude that the universal nature of rights theory does not provide the particular, specific guidance needed at the bedside of the critically ill infant.

Nasogastric feeding at the end of life: a virtue ethics approach.

PubMed

Krishna, Lalit

2011-07-01

The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family.

Detecting and (not) dealing with plagiarism in an engineering paper: beyond CrossCheck-a case study.

PubMed

Zhang, Xin-xin; Huo, Zhao-lin; Zhang, Yue-hong

2014-06-01

In papers in areas such as engineering and the physical sciences, figures, tables and formulae are the basic elements to communicate the authors' core ideas, workings and results. As a computational text-matching tool, CrossCheck cannot work on these non-textual elements to detect plagiarism. Consequently, when comparing engineering or physical sciences papers, CrossCheck may return a low similarity index even when plagiarism has in fact taken place. A case of demonstrated plagiarism involving engineering papers with a low similarity index is discussed, and editor's experiences and suggestions are given on how to tackle this problem. The case shows a lack of understanding of plagiarism by some authors or editors, and illustrates the difficulty of getting some editors and publishers to take appropriate action. Consequently, authors, journal editors, and reviewers, as well as research institutions all are duty-bound not only to recognize the differences between ethical and unethical behavior in order to protect a healthy research environment, and also to maintain consistent ethical publishing standards.

An African ethic for nursing?

PubMed

Haegert, S

2000-11-01

This article derives from a doctoral thesis in which a particular discourse was used as a 'paradigm case'. From this discourse an ethic set within a South African culture arose. Using many cultural 'voices' to aid the understanding of this narrative, the ethic shows that one can build on both a 'justice' and a 'care' ethic. With further development based on African culture one can take the ethic of care deeper and reveal 'layers of understanding'. Care, together with compassion, forms the foundation of morality. Nursing ethics has followed particular western moral philosophers. Often nursing ethics has been taught along the lines of Kohlberg's theory of morality, with its emphasis on rules, rights, duties and general obligations. These principles were universalistic, masculine and noncontextual. However, there is a new ethical movement among Thomist philosophers along the lines to be expounded in this article. Nurses such as Benner, Bevis, Dunlop, Fry and Gadow--to name but a few--have welcomed the concept of an 'ethic of care'. Gilligan's work gave a feminist view and situated ethics in the everyday aspects of responsiveness, responsibility, context and concern. Shutte's search for a 'philosophy for Africa' has resulted in finding similarities in Setiloane and in Senghor with those of Thomist philosophers. Using this African philosophy and a research participant's narrative, an African ethic evolves out of the African proverb: 'A person is a person through other persons', or its alternative rendering: 'I am because we are: we are because I am.' This hermeneutic narrative reveals 'the way affect imbues activity with ethical meaning' within the context of a black nursing sister in a rural South African hospital. It expands upon the above proverb and incorporates the South African constitutional idea of 'Ubuntu' (compassion and justice or humanness).

Bioethics for clinicians: 22. Jewish bioethics

PubMed Central

Goldsand, Gary; Rosenberg, Zahava R.S.; Gordon, Michael

2001-01-01

Jewish bioethics in the contemporary era emerges from the traditional practice of applying principles of Jewish law (Halacha) to ethical dilemmas. The Bible (written law) and the Talmud (oral law) are the foundational texts on which such deliberations are based. Interpretation of passages in these texts attempts to identify the duties of physicians, patients and families faced with difficult health care decisions. Although Jewish law is an integral consideration of religiously observant Jews, secularized Jewish patients often welcome the wisdom of their tradition when considering treatment options. Jewish bioethics exemplifies how an ethical system based on duties may differ from the secular rights-based model prevalent in North American society. PMID:11332319

Elective non-therapeutic intensive care and the four principles of medical ethics.

PubMed

Baumann, Antoine; Audibert, Gérard; Guibet Lafaye, Caroline; Lafaye, Caroline Guibet; Puybasset, Louis; Mertes, Paul-Michel; Claudot, Frédérique

2013-03-01

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented.

Do doctors have a moral duty to work in the public health sector? Ethical considerations regarding the social obligations of medicine.

PubMed

Aguilera Dreyse, Bernardo; López Gaete, Gonzalo

2017-12-22

This article discusses whether physicians have social obligations and whether these obligations imply a moral duty to work in the public sector. The article focuses on the context of the Chilean health system, which has an unequal distribution of physicians to the detriment of the public sector, thus making the issue a particularly pressing one. After addressing arguments from different ethical theories and some empirical evidence, the article concludes that the physician has some social obligations in relation to a fair distribution of health resources, and that professional excellence should incorporate cultivating virtues related to social justice. In addition, it is argued that the moral duty to work in the public sector can be placed in the context of prima facie obligations which admit exceptions and allow the possibility of conflict with other professional obligations.

Cultivating Teachers' Morality and the Pedagogy of Emotional Rationality

ERIC Educational Resources Information Center

Kim, Minkang

2013-01-01

Teachers are expected to act ethically and provide moral role models in performing their duties, even though teacher education has often relegated the cultivation of teachers' ethical awareness and moral development to the margins. When it is addressed, the main theoretical assumptions have relied heavily on the cognitivist developmental theories…

37 CFR 1.21 - Miscellaneous fees and charges.

Code of Federal Regulations, 2010 CFR

2010-07-01

... application by a person for recognition or registration after disbarment or suspension on ethical grounds, or... fiduciary duty; on petition for reinstatement by a person excluded or suspended on ethical grounds, or..., per hour or fraction thereof—$40.00 (k) For items and services that the Director finds may be supplied...

Discussions on Aristotle's "Ethics": Implications for Teachers and Administrators.

ERIC Educational Resources Information Center

Pemberton, Janette E.

A number of passages from Aristotle's "Ethics" are discussed in this paper, and their implications for teachers and administrators are examined. Among the many topics considered in relation to teaching and administration are: the importance of performing duties for their own sakes, tbe indispensability of knowledge, the need for…

Calculated Risk Taking in the Treatment of Suicidal Patients: Ethical and Legal Problems.

ERIC Educational Resources Information Center

Maltsberger, John T.

1994-01-01

Discusses discharge of suicidal patients from inpatient care from both economic and ethical perspectives. Suggests that clinicians must exercise prudence in discharging patients unlikely to recover, considering duty to preserve life. Encourages discharge when benefits outweigh risks, with careful preparation of patient and family and meticulous…

Reconstructing the duty of water: a study of emergent norms in socio-hydrology

NASA Astrophysics Data System (ADS)

Wescoat, J. L., Jr.

2013-12-01

This paper assesses the changing norms of water use known as the duty of water. It is a case study in historical socio-hydrology, or more precisely the history of socio-hydrologic ideas, a line of research that is useful for interpreting and anticipating changing social values with respect to water. The duty of water is currently defined as the amount of water reasonably required to irrigate a substantial crop with careful management and without waste on a given tract of land. The historical section of the paper traces this concept back to late 18th century analysis of steam engine efficiencies for mine dewatering in Britain. A half-century later, British irrigation engineers fundamentally altered the concept of duty to plan large-scale canal irrigation systems in northern India at an average duty of 218 acres per cubic foot per second (cfs). They justified this extensive irrigation standard (i.e., low water application rate over large areas) with a suite of social values that linked famine prevention with revenue generation and territorial control. The duty of water concept in this context articulated a form of political power, as did related irrigation engineering concepts such as "command" and "regime". Several decades later irrigation engineers in the western US adapted the duty of water concept to a different socio-hydrologic system and norms, using it to establish minimum standards for private water rights appropriation (e.g., only 40 to 80 acres per cfs). While both concepts of duty addressed socio-economic values associated with irrigation, the western US linked duty with justifications for, and limits of, water ownership. The final sections show that while the duty of water concept has been eclipsed in practice by other measures, standards, and values of water use efficiency, it has continuing relevance for examining ethical duties and for anticipating, if not predicting, emerging social values with respect to water.

Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court.

PubMed

Lareau, Craig R

2015-01-01

Forensic psychologists and psychiatrists are licensed in their respective professions, but they perform most of their work with attorneys in the legal arena. Both attorneys and mental health professionals place high value on confidentiality of information, reflected in the ethics of their professions and codified into laws governing their work. In psychology and psychiatry, there are some well-known exceptions to confidentiality; two primary exceptions include the mandated reporting of suspected child abuse and various "Tarasoff" duty to warn or protect laws. Generally, however, the corresponding duty for attorneys to report suspected child abuse or to warn or protect intended victims of threatened harm is not as extensive. This difference in mandated reporting responsibilities can create significant difficulties when attorneys need to retain forensic psychologists and psychiatrists to evaluate their clients, especially in criminal contexts. If the retained psychologist or psychiatrist is required to report suspected abuse or threatened harm, the attorney may be harming his or her client's legal interests by using the forensic psychologist or psychiatrist to evaluate his or her client. This article will briefly review the development of mandated reporting laws for psychologists and psychiatrists and juxtapose those with the legal and ethical requirements of confidentiality for attorneys embodied in the attorney-client privilege and attorney work product privilege. The article will then discuss the California Court of Appeals case in Elijah W. v. Superior Court, where the court addressed the issue of whether retained mental health professionals must report suspected child abuse and threatened harm to others as required by law or if they do not need to report because they come under the umbrella of the attorney work product privilege. This California court ultimately concluded that retained psychologists and psychiatrists work under the attorney work product privilege and are not required to comply with mandated reporting laws and "Tarasoff" duties. Copyright © 2015 Elsevier Ltd. All rights reserved.

The duty to care in an influenza pandemic: a qualitative study of Canadian public perspectives.

PubMed

Bensimon, Cécile M; Smith, Maxwell J; Pisartchik, Dmitri; Sahni, Sachin; Upshur, Ross E G

2012-12-01

Ever since the emergence of SARS, when we were reminded that the nature of health care practitioners' duty to care is greatly contested, it has remained a polarizing issue. Discussions on the nature and limits of health care practitioners' duty to care during disasters and public health emergencies abounds the literature, ripe with arguments seeking to ground its foundations. However, to date there has been little public engagement on this issue. This study involved three Townhall meetings held between February 2008 and May 2010 in three urban settings in Canada in order to probe lay citizens' views about ethical issues related to pandemic influenza, including issues surrounding the duty to care. Participants included Canadian residents aged 18 and over who were fluent in English. Data were collected through day-long facilitated group discussions using case scenarios and focus group guides. Participant's views were organized according to several themes, including the following main themes (and respective sub-themes): 1. Legitimate limits; a) competing obligations; and b) appeal to personal choice; and 2. Legitimate expectations; a) reciprocity; and b) enforcement and planning. Our findings show that participants moved away from categorical notions of the duty to care towards more equivocal and often normative views throughout deliberations. Our analysis contributes a better understanding of the constitutive nature of the duty to care, defined in part by taking account of public views. This broadened understanding can further inform the articulation of acceptable norms of duty to care and policy development efforts. What is more, it illustrates the urgent need for policy-makers and regulators to get clarity on obligations, responsibilities, and accountability in the execution of HCPs' duty to care during times of universal vulnerability. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ethical issues in organ transplantation.

PubMed

Freeman, Richard B; Bernat, James L

2012-01-01

We discuss ethical issues of organ transplantation including the stewardship tension between physicians' duty to do everything possible for their patients and their duty to serve society by encouraging organ donation. We emphasize consideration of the role of the principles of justice, utility and equity in the just distribution of transplantable organ as scarce resources. We then consider ethical issues of determining death of the organ donor including the remaining controversies in brain death determination and the new controversies raised by circulatory death determination. We need uniformity in standards of death determination, agreement on the duration of asystole before death is declared, and consensus on the allowable circulatory interventions on the newly declared organ donor that are intended to improve organ function. We discuss the importance of maintaining the dead donor rule, despite the argument of some scholars to abandon it. Copyright © 2012 Elsevier Inc. All rights reserved.

RECONCEPTUALIZING CONSENT FOR DIRECT-TO-CONSUMER HEALTH SERVICES.

PubMed

Spector-Bagdady, Kayte

2015-01-01

The market for direct-to-consumer (DTC) health services continues to grow rapidly with former patients converting to customers for the opportunity to purchase varied diagnostic tests without the involvement of their clinician. For the first time a DTC genetic testing company is advertising health-related reports "that meet [Food and Drug Administration] standards for being clinically and scientifically valid." Ethicists and regulatory agencies alike have recognized the need for a more informed transaction in the DTC context, but how should we classify a commercial transaction for something normally protected by a duty of care? How can we assure informed agreements in an industry with terms and conditions as varied as the services performed? The doctrine of "informed consent" began as an ethical construct building on the promise of beneficence in the clinical relationship and elevating the principle of autonomy--but in the DTC context should we hold providers to legal standards of informed consent and associated medical malpractice liability, or contractual obligations where consumers would seek remedy for breach? This Article analyzes the fine balance that must be struck in an industry where companies are selling services for entertainment or non-medical purposes that possess the capacity to produce serious and disquieting medical information. It begins by reviewing current standards of consent in the clinical setting from both a legal and ethical perspective and then lays forth current standards for DTC consent using two currently controversial case studies: that of keepsake fetal ultrasound and genetic testing. DTC keepsake ultrasound and genetic testing providers attempt to de-medicalize the devices used for these procedures from their intended medical uses to non-medical uses. But while keepsake ultrasound is marketed as "intended for entertainment purposes only," it can provide medical information as an incidental finding. 23andMe currently purports to be the only DTC genetics service that "includes" reports that meet FDA qualifications, despite disclaimers of intent to "provide medical advice." The attempted de-medicalization of these devices, therefore, has not been fully transformative, and DTC providers should have more robust ethical and legal duties than the average goods and services seller. This Article delineates these responsibilities, beginning with ethical duties surrounding marketing, entering into, and providing DTC services. It then turns to the legal paradigms necessary to enable, or at least allow for, DTC providers to meet these ethical obligations. While it argues that contractual, as opposed to fiduciary, requirements are most appropriate and that waivers of liability will likely be upheld, it also advocates for a heightened expectation of disclosure during contracting.

Evidence-based medicine and quality of care.

PubMed

Dickenson, Donna; Vineis, Paolo

2002-01-01

In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice.

PubMed

Horner, Jennifer; Modayil, Maria; Chapman, Laura Roche; Dinh, An

2016-11-01

When patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice. The authors use a hypothetical case of a "noncompliant" individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient-practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy. Speech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.

Euthanasia and common sense: a reply to Garcia.

PubMed

Seay, Gary

2011-06-01

J. L. A. Garcia holds that my defense of voluntary euthanasia in an earlier paper amounts to an "assault on traditional common sense" about what medical ethics permits physicians to do, particularly insofar as I hold that a physician's duty to abstain from intentionally killing is only a defeasible duty, not an unconditional one. But I argue here that it is Garcia's views that are more at odds with common sense, and that voluntary euthanasia is in fact a humane alternative that respects patient autonomy and is consistent with the most fundamental moral duties of physicians. Among these is a duty to relieve suffering, which can sometimes outweigh the fundamental duty to conserve life.

Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review.

PubMed

Leider, Jonathon P; DeBruin, Debra; Reynolds, Nicole; Koch, Angelica; Seaberg, Judy

2017-09-01

Terrorism, disease outbreaks, and other natural disasters and mass casualty events have pushed health care and public health systems to identify and refine emergency preparedness protocols for disaster response. Ethical guidance, alongside legal and medical frameworks, are increasingly common components of disaster response plans. To systematically review the prevalence and content of ethical guidance offered for disaster response, specifically around crisis standards of care (CSCs). We systematically indexed academic literature from PubMed, Google Scholar, and ISI Web of Science from 2012 to 2016. We searched for peer-reviewed articles that substantively engaged in discussion of ethical guidance for CSCs. Researchers screened potential articles for identification and discussion of ethical issues in CSC planning. We categorized and cataloged ethical concepts and principles. Of 580 peer-reviewed articles mentioning ethics and CSCs or disaster planning, 38 (6%) met selection criteria. The systematic review of the CSC ethics literature since 2012 showed that authors were primarily focused on the ethical justifications for CSC (n = 20) as well as a need for ethics guidelines for implementing CSCs; the ethical justifications for triage (n = 19), both as to which criteria to use and the appropriate processes by which to employ triage; and international issues (n = 17). In addition to these areas of focus, the scholarly literature included discussion of a number of other ethical issues, including duty to care (n = 11), concepts of a duty to plan (n = 8), utilitarianism (n = 5), moral distress (n = 4), professional norms (n = 3), reciprocity (n = 2), allocation criteria (n = 4), equity (n = 4), research ethics (n = 2), duty to steward resources (n = 2), social utility and social worth (n = 2), and a number of others (n = 20). Although public health preparedness efforts have paid increasing attention to CSCs in recent years, CSC plans have rarely been implemented within the United States to date, although some components are common (e.g., triage is used in US emergency departments regularly). Conversely, countries outside the United States more commonly implement CSCs within a natural disaster or humanitarian crisis response, and may offer significant insight into ethics and disaster response for US-based practitioners. This systematic review identifies the most oft-used and -discussed ethical concepts and principles used in disaster planning around CSCs. Although discussion of more nuanced issues (e.g., health equity) are present, the majority of items substantively engaging in ethical discussion around disaster planning do so regarding triage and why ethics is needed in disaster response generally. Public health implications. A significant evolution in disaster planning has occurred within the past decade; ethical theories and frameworks have been put to work. For ethical guidance to be useful, it must be practical and implementable. Although high-level, abstract frameworks were once prevalent in disaster planning-especially in the early days of pandemic planning-concerns about the ethically difficult concept of CSCs pervade scholarly articles. Ethical norms must be clearly stated and justified and practical guidelines ought to follow from them. Ethical frameworks should guide clinical protocols, but this requires that ethical analysis clarifies what strategies to use to honor ethical commitments and achieve ethical objectives. Such implementation issues must be considered well ahead of a disaster. As governments and health care systems plan for mass casualty events, ethical guidance that is theoretically sound and practically useful can-and should-form an important foundation from which to build practical guidance for responding to disasters with morally appropriate means.

Ethics and governance of global health inequalities

PubMed Central

Ruger, J P

2006-01-01

Background A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. Aim To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Discussion and conclusions Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well‐being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self‐interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of “human flourishing” and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation‐state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale. PMID:17053290

Care ethics for guiding the process of multiple sclerosis diagnosis.

PubMed

Krahn, Timothy Mark

2014-12-01

Multiple sclerosis (MS) is a chronic neurological disorder for which there is no definitive diagnostic test. Uncertainty characterises most of its features with diagnosis reached through a process of elimination. Coping with uncertainty has been recognised as a significant problem for MS patients. Discussions in the literature concerning the ethics of MS diagnosis have focused on an ethics of duty emphasising the rules for disclosure and healthcare professionals' obligations to provide information to patients. This narrow construal of the ethics at stake with MS diagnosis may be driven by a common misperception that diagnosis is an event, or series of events, rather than a process. Scant attention has been given to the dynamic, situated relational space between patient and physician as they journey potentially together (or apart) through the process of diagnosis. The healthcare provider cannot properly judge 'the how, what and when' of MS disclosure merely by applying rules pertaining to general professional duties to tell the truth and patients' rights to know their medical status. Proper disclosure and effective communication require the practice of flexible, caring responsibility and sustained, ongoing attention to the particular relational needs of 'this' patient in her own situational context. Accordingly, this article argues that care ethics is especially useful (but not without certain limitations) for attending to a broader swath of responsibilities (different from minimal duties) and affective components implicated in meeting patients' overall needs for care as the patient and physician cope with uncertainty through the process of establishing an MS diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Breaching confidentiality: medical mandatory reporting laws in Iran

PubMed Central

Milanifar, Alireza; Larijani, Bagher; Paykarzadeh, Parvaneh; Ashtari, Golanna; Mehdi Akhondi, Mohammad

2014-01-01

Medical ethics is a realm where four important subjects of philosophy, medicine, theology and law are covered. Physicians and philosophers cooperation in this area will have great efficiency in the respective ethical rules formation. In addition to respect the autonomy of the patient, physician’s obligation is to ensure that the medical intervention has benefit for the patient and the harm is minimal. There is an obvious conflict between duty of confidentiality and duty of mandatory reporting. Professional confidentiality is one of the basic components in building a constant physician-patient relationship which nowadays, beside the novelty, it is the subject of discussion. Legal obligation of confidentiality is not absolute. In physician-patient relationship, keeping patient’s secrets and maintaining confidentiality is a legal and ethical duty, and disclosure of such secrets is mainly through specific statutes. Thus, there are a number of situations where breach of confidentiality is permitted in different legal systems. One of the situations where breaching confidentiality is permitted is the medical mandatory reporting to the relevant authority which is in accordance with many countries’ legal systems. Some situations are considered in many countries legal systems’ such as notification of births and deaths, infectious diseases, child abuse, sport and relevant events, medical errors, drug side effects and dangerous pregnancies. In this paper, we will examine and discuss medical mandatory reporting and its ethical and legal aspects in the judicial and legal system of Iran and few other countries. Finally we will suggest making Medical Mandatory Reporting Law in Iran. PMID:25512832

Breaching confidentiality: medical mandatory reporting laws in Iran.

PubMed

Milanifar, Alireza; Larijani, Bagher; Paykarzadeh, Parvaneh; Ashtari, Golanna; Mehdi Akhondi, Mohammad

2014-01-01

Medical ethics is a realm where four important subjects of philosophy, medicine, theology and law are covered. Physicians and philosophers cooperation in this area will have great efficiency in the respective ethical rules formation. In addition to respect the autonomy of the patient, physician's obligation is to ensure that the medical intervention has benefit for the patient and the harm is minimal. There is an obvious conflict between duty of confidentiality and duty of mandatory reporting. Professional confidentiality is one of the basic components in building a constant physician-patient relationship which nowadays, beside the novelty, it is the subject of discussion. Legal obligation of confidentiality is not absolute. In physician-patient relationship, keeping patient's secrets and maintaining confidentiality is a legal and ethical duty, and disclosure of such secrets is mainly through specific statutes. Thus, there are a number of situations where breach of confidentiality is permitted in different legal systems. One of the situations where breaching confidentiality is permitted is the medical mandatory reporting to the relevant authority which is in accordance with many countries' legal systems. Some situations are considered in many countries legal systems' such as notification of births and deaths, infectious diseases, child abuse, sport and relevant events, medical errors, drug side effects and dangerous pregnancies. In this paper, we will examine and discuss medical mandatory reporting and its ethical and legal aspects in the judicial and legal system of Iran and few other countries. Finally we will suggest making Medical Mandatory Reporting Law in Iran.

45 CFR 73.735-904 - Resolution of apparent or actual conflicts of interest.

Code of Federal Regulations, 2012 CFR

2012-10-01

... interest. 73.735-904 Section 73.735-904 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... to his or her official duties, and the reviewing official, in consultation with a deputy ethics counselor or the Department Ethics Counselor, determines that the financial interest is not so substantial...

45 CFR 73.735-904 - Resolution of apparent or actual conflicts of interest.

Code of Federal Regulations, 2013 CFR

2013-10-01

... interest. 73.735-904 Section 73.735-904 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... to his or her official duties, and the reviewing official, in consultation with a deputy ethics counselor or the Department Ethics Counselor, determines that the financial interest is not so substantial...

45 CFR 73.735-904 - Resolution of apparent or actual conflicts of interest.

Code of Federal Regulations, 2014 CFR

2014-10-01

... interest. 73.735-904 Section 73.735-904 Public Welfare Department of Health and Human Services GENERAL... to his or her official duties, and the reviewing official, in consultation with a deputy ethics counselor or the Department Ethics Counselor, determines that the financial interest is not so substantial...

45 CFR 73.735-904 - Resolution of apparent or actual conflicts of interest.

Code of Federal Regulations, 2010 CFR

2010-10-01

... interest. 73.735-904 Section 73.735-904 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... to his or her official duties, and the reviewing official, in consultation with a deputy ethics counselor or the Department Ethics Counselor, determines that the financial interest is not so substantial...

45 CFR 73.735-904 - Resolution of apparent or actual conflicts of interest.

Code of Federal Regulations, 2011 CFR

2011-10-01

... interest. 73.735-904 Section 73.735-904 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... to his or her official duties, and the reviewing official, in consultation with a deputy ethics counselor or the Department Ethics Counselor, determines that the financial interest is not so substantial...

Ethical Parenting of Sexually Active Youth: Ensuring Safety While Enabling Development

ERIC Educational Resources Information Center

Bay-Cheng, Laina Y.

2013-01-01

The protection of children from harm is commonly accepted as the cardinal duty of parents. In the USA, where young people's sexuality is often regarded with anxiety, attempts to restrict adolescent sexual behaviour are seen as ethically justified and even required of "good" parents. Running counter to popular anxiety surrounding young…

Digital Citizenship: Developing an Ethical and Responsible Online Culture

ERIC Educational Resources Information Center

Oxley, Cathy

2010-01-01

Responsible and ethical use of the Internet is not something that teenagers, in particular, consider to be important, and serious consequences are beginning to emerge as a result of careless and offensive online behaviour. Teachers and teacher-librarians have a duty of care to make students aware of the potentially devastating effects of…

Engineering Codes of Ethics and the Duty to Set a Moral Precedent.

PubMed

Schlossberger, Eugene

2016-10-01

Each of the major engineering societies has its own code of ethics. Seven "common core" clauses and several code-specific clauses can be identified. The paper articulates objections to and rationales for two clauses that raise controversy: do engineers have a duty (a) to provide pro bono services and/or speak out on major issues, and (b) to associate only with reputable individuals and organizations? This latter "association clause" can be justified by the "proclamative principle," an alternative to Kant's universalizability requirement. At the heart of engineering codes of ethics, and implicit in what it is to be a moral agent, the "proclamative principle" asserts that one's life should proclaim one's moral stances (one's values, principles, perceptions, etc.). More specifically, it directs engineers to strive to insure that their actions, thoughts, and relationships be fit to offer to their communities as part of the body of moral precedents for how to be an engineer. Understanding codes of ethics as reflections of this principle casts light both on how to apply the codes and on the distinction between private and professional morality.

American College of Physicians Ethics Manual: sixth edition.

PubMed

Snyder, Lois

2012-01-03

Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.

The Ethics of Organ Tourism: Role Morality and Organ Transplantation.

PubMed

Adams, Marcus P

2017-11-15

Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to relist organ tourists. Specifically, I contend that we should locate physicians' duties in these cases within the new role of "transplant physician." This role results from transplant physicians' participation in a system that depends on organ donors' voluntary act of donation. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cesarean delivery on maternal request: Can the ethical problem be solved by the principlist approach?

PubMed Central

Nilstun, Tore; Habiba, Marwan; Lingman, Göran; Saracci, Rodolfo; Da Frè, Monica; Cuttini, Marina

2008-01-01

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice). Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging. PMID:18559083

Cesarean delivery on maternal request: can the ethical problem be solved by the principlist approach?

PubMed

Nilstun, Tore; Habiba, Marwan; Lingman, Göran; Saracci, Rodolfo; Da Frè, Monica; Cuttini, Marina

2008-06-17

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice).Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging.

Ethical Virtues in Scientific Research

PubMed Central

Resnik, David B.

2012-01-01

Most approaches to promoting integrity in research are principle-based in that they portray ethical conduct as consisting of adherence to ethical rules, duties, or responsibilities. Bruce MacFarlane has recently criticized the principle-based approach to promoting integrity in research and offered a virtue-based alternative. MacFarlane argues that principle-based approaches do not provide adequate guidance for ethical decision-making and are not very useful in moral education. In this article, I examine and critique MacFarlane’s defense of the virtue-based approach. I argue that virtue-based and principle-based approaches to ethics are complementary and that they both can help promote research integrity. PMID:23074991

Ethical virtues in scientific research.

PubMed

Resnik, David B

2012-01-01

Most approaches to promoting integrity in research are principle-based in that they portray ethical conduct as consisting of adherence to ethical rules, duties, or responsibilities. Bruce MacFarlane has recently criticized the principle-based approach to promoting integrity in research and offered a virtue-based alternative. MacFarlane argues that principle-based approaches do not provide adequate guidance for ethical decision-making and are not very useful in moral education. In this article, I examine and critique MacFarlane's defense of the virtue-based approach. I argue that virtue-based and principle-based approaches to ethics are complementary and that they both can help promote research integrity.

2015 QuickCompass of Sexual Assault Prevention and Response-Related Responders (QSAPR). Overview Report

DTIC Science & Technology

2016-03-01

experience ethical dilemmas in conducting the program. SARCs As shown in Table 5, the most frequently performed duty of SARCs, to a large extent...to indicate they experience ethical dilemmas in conducting the program, whereas SARCs in the Air Force (23%) were less likely. VAs As shown in...the Navy (41%) were more likely to indicate they experience ethical dilemmas in conducting the program, whereas VAs in the Air Force (31%) were less

Robot Wars: Legal and Ethical Dilemmas of Using Unmanned Robotics Systems in 21st Century Warfare and Beyond

DTIC Science & Technology

2008-06-12

becoming a reality (Edwards 2005, 30). In theory , the new sensory systems would acquire electrical signatures emitting from distant communication...rationalization regarding the increased use of technology that may be employed during war. According to Hinman, The Ethics of Duty Theory and The...Utilitarianism Theory provide the theoretical framework that best describes how the current Law of War and philosophy of ethics define the virtue of

[Retraction of papers in bioethics: proposal for a paradigmatic case].

PubMed

Herranz Rodríguez, Gonzalo

2011-01-01

The phenomenon of ethically deficient publication in the field of bioethics is practically unknown. In contrast to the numerous articles and regulations on the ethics of biomedical publications, there is a practical absence of articles devoted to consider the nature, types and prevalence of ethically defective publications in the bioethical literature. No regulatory framework for misbehavior in this field has been proposed until now. Certainly, this is a difficult subject. On one side, it is not easy to draw the ethical limits of the freedoms of thought and expression in bioethics, a discipline that flourishes in the open debate of principles, norms, cases, and imaginary scenarios, where the boundaries between rhetoric and misrepresentation are frequently blurred. After showing some examples of minor violations taken from the literature, the author deals with the moral duty to retract fraudulent bioethical articles, especially when they include deliberate distortions of the data or conclusions from published biomedical research. A detailed analysis of a fraudulent article is made (Haring B. ″New Dimensions of Responsible Parenthood. ″ Theological Studies 37, (1976), 120-132), in which an almost systematic distortion of data and opinions of the cited literature has been made. The article, published in a time of intense and critical protest against the encyclical Humanae vitae, pretends to condemn the methods of natural family planning, the only acceptable means to the Pope, on the allegation that those methods were harmful for the embryo and fetus. According to the author, the retraction of Haring's article is necessary.

The role of national ethics commissions in Finland.

PubMed

Halila, Ritva

2003-08-01

There are six national ethics commissions in Finland. The National Advisory Board on Research Ethics was first established in 1991, followed by the National Advisory Board on Biotechnology and the Board on Gene Technology in 1995. The National Advisory Board on Health Care Ethics was established in 1998, followed by its Sub-Committee on Medical Research Ethics in 1999. The Co-operation Group for Laboratory Animal Sciences was established in 2001. Only the Board on Gene Technology works as a national authority and gives binding opinions and recommendations about the use of genetically modified organisms. The Sub-Committee on Medical Research Ethics acts a national research ethics committee and gives opinions about research projects. Other advisory boards do not make legally binding decisions, but their expertise gives a lot of power to their opinions and statements. The commissions work in close collaboration with each other, having regular meetings. They arrange seminars and conferences, and share information with each other. The commissions also share duties and information in international collaboration. How the voice and opinions of these commissions is heard in society lies in the wide, multi-professional expertise of their members. Large commissions and wide expertise may make it difficult to find consensus in their opinions and statements, although wide expertise may, more than discussion in a small expert group, help to further process difficult ethical issues. Collaboration between different bodies is important in order to share duties, and also to add more emphasis to the statements and opinions where different bodies share interests. In our country, the interest that national commissions share is research ethics, where the advisory boards and their members have discharged collaborative activities for years.

The Roles, Duties, and Ethical Responsibilities of the Chief Financial Officer. Perspectives…Presenting Thought Leaders' Points of View

ERIC Educational Resources Information Center

Ladd, Lawrence R.

2011-01-01

Released in conjunction with the "Sustaining an Ethical Culture on Campus" webcast, this essay in the "Perspectives" series examines the complexities of the role of the chief financial officer. This white paper focuses on how the financial leader of an institution must balance technical knowledge along with stellar…

The Danger-to-Self-or-Others Exception to Confidentiality. ACA Legal Series, Volume 8.

ERIC Educational Resources Information Center

Ahia, C. Emmanuel; Martin, Dan

A counselor's obligation to safeguard information shared in counseling has clinical, ethical, and legal implications. This volume focuses on the duty-to-warn exception in client confidentiality. It provides general ethical and legal guidelines and, where possible, specific information to help the practitioner make good choices. It is intended for…

[Research ethics and the use of placebo: status of the debate in Canada].

PubMed

Keating, Bernard

2004-01-01

The question of the use of the placebo is one of the most controversial in the field of the ethics of research today. The use of the placebo remains the standard practice of biomedical research in spite of the fact that various revisions of the Helsinki Declaration have sought to limit its use. In Canada, the Tri-council policy statement: Ethical conduct for research involving humans adopted a very restrictive position with respect to the use of placebos, precisely defining the situations in which its use would meet the demands of ethical research. The positions taken by the various ethical decision-making bodies are, however, hardly shared by regulatory bodies such as the Food and drug administration (FDA), the Council for international organization of medical sciences (CIOMS) or the European agency for the evaluation of medicinal products (EMEA). This divergence of opinions reveals two quite different conceptions of what constitutes the ethical. In the case of decision-making bodies in the ethical field, it is clearly medicine's Hippocratic Oath which explains their reluctance to use placebos. The first responsibility of the doctor is to "do no harm" to his or her patient. This duty is inherent to the medical profession and as such is not grounded in the view of medicine as a contract for care. In the case of regulatory bodies, it is the vision of "medicine as contract" which is in view; and it is this notion that justifies the use of placebos once free and informed consent has been obtained. It is also worth noting that these regulatory bodies make frequent use of arguments based on utilitarian ends. In an unprecedented move, the World medical association published in October 2001 a clarification note about the use of placebos. An analysis of this text raises the question about its real meaning: clarification or concession?

Reflections on bioethics: consolidation of the principle of autonomy and legal aspects.

PubMed

Segre, M

1999-01-01

The author highlights the importance of emotions in all ethical reflections. He describes the most common positions of ethicists employing duties and rights as the basis for ethical thought. The author, goes to Freudian theory as viewed by the utilitarians, stating that the 'quest for pleasure' is not necessarily egocentric, especially for adults. For example, the feeling of solidarity emerges 'from the inside out', making irrelevant all the emphasis laid on obedience to duty (from the outside in). The article questions the essence of Kantian theory, based exclusively on 'reason' with disregard for feelings, by establishing what he considers a 'positivist' view of rational thought. It emphasizes the principle of autonomy, which it seen as basically opposing the principles of beneficence and fairness. It is proposed that the latter should be seen as what he calls heteronomy (a concept different from that of the rational ethicists). In theory, autonomy is not assigned to anyone on the basis of an external assessment. Any intervention in individual autonomy must be made (by the intervenor) when it becomes imperative in the defense of social or cultural values. The article distinguishes between ethics and morals) and states that the sole acceptable ethical principle is that ethics (theoretically) has no principle.

Can ethics survive the onslaught of science?

PubMed

Lupton, Michael

2013-09-01

The issue on which I will attempt to cast some light is certainly not novel. It has been ongoing for many years but the pace of scientific progress is gathering and the retreat of ethical barriers is relentless. I will illustrate my thesis by using examples of legal decisions from the realm of assisted human procreation and the posthumous conception of children from the sperm of deceased fathers e.g., the cases of Diane Blood, Parpalaix and Nikolas Coltan Evans. I will also highlight the recent case of Ashley X, a nine year old girl whose parents authorised radical medical treatment to arrest her development. I will argue that the law is being driven to roll back the ethical standards derived from our legacy of Natural Law by the imperatives of human rights e.g., the right to found a family, and the quest for patient autonomy. These are both admirable goals but fulfilling these goals comes at a cost to cherished ethical values e.g., that children are conceived by living fathers and that indulging the personal desires of every individual cannot forever be encompassed. As our legislators and courts chip away at our core network of ethical values, are they replacing them with equivalent values or do their decisions amount to a hollowing out of the core ethical values e.g., Thou shalt not kill and that human life is sacrosanct? Yet abortion is legal in many countries as is euthanasia. Paradoxically there is legislative protection for embryos by limiting experimentation on these clusters of cells. How do you construct a rational ethical framework with such blatant legal inconsistencies in the protection of human life? The sanctity of human life constitutes one of the fundamental pillars of ethical values which, in turn, support much more of the structure of ethics. Is a society that permits freezing the development of a nine year old child not a society whose ethics are so compromised that it is doomed to defend an ever diminishing mass of ethical values? Is there a core of ethics which is sacrosanct or is every ethical frontier fair game for invasion? Are the Ethics Committees, which approve and monitor research in the field of bioethics in Universities. Hospitals and laboratories failing in their duty as gatekeepers? They are after all the first line of defence for the survival of crucial ethical values. Can we continue to indulge the whims and needs of every individual under the guise of human rights or patient autonomy? Can a civilised society endure as such with an ever diminishing mass of ethical values?

The Legal Implications of Report Back in Household Exposure Studies

PubMed Central

Goho, Shaun A.

2016-01-01

Background: Scientists conducting research into household air or dust pollution must decide whether, when, and how to disclose to study participants their individual results. A variety of considerations factor into this decision, but one factor that has not received attention until now is the possibility that study participants’ receipt of their results might create legal duties under environmental, property, landlord–tenant, or other laws. Objectives: This article examines relevant laws and regulations and explores the scope of participants’ legal duties and the resulting legal and ethical consequences for researchers. Participants could be required in some situations to disclose the presence of certain chemicals when selling or renting their homes or to frequent visitors. The article discusses hypothetical case studies involving the reporting back of results regarding lead, polychlorinated biphenyls, and phthalates. Discussion: The potential legal duties of study participants have both ethical and legal implications for researchers. Issues include whether the legal consequences for participants should affect the decision whether to report back individual results, how researchers should disclose the legal risks to participants during the informed consent process, and whether researchers would be liable to study participants for legal or economic harm arising from reporting study results to them. The review provides recommendations for language that researchers could use in the informed consent process to disclose the legal risks. Conclusions: Researchers should still report back to participants who want to see their results, but they should disclose the risks of obtaining the information as part of the informed consent process. Citation: Goho SA. 2016. The legal implications of report back in household exposure studies. Environ Health Perspect 124:1662–1670; http://dx.doi.org/10.1289/EHP187 PMID:27153111

The Legal Implications of Report Back in Household Exposure Studies.

PubMed

Goho, Shaun A

2016-11-01

Scientists conducting research into household air or dust pollution must decide whether, when, and how to disclose to study participants their individual results. A variety of considerations factor into this decision, but one factor that has not received attention until now is the possibility that study participants' receipt of their results might create legal duties under environmental, property, landlord-tenant, or other laws. This article examines relevant laws and regulations and explores the scope of participants' legal duties and the resulting legal and ethical consequences for researchers. Participants could be required in some situations to disclose the presence of certain chemicals when selling or renting their homes or to frequent visitors. The article discusses hypothetical case studies involving the reporting back of results regarding lead, polychlorinated biphenyls, and phthalates. The potential legal duties of study participants have both ethical and legal implications for researchers. Issues include whether the legal consequences for participants should affect the decision whether to report back individual results, how researchers should disclose the legal risks to participants during the informed consent process, and whether researchers would be liable to study participants for legal or economic harm arising from reporting study results to them. The review provides recommendations for language that researchers could use in the informed consent process to disclose the legal risks. Researchers should still report back to participants who want to see their results, but they should disclose the risks of obtaining the information as part of the informed consent process. Citation: Goho SA. 2016. The legal implications of report back in household exposure studies. Environ Health Perspect 124:1662-1670; http://dx.doi.org/10.1289/EHP187.

Ethical persuasion: the rhetoric of communication in critical care.

PubMed

Dubov, Alex

2015-06-01

This article reviews the ethics of rhetoric in critical care. Rational appeals in critical care fail to move patients or surrogates to a better course of action. Appeals to their emotions are considered illegitimate because they may preclude autonomous choice. This article discusses whether it is always unethical to change someone's beliefs, whether persuasive communication is inherently harmful and whether it leaves no space for voluntariness. To answer these questions, the article engages with Aristotle's work, Rhetoric. In considering whether there is a place for emotionally charged messages in a patient-provider relationship, the article intends to delineate the nature of this relationship and describe the duties this relationship implies. The article presents examples of persuasive communication used in critical care and discusses whether providers may have a duty to persuade patients. This duty is supported by the fact that doctors often influence patients' and families' choices by framing presented options. Doctors should assume responsibility in recognizing these personal and contextual influences that may influence the medical choices of their patients. They should attempt to modify these contextual factors and biases in a way that would assist patients and families in reaching the desired outcomes. The opening sections surveyed a number of definitions found in relevant literature and outlined some of the concepts included in the proposed definition. This definition helps to distinguish instances of persuasion from cases of manipulation, coercion and deception. Considering the fact that patients and families often make irrational decisions and the fact that doctors inadvertently influence their choices, the article suggested that persuasion can be a positive tool in medical communication. When patients or families clearly do not understand the risks or make decisions that contradict their long-term goals, persuasion can be used as a positive influence. © 2015 John Wiley & Sons, Ltd.

Dental ethics case 6. Stalled payment for ongoing orthodontic treatment--balancing responsibilities.

PubMed

Doyal, L; Naidoo, S

2010-10-01

It is not always easy for an orthodontist to strike the right balance between a caring, supportive and patient-centered approach, and the need to make a living and to run a profitable business in order to achieve this. Striving to act ethically and professionally at all times will help find this elusive balance and ultimately it will be more rewarding and professionally satisfying. Especially when dealing with children whose lives may be dramatically affected by the interruption or cessation of treatment, orthodontists have a duty to reassure themselves about the financial stability of their contractual relationships with patients or parents. Having consistent financial policies and flexible payment options may assist in this regard. Even in the face of non-payment of fees, treatments that have begun must in some form continue if their cessation would compromise the best interests of patients.

Ethical vulnerabilities in nursing history: conflicting loyalties and the patient as 'other'.

PubMed

Lagerwey, Mary Deane

2010-09-01

The purpose of this article is to explore enduring ethical vulnerabilities of the nursing profession as illustrated in historical chapters of nursing's past. It describes these events, then explores two ethical vulnerabilities in depth: conflicting loyalties and duties, and relationships with patients as 'other'. The article concludes with suggestions for more ethical approaches to the other in current nursing practice. The past may be one of the most fruitful sites for examining enduring ethical vulnerabilities of the nursing profession. First of all, professional identity, which includes moral identity, comes in part from knowledge of the nursing profession's past. Second, looking to the past to understand better how events and ideologies have brought vulnerabilities to the fore raises questions about ethical nursing practice today.

Planning and response to the influenza A (H1N1) pandemic: ethics, equity and justice.

PubMed

Devnani, Mahesh; Gupta, Anil Kumar; Devnani, Bharti

2011-01-01

This paper aims to highlight three ethical considerations related to influenza pandemic planning and response: ethical allocation of scarce resources; obligations and duties of healthcare workers to treat patients, and the balance between conflicting individual and community interests. Among these, perhaps the most challenging question facing bioethics is how to allocate scarce, life-saving resources given the devastating social and economic ramifications of a pandemic. In such situations, the identification of clear overall goals for pandemic planning is essential in making difficult choices. The dilemma between the duty to save patients and the right to protect the healthcare personnel's own life and health is a key issue. During the course of a pandemic, civil liberties may also be threatened, requiring limits on individual freedom to protect individuals as well as entire communities. Yet, individual liberty should be restricted with great care, and only when alternative approaches are not effective. Pandemic influenza planning and response should be a cooperative and shared responsibility that balances community and individual interests.

Ethical Obligations in the Face of Dilemmas Concerning Patient Privacy and Public Interests: The Sasebo Schoolgirl Murder Case.

PubMed

Kadooka, Yasuhiro; Okita, Taketoshi; Asai, Atsushi

2016-09-01

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep it confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others' actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. © 2016 John Wiley & Sons Ltd.

Physicians, AIDS, and occupational risk. Historic traditions and ethical obligations.

PubMed

Zuger, A; Miles, S H

1987-10-09

The profound reluctance of some physicians to care for patients with acquired immunodeficiency syndrome prompted us to review medical responses to other historic plagues. No consistent professional tradition emerged. Many physicians, including Galen and Sydenham, fled from patients with contagious epidemic diseases. Many of their colleagues, at considerable personal risk, remained behind to care for plague victims. This inconsistency suggests that an ethic stressing traditional professional duties may not be ideal for defining the optimal relation of the medical profession to patients with acquired immunodeficiency syndrome. A new professional ethic to guide physicians in the acquired immunodeficiency syndrome pandemic is needed. This ethic cannot be entirely derived from these patients' right to health care, which is primarily a claim against society rather than individual practitioners. Civil and professional proscriptions against negligence or abandonment apply only to therapeutic relationships after they are contracted. However, a professional duty to treat human immunodeficiency virus-infected persons could be based on the understanding of medicine as a moral enterprise. In this context, treating human immunodeficiency virus-infected persons is a virtuous act, which meets both patients' and society's health needs and affirms the moral mission of health care.

Conscientious objection or fear of social stigma and unawareness of ethical obligations.

PubMed

Faúndes, Anibal; Duarte, Graciana Alves; Osis, Maria José Duarte

2013-12-01

Conscientious objection is a legitimate right of physicians to reject the practice of actions that violate their ethical or moral principles. The application of that principle is being used in many countries as a justification to deny safe abortion care to women who have the legal right to have access to safe termination of pregnancy. The problem is that, often, this concept is abused by physicians who camouflage under the guise of conscientious objection their fear of experiencing discrimination and social stigma if they perform legal abortions. These colleagues seem to ignore the ethical principle that the primary conscientious duty of OB/GYNs is-at all times-to treat, or provide benefit and prevent harm to, the patients for whose care they are responsible. Any conscientious objection to treating a patient is secondary to this primary duty. One of the jobs of the FIGO Working Group for the Prevention of Unsafe Abortion is to change this paradigm and make our colleagues proud of providing legal abortion services that protect women's life and health, and concerned about disrespecting the human rights of women and professional ethical principles. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing.

PubMed

Clancy, Anne; Svensson, Tommy

2007-07-01

This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform 'hands on' nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906-1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses' stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses' responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.

Ethics, pandemics, and the duty to treat.

PubMed

Malm, Heidi; May, Thomas; Francis, Leslie P; Omer, Saad B; Salmon, Daniel A; Hood, Robert

2008-08-01

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard.

‘Practice what you preach’: Nurses’ perspectives on the Code of Ethics and Service Pledge in five South African hospitals

PubMed Central

White, Janine; Phakoe, Maureen; Rispel, Laetitia C.

2015-01-01

Background A recent focus of the global discourse on the health workforce has been on its quality, including the existence of codes of ethics. In South Africa, the importance of ethics and value systems in nursing was emphasised in the 2011 National Nursing Summit. Objective The study explored hospital nurses’ perceptions of the International Code of Ethics for Nurses; their perceptions of the South African Nurses’ Pledge of Service; and their views on contemporary ethical practice. Methods Following university ethics approval, the study was done at a convenience sample of five hospitals in two South African provinces. In each hospital, all day duty nurses in paediatric, maternity, adult medical, and adult surgical units were requested to complete a self-administered questionnaire. The questionnaire focused on their perceptions of the Code of Ethics and the Pledge, using a seven-point Likert scale. STATA® 13 and NVIVO 10 were used to analyse survey data and open-ended responses, respectively. Results The mean age of survey participants (n=69) was 39 years (SD=9.2), and the majority were female (96%). The majority agreed with a statement that they will promote the human rights of individuals (98%) and that they have a duty to meet the health and social needs of the public (96%). More nuanced responses were obtained for some questions, with 60% agreeing with a statement that too much emphasis is placed on patients’ rights as opposed to nurses’ rights and 32% agreeing with a statement that they would take part in strike action to improve nurses’ salaries and working conditions. The dilemmas of nurses to uphold the Code of Ethics and the Pledge in face of workplace constraints or poor working conditions were revealed in nurses’ responses to open-ended questions. Conclusion Continuing education in ethics and addressing health system deficiencies will enhance nurses’ professional development and their ethical decision-making and practice. PMID:25971398

'Practice what you preach': Nurses' perspectives on the Code of Ethics and Service Pledge in five South African hospitals.

PubMed

White, Janine; Phakoe, Maureen; Rispel, Laetitia C

2015-01-01

A recent focus of the global discourse on the health workforce has been on its quality, including the existence of codes of ethics. In South Africa, the importance of ethics and value systems in nursing was emphasised in the 2011 National Nursing Summit. The study explored hospital nurses' perceptions of the International Code of Ethics for Nurses; their perceptions of the South African Nurses' Pledge of Service; and their views on contemporary ethical practice. Following university ethics approval, the study was done at a convenience sample of five hospitals in two South African provinces. In each hospital, all day duty nurses in paediatric, maternity, adult medical, and adult surgical units were requested to complete a self-administered questionnaire. The questionnaire focused on their perceptions of the Code of Ethics and the Pledge, using a seven-point Likert scale. STATA(®) 13 and NVIVO 10 were used to analyse survey data and open-ended responses, respectively. The mean age of survey participants (n=69) was 39 years (SD=9.2), and the majority were female (96%). The majority agreed with a statement that they will promote the human rights of individuals (98%) and that they have a duty to meet the health and social needs of the public (96%). More nuanced responses were obtained for some questions, with 60% agreeing with a statement that too much emphasis is placed on patients' rights as opposed to nurses' rights and 32% agreeing with a statement that they would take part in strike action to improve nurses' salaries and working conditions. The dilemmas of nurses to uphold the Code of Ethics and the Pledge in face of workplace constraints or poor working conditions were revealed in nurses' responses to open-ended questions. Continuing education in ethics and addressing health system deficiencies will enhance nurses' professional development and their ethical decision-making and practice.

[Honesty and good faith: two cornerstones in the ethics of biomedical publications].

PubMed

Reyes, Humberto

2007-04-01

The editors of medical journals should take the steps necessary to assure its readers that the contents of their publications are based in true data, that they are original and fulfill the ethical rules of biomedical and clinical research, including its reporting. This editors role has become increasingly difficult since the pressure to publish scientific papers is progressively stimulated by the role that those papers play in curricula vitae when the authors apply for university positions, academic promotions, research grants and for their personal prestige. As a consequence, increasing instances of misconduct in scientific publications are detected. Some cases are noticed during the editorial process, mostly when peer reviewers identify redundant publications or plagiarism. Other cases are denounced after a manuscript was published. It is the editors duty to verify the misconduct, request an explanation from the authors and, if their answer is unsatisfactory, report the problem to the institutional authorities supporting the authors. The editors should denounce the situation in a forthcoming issue of the journal. Universities should enforce the teaching of ethical rules that govern the report of scientific information. Revista Médica de Chile follows recommendations given by the International Committee of Medical Journal Editors, the World Association of Medical Editors and other groups, but honesty and good faith in all the actors involved in the process of biomedical publications (authors, reviewers, editors) remain the cornerstones of scientific good behavior.

Against the magnanimous in medical ethics.

PubMed

Kottow, M H

1990-09-01

Supererogatory acts are considered by some to be part of medicine, whereas others accept supererogation to be a gratuitous virtue, to be extolled when present, but not to be demanded. The present paper sides with those contending that medicine is duty-bound to benefit patients and that supererogation/altruism must per definition remain outside and beyond any role-description of the profession. Medical ethics should be bound by rational ethics and steer away from separatist views which grant exclusive privileges but also create excessive demands, way beyond what physicians perform or are willing and able to offer.

Doctors' duty to disclose error: a deontological or Kantian ethical analysis.

PubMed

Bernstein, Mark; Brown, Barry

2004-05-01

Medical (surgical) error is being talked about more openly and besides being the subject of retrospective reviews, is now the subject of prospective research. Disclosure of error has been a difficult issue because of fear of embarrassment for doctors in the eyes of their peers, and fear of punitive action by patients, consisting of medicolegal action and/or complaints to doctors' governing bodies. This paper examines physicians' and surgeons' duty to disclose error, from an ethical standpoint; specifically by applying the moral philosophical theory espoused by Immanuel Kant (ie. deontology). The purpose of this discourse is to apply moral philosophical analysis to a delicate but important issue which will be a matter all physicians and surgeons will have to confront, probably numerous times, in their professional careers.

[The obligation to inform the patient: issues on the right to be informed].

PubMed

Parra S, Darío

2013-12-01

This article aims to analyze, from a legal perspective, the boundaries of the obligation imposed on health care providers to inform the patient. This requirement originated and was developed as an ethical issue. However, with the newly approved law regulating the rights and duties of patients, the obligation to inform can be viewed from prisms and principles that differ from those governing medical ethics. With this purpose, we will focus on the comparative experience, which will allow us to evaluate the responsibility of health care providers when this duty is breached. We will try to answer the following questions: Which medical information must be informed to the patient? When should the doctor inform the patient? In which form should this information be provided?.

[Medicine and conscientious objection].

PubMed

Martínez, K

2007-01-01

Conscientious objection to democratically accepted laws in democratic societies is a fact, both among citizens and among professionals. Due respect for laws is a prima facie duty in these societies. But democratic justice must at the same time respect peoples' conscience for it constitutes the ethical identity of individuals. And both law and ethics are necessary - although neither of them is sufficient - for its realization. The problem of conscientious objection among healthcare professionals is analysed from this standpoint and the conclusion is that objection is not an absolute right to exemption from several duties, but that the responsibility of the professional and of the institutions towards the citizenry must always be taken into account. Some solutions are suggested that try to protect both the professionals and the citizens in a bi-directional way.

Aristotle, nursing and health care ethics.

PubMed

Scott, P A

1995-12-01

Even a brief consideration of the nature of nursing will indicate that an ethical dimension underlies much, if not all, of nursing practice. It is therefore important that students and practitioners are facilitated in developing an ethical awareness and sensitivity from early in their professional development. This paper argues that Aristotelian virtue theory provides a practice-based focus for health care ethics for a number of reasons. Also, because of his emphasis on the character of the moral agent, and on the importance of perception and emotion in moral decision-making, Aristotelian virtue theory provides a useful supplement to the traditional duty-based approaches to health care ethics analysis, which are increasingly being identified in the literature as having limits to their application within the health care context.

The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring.

PubMed

Jones, Barbara L; Contro, Nancy; Koch, Kendra D

2014-02-01

Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.

A code of ethics for health care ethics consultants: journey to the present and implications for the field.

PubMed

Tarzian, Anita J; Wocial, Lucia D

2015-01-01

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.

The epigenetic effects of assisted reproductive technologies: ethical considerations.

PubMed

Roy, M-C; Dupras, C; Ravitsky, V

2017-08-01

The use of assisted reproductive technologies (ART) has increased significantly, allowing many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, as superovulation, fertilization methods and embryo culture could impair the embryo's epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals and society. This paper focuses on ethical issues raised by the consideration of these risks when using ART. We apply two key ethical principles of North American bioethics (respect for autonomy and non-maleficence) and suggest that an ethical tension may emerge from conflicting duties to promote the reproductive autonomy of prospective parents on one hand, and to minimize risks to prospective children on the other. We argue that this tension is inherent to the entire enterprise of ART and thus cannot be addressed by individual clinicians in individual cases. We also consider the implications of the 'non-identity problem' in this context. We call for additional research that would allow a more robust evidence base for policy. We also call upon professional societies to provide clinicians with guidelines and educational resources to facilitate the communication of epigenetic risks associated with ART to patients, taking into consideration the challenges of communicating risk information whose validity is still uncertain.

Teaching moral reasoning to student nurses.

PubMed

Weber, J R

1992-09-01

Teaching moral reasoning to students is a challenge for all nursing educators. The National League for Nursing and American Nurses' Association emphasize the importance of ethical content within the curriculum. Review of the literature indicates that ethics has been part of the nursing curriculum since the early 1900s. However, the focus of nursing ethics has changed to more critical reflective thinking versus duties and etiquette. Educators have used a variety of methods for teaching ethics and integrating it into the curriculum. Yet nursing graduates still lack adequate skills to be morally accountable practitioners. This creates a dilemma for the educator to find ways to integrate more ethics content into an already crowded curriculum. The code of ethics of holistic nurses may serve as a basis to guide nurse educators in resolving some of the problems encountered in promoting moral education.

Nursing students' responses to ethical dilemmas in nursing practice.

PubMed

Dierckx de Casterlé, B; Grypdonck, M; Vuylsteke-Wauters, M; Janssen, P J

1997-01-01

In literature as well as in nursing practice a growing concern about nurses' ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students' ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg's definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg's theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.

Respecting patient autonomy versus protecting the patient's health: a dilemma for healthcare providers.

PubMed

Badger, James M; Ladd, Rosalind Ekman; Adler, Paul

2009-01-01

A 74-year-old man with multiple chronic medical problems was hospitalized for respiratory distress. He experienced recurrent aspiration and required frequent suctioning and endotracheal intubation on several occasions. The patient was deemed competent and steadfastly refused feeding tube placement. The patient demanded that he be allowed to eat a normal diet despite being told that it could lead to his death. The patient wanted to go home, but there was no one there to care for him. Additionally, neither a nursing home nor hospice would accept him in his present condition. The case is especially interesting because of the symbolic value of food and the plight of the patient who has no alternative to hospitalization. The hospital staff experienced considerable stress at having to care for him. They were uncertain whether their obligation was to respect his autonomy and continue to provide food or to protect his health by avoiding aspiration, pneumonia, and possible death by denying him food. This ethical dilemma posed by the professionals' duty to do what is in the patient's best interest versus the patient's right to decide treatment serves as the focus for this case study. Ethical, legal, and healthcare practitioners' considerations are explored. The case study concludes with specific recommendations for treatment.

How to Implement the Ways of Knowing through the Realms of Meaning as an Ethical Decision-Making Process to Improve Academic Achievement--Ten Recommendations

ERIC Educational Resources Information Center

Skinner, Desiree A.; Kritsonis, William Allan

2006-01-01

"Values, purposes, and understandings are fragile achievements and give way all too readily to attitudes of futility, frustration, and doubt" (Kritsonis, 2007, pg. 7). Ethical decision-making is one way for school leaders to contribute to improving education. Effecting change is the duty of school principals; this may often come in making…

Ethics in child and adolescent psychiatric care: An international perspective.

PubMed

Koelch, Michael; Fegert, Joerg M

2010-01-01

In the treatment of children with psychiatric disorders as a vulnerable population, ethical issues arise that seldom come into play with adults. The UN Conventions on the Rights of the Child and the Rights of Persons with Disabilities set out rights to be respected in child and adolescent psychiatric treatment. Rights of participation and inclusion (minimizing of barriers to the involvement of disabled people) can create complex problems in cases of restraint or deprivation of liberty. This paper analyses the consequences of these conventions and other ethics guidelines on child and adolescent psychiatric treatment and research. Beneficence, justice and autonomy are core principles that are mirrored in the problems of inclusion and protection, confidentiality, and the safety of psychopharmacological interventions. Factors of inclusion are involved in the areas of availability of care, participation in best evidence-based treatment, and research. The right of the child to protection, the right of inclusion, and parents' rights and duties to safeguard their child's wellbeing form a triangle. National laws to regulate the treatment of psychiatrically ill children should be created and implemented and these should be non-discriminatory but at the same time safeguard the developing human being.

Notifying patients exposed to blood products associated with Creutzfeldt-Jakob disease: integrating science, legal duties and ethical mandates

PubMed Central

Caulfield, T; Dossetor, J; Boshkov, L; Hannon, J; Sawyer, D; Robertson, G

1997-01-01

The issue of notifying people who have been exposed to blood products that have been associated with Creutzfeldt-Jakob disease (CJD) has arisen at a time when the Canadian blood system is under intense scrutiny. As a result, the Canadian Red Cross Society issued a recommendation to health care institutions that recipients of CJD-associated blood products be identified, notified and counselled. Although Canadian jurisprudence in the realm of informed consent may support a policy of individual notification, a review of the scientific evidence and the applicable ethical principles arguably favours a policy of a more general public notification. Indeed, situations such as this require a unique approach to the formation of legal and ethical duties, one that effectively integrates all relevant factors. As such, the authors argue that individual notification is currently not justified. Nevertheless, if a system of general notification is implemented (e.g., through a series of public health announcements), it should provide, for people who wish to know, the opportunity to find out whether they were given CJD-associated products. PMID:9371070

Human Trafficking in Areas of Conflict: Health Care Professionals' Duty to Act.

PubMed

Bloem, Christina; Morris, Rikki E; Chisolm-Straker, Makini

2017-01-01

Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked. © 2017 American Medical Association. All Rights Reserved.

Ethical decision making in pain management: a conceptual framework.

PubMed

Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

2018-01-01

The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician-patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding "last-ditch" treatments of severe pain; and 6) failure to be accountable and equitable. The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound.

Duty to speak up in the health care setting a professionalism and ethics analysis.

PubMed

Topazian, Rachel J; Hook, C Christopher; Mueller, Paul S

2013-11-01

Staff and students working in health care settings are sometimes reluctant to speak up when they perceive patients to be at risk for harm. In this article, we describe four incidents that occurred at our institution (Mayo Clinic). In two of them, health care professionals failed to speak up, which resulted in harm; in the other two, they did speak up, which prevented harm and improved patient care. We analyzed each scenario using the Physician's Charter on Medical Professionalism and prima facie ethics principles to determine whether principles were violated or upheld. We conclude that anyone who works in a health care setting has a duty to speak up when a patient faces harm. We also provide guidance for health care institutions on promoting a culture in which speaking up is encouraged and integrated into routine practice.

Ethical issues identified by obstetrics and gynecology learners through a novel ethics curriculum.

PubMed

Mejia, Rachel B; Shinkunas, Laura A; Ryan, Ginny L

2015-12-01

Obstetrics and gynecology (ob/gyn) is fraught with bioethical issues, the professional significance of which may vary based on clinical experience. Our objective was to utilize our novel ethics curriculum to identify ethics and professionalism issues highlighted by ob/gyn learners and to compare responses between learner levels to further inform curricular development. We introduced an integrated and dynamic ob/gyn ethics and professionalism curriculum and mixed methods analysis of 181 resulting written reflections (case observation and assessments) from third-year medical students and from first- to fourth-year ob/gyn residents. Content was compared by learner level using basic thematic analysis and summary statistics. Within the 7 major ethics and professionalism domains, learners wrote most frequently about miscellaneous ob/gyn issues such as periviability and abortion (22% of students, 20% of residents) and problematic treatment decisions (20% of students, 19% of residents) rather than professional duty, communication, justice, student-/resident-specific issues, or quality of care. The most commonly discussed ob/gyn area by both learner groups was obstetrics rather than gynecology, gynecologic oncology, or reproductive endocrinology and infertility, although residents were more likely to discuss obstetrics-related concerns than students (65% vs 48%; P = .04) and students wrote about gynecologic oncology-related concerns more frequently than residents (25% vs 6%; P = .002). In their reflections, sources of ethical value (eg, the 4 classic ethics principles, professional guidelines, and consequentialism) were cited more frequently and in greater number by students than by residents (82% of students cited at least 1 source of ethical value vs 65% of residents; P = .01). Residents disagreed more frequently with the ethical propriety of clinical management than did students (67% vs 43%; P = .005). Our study introduces an innovative and dynamic approach to an ob/gyn ethics and professionalism curriculum that highlights important learner-identified ethics and professionalism issues both specific to ob/gyn and common to clinical medicine. Findings will help ob/gyn educators best utilize and refine this flexible curriculum such that it is appropriately focused on topics relevant to each learner level. Copyright © 2015 Elsevier Inc. All rights reserved.

Five key players shape institution's ethical character.

PubMed

Craig, R P; Middleton, C J; O'Connell, L J

1986-05-01

Various individuals or groups play important roles in achieving moral insight and direction in a health care facility. The administration, medical and nursing staffs, the professional theologian, and the bishop all contribute unique perspectives to the complex process of developing an institution's ethical character. An institutional ethics committee's (IEC's) effectiveness depends largely on the administrator's ability to support educational programming in ethics for the entire staff, coordinate ethical reflection throughout the organization, and shape ethically informed policy based on an IEC's practical experience. The medical staff brings its scientific background and practical experience to ethical issues under a committee's consideration, and nurses offer valuable insights based on their close contact with patients and family. The theologian provides resources and background on Catholic tradition as well as information on current theological developments. The IEC also should maintain a relationship with the local bishop whose duty is to articulate the Church's positions in health care ethics. Forthright dialogue among all parties is central to the IEC's task.

The duty to do the best for one's patient.

PubMed

Crisp, Roger

2015-03-01

This paper is a discussion of the duty of doctors to do what is best for their patients. What is required by this duty is shown to depend on the circumstances, including any financial constraints on the doctor. The duty to do the best is a duty of benevolence, and this virtue itself has to be understood as bounded by other virtues, including justice and professional responsibility. An Aristotelian account of medical benevolence is developed, and the issues of supererogation and individual judgement are discussed within this framework. The paper ends with the claim that the patient-centred conception of benevolence defended in the paper is in line with consequentialist and deontological ethical traditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Adolescents' health choices related rights, duties and responsibilities: An integrative review.

PubMed

Moilanen, Tanja; Pietilä, Anna-Maija; Coffey, Margaret; Kangasniemi, Mari

2016-08-11

Although the link between adolescents' health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject. To identify, describe and synthesize previous studies on adolescents' health choices in relation to rights, duties and responsibilities. Ethical approval is not needed as it is an integrative review of published literature. The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies. The review identified 13 studies. Adolescents' health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned. Research into adolescents' health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents' health promotion initiatives and increase their involvement opportunities. © The Author(s) 2016.

Against the magnanimous in medical ethics.

PubMed Central

Kottow, M H

1990-01-01

Supererogatory acts are considered by some to be part of medicine, whereas others accept supererogation to be a gratuitous virtue, to be extolled when present, but not to be demanded. The present paper sides with those contending that medicine is duty-bound to benefit patients and that supererogation/altruism must per definition remain outside and beyond any role-description of the profession. Medical ethics should be bound by rational ethics and steer away from separatist views which grant exclusive privileges but also create excessive demands, way beyond what physicians perform or are willing and able to offer. PMID:2231634

Analyzing the politico-moral foundations of the Iran’s health system based on theories of justice

PubMed Central

Akrami, Forouzan; Abbasi, Mahmoud; Karimi, Abbas; Shahrivari, Akbar; Majdzadeh, Reza; Zali, Alireza

2017-01-01

Public health ethics is a field that covers both factual and ethical issues in health policy and science, and has positive obligations to improve the well-being of populations and reduce social inequalities. It is obvious that various philosophies and moral theories can differently shape the framework of public health ethics. For this reason, the present study reviewed theories of justice in order to analyze and criticize Iran’s general health policies document, served in 14 Articles in 2014. Furthermore, it explored egalitarianism as the dominant theory in the political philosophy of the country’s health care system. According to recent theories of justice, however, health policies must address well-being and its basic dimensions such as health, reasoning, autonomy, and the role of the involved agencies and social institutions in order to achieve social justice beyond distributive justice. Moreover, policy-making in the field of health and biomedical sciences based on Islamic culture necessitates a theory of social justice in the light of theological ethics. Educating people about their rights and duties, increasing their knowledge on individual agency, autonomy, and the role of the government, and empowering them will help achieve social justice. It is recommended to design and implement a strategic plan following each of these policies, based on the above-mentioned values and in collaboration with other sectors, to clarify the procedures in every case. PMID:29291037

Analyzing the politico-moral foundations of the Iran's health system based on theories of justice.

PubMed

Akrami, Forouzan; Abbasi, Mahmoud; Karimi, Abbas; Shahrivari, Akbar; Majdzadeh, Reza; Zali, Alireza

2017-01-01

Public health ethics is a field that covers both factual and ethical issues in health policy and science, and has positive obligations to improve the well-being of populations and reduce social inequalities. It is obvious that various philosophies and moral theories can differently shape the framework of public health ethics. For this reason, the present study reviewed theories of justice in order to analyze and criticize Iran's general health policies document, served in 14 Articles in 2014. Furthermore, it explored egalitarianism as the dominant theory in the political philosophy of the country's health care system. According to recent theories of justice, however, health policies must address well-being and its basic dimensions such as health, reasoning, autonomy, and the role of the involved agencies and social institutions in order to achieve social justice beyond distributive justice. Moreover, policy-making in the field of health and biomedical sciences based on Islamic culture necessitates a theory of social justice in the light of theological ethics. Educating people about their rights and duties, increasing their knowledge on individual agency, autonomy, and the role of the government, and empowering them will help achieve social justice. It is recommended to design and implement a strategic plan following each of these policies, based on the above-mentioned values and in collaboration with other sectors, to clarify the procedures in every case.

HIV prevention and the two faces of partner notification.

PubMed Central

Bayer, R; Toomey, K E

1992-01-01

In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made. PMID:1304728

Science and society: different bioethical approaches towards animal experimentation.

PubMed

Brom, Frans W A

2002-01-01

The use of live animals for experiments plays an important role in many forms of research. This gives rise to an ethical dilemma. On the one hand, most of the animals used are sentient beings who may be harmed by the experiments. The research, on the other hand, may be vital for preventing, curing or alleviating human diseases. There is no consensus on how to tackle this dilemma. One extreme is the view taken by adherents of the so-called animal rights view. According to this view, we are never justified in harming animals for human purposes - however vital these purposes may be. The other extreme is the ruthless view, according to which animals are there to be used at our discretion. However, most people have a view situated somewhere between these two extremes. It is accepted that animals may be used for research - contrary to the animal rights view. However, contrary to the ruthless view, that is only accepted under certain conditions. The aim of this presentation is to present different ethical views which may serve as a foundation for specifying the circumstances under which it is acceptable to use animals for research. Three views serving this role are contractarianism, utilitarianism and a deontological approach. According to contractarianism, the key ethical issue is concern for the sentiments of other human beings in society, on whose co-operation those responsible for research depend. Thus it is acceptable to use animals as long as most people can see the point of the experiment and are not offended by the way it is done. According to utilitarianism, the key ethical issue is about the consequences for humans and animals. Thus it is justified to use animals for research if enough good comes out of it in terms of preventing suffering and creating happiness, and if there is no better alternative. In the deontological approach the prima facie duty of beneficence towards human beings has to be weighed against the prima facie duties not to harm animals and to respect their integrity. By weighing these prima facie duties, the moral problem of animal experimentation exists in finding which duty actually has to be considered as the decisive duty. It will be argued that these three views, even though they will all justify animal experimentation to some extent, will do so in practice under different conditions. Many current conflicts regarding the use of animals for research may be better understood in light of the conflict between the three bioethical perspectives provided by these views.

42 CFR 460.71 - Oversight of direct participant care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... organization must provide each employee and all contracted staff with an orientation. The orientation must... plan, ethics, the PACE benefit, and any policies related to the job duties of specific staff. (2) The...

Breakdowns in communication of radiological findings: an ethical and medico-legal conundrum

PubMed Central

Murphy, Daniel R.; Singh, Hardeep

2016-01-01

Communication problems in diagnostic testing have increased in both number and importance in recent years. The medical and legal impact of failure of communication is dramatic. Over the past decades, the courts have expanded and strengthened the duty imposed on radiologists to timely communicate radiologic abnormalities to referring physicians and perhaps the patients themselves in certain situations. The need to communicate these findings goes beyond strict legal requirements: there is a moral imperative as well. The Code of Medical Ethics of the American Medical Association points out that “Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties.” Thus, from the perspective of the law, radiologists are required to communicate important unexpected findings to referring physicians in a timely fashion, or alternatively to the patients themselves. From a moral perspective, radiologists should want to effect such communications. Practice standards, moral values, and ethical statements from professional medical societies call for full disclosure of medical errors to patients affected by them. Surveys of radiologists and non-radiologic physicians reveal that only few would divulge all aspects of the error to the patient. In order to encourage physicians to disclose errors to patients and assist in protecting them in some manner if malpractice litigation follows, more than 35 states have passed laws that do not allow a physician’s admission of an error and apologetic statements to be revealed in the courtroom. Whether such disclosure increases or decreases the likelihood of a medical malpractice lawsuit is unclear, but ethical and moral considerations enjoin physicians to disclose errors and offer apologies. PMID:27006891

Utilitarian and deontological ethics in medicine.

PubMed

Mandal, Jharna; Ponnambath, Dinoop Korol; Parija, Subhash Chandra

2016-01-01

Medical ethics is a sensible branch of moral philosophy and deals with conflicts in obligations/duties and their potential outcome. Two strands of thought exist in ethics regarding decision-making: deontological and utilitarian. In deontological approach, outcomes/consequences may not just justify the means to achieve it while in utilitarian approach; outcomes determine the means and greatest benefit expected for the greatest number. In brief, deontology is patient-centered, whereas utilitarianism is society-centered. Although these approaches contradict each other, each of them has their own substantiating advantages and disadvantages in medical practice. Over years, a trend has been observed from deontological practice to utilitarian approach leading to frustration and discontentment. Health care system and practitioners need to balance both these ethical arms to bring congruity in medical practice.

The Origins of a Modern Medical Ethics in Enlightenment Scotland: Cheyne, Gregory and Cullen as Practitioners of Sensibility.

PubMed

Wild, Wayne

2014-01-01

The foundations of a modern medical ethics does not appear in Britain until the late-eighteenth century, with the publication of John Gregory's Lectures on the Duties and Qualifications of a Physician in 1772. Focusing on the contemporary Moral Sense philosophical ideas formulated primarily by leading members of the Kirk, and the medical writings of the Scottish physicians, George Cheyne, John Gregory, and William Cullen, this chapter explores the fusion of classical and holistic Christian-based medical ethics. It is argued that it was the convergence of new theories of nervous sensibility, Scottish Enlightenment, Christian-based sentimental moral philosophies, and the rhetoric of the "man of feeling" that created a new modern medical ethics.

[A case study on duty of care in professional nursing].

PubMed

Huang, Hui-Man; Liao, Chi-Chun

2013-08-01

Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.

The use of ethical frameworks by students following a new science course for 16 18 year-olds

NASA Astrophysics Data System (ADS)

Reiss, Michael

2008-09-01

There has been a move in recent years towards the greater inclusion of social and ethical issues within science courses. This paper examines a new context-based course for 16 18 year-olds (Salters-Nuffield Advanced Biology) who are studying biology in England and Wales. The course is taught through contexts and has an emphasis on social issues and the development of ethical reasoning. Examination of a sample of reports written by students in 2005 as part of the course’s summative assessment shows that utilitarian ethical reasoning is used widely and that the other ethical frameworks to which students are introduced in the course—rights and duties, autonomy and virtue ethics—are used substantially less often. In addition, students mostly argue anthropocentrically though many of them argue ecocentrically and/or biocentrically too.

A proposed non-consequentialist policy for the ethical distribution of scarce vaccination in the face of an influenza pandemic.

PubMed

McLachlan, Hugh V

2012-05-01

The current UK policy for the distribution of scarce vaccination in an influenza pandemic is ethically dubious. It is based on the planned outcome of the maximum health benefit in terms of the saving of lives and the reduction of illness. To that end, the population is classified in terms of particular priority groups. An alternative policy with a non-consequentialist rationale is proposed in the present work. The state should give the vaccination, in the first instance, to those who are at risk of catching the pandemic flu in the line of their duties of public employment. Thereafter, if there is not sufficient vaccine to give all citizens equally an effective dose, the state should give all citizens an equal chance of receiving an effective dose. This would be the just thing to do because the state has a duty to treat each and all of its citizens impartially and they have a corresponding right to such impartial treatment. Although this article specifically refers to the UK, it is considered that the suggested alternative policy would be applicable generally. The duty to act justly is not merely a local one.

Gallant Atavism. The Military Ethic in an Age of Nihilism

DTIC Science & Technology

1996-01-01

Oxford: Clarendon Press, 1930). In chap. 2, Ross discusses his theory of “ prima facie ” or “conditional” duties , which represent claims on our moral...distinctive of a professional military group? I think we could trace through rather a large number of such values—a sense of honor and duty , a...it has been recently by William Bennett: [From 1960 to 1990] there has been more than a 500 percent increase in violent crime; more than a 400

Parameters, Journal of the US Army War College, Volume 15, Number 4, Winter 1985.

DTIC Science & Technology

1985-01-01

devices, has built consist entirely of a staff-no legions, just palace its own close-support air force-hundreds of courtesans. armed helicopters...newscasters who announce how many ON BUCKINGHAM Americans are involved in an international crisis AND MILITARY ETHICS because they know you will be...moral outrage when MG Buckingham was very simple and self-evident concept explains why on active duty? Is it ethical to wait until his many of the

Medical marijuana: should minors have the same rights as adults?

PubMed

Clark, Peter A

2003-06-01

After reviewing the pertinent scientific data, it is clear that there is more than sufficient medical and ethical evidence to warrant the Bush Administration to authorize the Drug Enforcement Agency to reclassify marijuana as a Schedule II drug so that it can be used for medical purposes. Failure to give an effective therapy to seriously ill patients, either adults or children, violates the core principles of both medicine and ethics. Medically, to deny physicians the right to prescribe to their patients a therapy that relieves pain and suffering violates the physician-patient relationship. Ethically, failure to offer an available therapy that has proven to be effective violates the basic ethical principle of nonmaleficence, which prohibits the infliction of harm, injury, or death and is related to the maxim primum non nocere ('above all, or first, do no harm'), which is widely used to describe the duties of a physician. Therefore, in the patient's best interest, patients and parents/surrogates, have the right to request medical marijuana under certain circumstances and physicians have the duty to disclose medical marijuana as an option and prescribe it when appropriate. The right to an effective medical therapy, whose benefits clearly outweigh the burdens, must be available to all patients including children. To deny children the use of medical marijuana when appropriate is a grave injustice which violates the basic foundational beliefs of both medicine and

Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study).

PubMed

Ignatowicz, Agnieszka; Slowther, Anne-Marie; Elder, Patrick; Bryce, Carol; Hamilton, Kathryn; Huxley, Caroline; Forjaz, Vera; Sturt, Jackie; Griffiths, Frances

2018-02-23

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician's duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to.

The Health Legislation Amendment Act 2013 (QLD) and Queensland's health assets privatisation dispute.

PubMed

Colton, Caroline; Faunce, Thomas

2014-09-01

'New legislation in Queensland has provided a "pathway" for the privatisation of health assets and services in Queensland, which effectively realigns the health care system to the financial market. This column explores how this legislation contained the antecedents of the Queensland doctors' dispute when doctors roundly rejected new employment contracts in February 2014. It also argues that such legislation and its attendant backlash provides a valuable case study in view of the federal government's 2014 budget offer to the States of extra funding if they sell their health assets to fund new infrastructure. The move to privatise health in Queensland has also resulted in a government assault on the ethical credibility of the opposing medical profession and changes to the health complaints system with the introduction of a Health Ombudsman under ministerial control. The column examines these changes in light of R (Heather) v Leonard Cheshire Foundation [2001] EWHC Admin 429, a case concerning the obligations of a private entity towards publically funded clients in the United Kingdom. In discussing concerns about the impact of privatisation on the medical profession, the column points to a stark conflict between the duty to operate hospitals as a business rather than as a duty to patients.

Regulating Gamete Donation in the U.S.: Ethical, Legal and Social Implications

PubMed Central

Sabatello, Maya

2015-01-01

This article explores the practice of gamete donation in the U.S. having in mind the larger question of what do we as a society owe children born as a result (donor-conceived children). Do recipient-parents have a duty to tell their donor-conceived child about his/her genetic origins? Should the identity of the donor be disclosed or remain anonymous? Does the child have a right to know her conception story and to receive information, including identifying information, about the donor? Furthermore, if a donor-conceived child has a right to know, who has the duty to tell her/him about it? The Article underscores the ethical, legal and social dilemmas that arise, comparing and contrasting with international developments in this arena. It highlights the market-based and more specific medical justifications for regulating this field, explores the emerging so-called right of the child to know his/her genetic origins (“the right to know”), and considers the challenges such a right evokes to existing legal culture and principles of medical ethics in the U.S. as well as other broader societal implications of such a right. PMID:26388996

Regulating Gamete Donation in the U.S.: Ethical, Legal and Social Implications.

PubMed

Sabatello, Maya

2015-09-01

This article explores the practice of gamete donation in the U.S. having in mind the larger question of what do we as a society owe children born as a result (donor-conceived children). Do recipient-parents have a duty to tell their donor-conceived child about his/her genetic origins? Should the identity of the donor be disclosed or remain anonymous? Does the child have a right to know her conception story and to receive information, including identifying information, about the donor? Furthermore, if a donor-conceived child has a right to know, who has the duty to tell her/him about it? The Article underscores the ethical, legal and social dilemmas that arise, comparing and contrasting with international developments in this arena. It highlights the market-based and more specific medical justifications for regulating this field, explores the emerging so-called right of the child to know his/her genetic origins ("the right to know"), and considers the challenges such a right evokes to existing legal culture and principles of medical ethics in the U.S. as well as other broader societal implications of such a right.

48 CFR 2401.603-2 - Selection.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the experience, education, training, business acumen, judgment, character, reputation, and ethics of... authority, and whose primary duties are performed as a Contracting Officer, other than contracting authority limited to simplified acquisition procedures, shall meet the following requirements: (1) The education and...

A resuscitation "dilemma" theory-practice-ethics. Is there a theory-practice-ethics gap?

PubMed

Mortell, Manfred

2009-07-01

The theory-practice-ethics gap - a new paradigm to contemplate. Practices based on tradition, rituals and outdated information are placed into a nonscientific paradigm called the theory-practice gap. Within this paradigm there is often a gap between theoretical knowledge and its application in practice. This theory-practice gap has always existed [Allmark, P., 1995. A classical view of the theory-practice gap in nursing. J. Adv. Nurs. 22 (1), 18-23; Hewison, A. et al., 1996. The theory-practice gap in nursing: a new dimension. J. Adv. Nurs. 24 (4), 754-761]. Its creation is often sited as a culmination of theory being idealistic and impractical, even if practical and beneficial, are often ignored. Most of the evidence relating to the non integration of theory and practice makes the assumption that environmental factors are responsible and will affect learning and practice outcomes, hence the "gap". In fact, it is the author's belief, that to "bridge the gap" between theory and practice an additional component is required, called ethics. A moral duty and obligation ensuring theory and practice integrate. In order to effectively implement new practices, one must deem these practices are worthy and relevant to their role as healthcare providers. Otherwise, we fall victims to providing nothing more than a lip service. This introduces a new concept which the author refers to as the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when reviewing some of the unacceptable outcomes in health care practice. The author believes that there is a crisis of ethics where theory and practice integrate, and as a consequence, malfeasance. We are failing to fulfill our duty as healthcare providers and as patient advocates. One practice of major concern, which the author will endeavor to unfold relates to adult and pediatric resuscitation.

It's been a privilege: advising patients of the Tarasoff duty and its legal consequences for the federal psychotherapist-patient privilege.

PubMed

Klinka, Elisha

2009-11-01

State laws modeled on Tarasoff v. Regents of the University of California require psychotherapists to warn potential victims or law enforcement when treating dangerous patients who make serious threats of harm to another person. In practice, many psychotherapists advise their patients who make such threats about their duty under these Tarasoff-model laws. Although they are not required to make these advisories by law, psychotherapists generally assume that they also have a concomitant ethical duty to advise their patients that such threats will not be kept confidential, as their communications normally would be. This Note looks at how these advisories affect the status of privilege for subsequent threatening statements relayed to a psychotherapist. It explores the opposing views in the federal circuit courts regarding whether such an advisory precludes the existence of privilege for subsequent statements, or whether the advisory operates as a waiver to the privilege. This Note argues that threats communicated to a psychotherapist after an advisory about a psychotherapist's Tarasoff duty cannot be considered privileged if the patient intended for the threat to be passed on to a third party. Psychotherapists must now be aware of the possible legal consequences regarding the patients' diminished expectation of confidentiality and lack of privilege following such advisories. In order to act in their patients' best interest, psychotherapists should educate themselves about the scope of a Tarasoff duty in their applicable states and should consider alternative intervention techniques that could reduce dangerous patients' risk of harm. Psychotherapists should continue to follow professional ethical guidelines about advising patients of the limits of confidentiality, but implement techniques that evidence the patients' true intent about confidentiality, in order to bolster the patients' possible privilege claims later on and minimize harm to the treatment relationship.

Kant on euthanasia and the duty to die: clearing the air.

PubMed

Cholbi, Michael

2015-08-01

Thanks to recent scholarship, Kant is no longer seen as the dogmatic opponent of suicide that he appears to be at first glance. However, some interpreters have recently argued for a Kantian view of the morality of suicide with surprising, even radical, implications. More specifically, they have argued that Kantianism (1) requires that those with dementia or other rationality-eroding conditions end their lives before their condition results in their loss of identity as moral agents and (2) requires subjecting the fully demented or those confronting future dementia to non-voluntary euthanasia. Properly understood, Kant's ethics have neither of these implications (1) wrongly assumes that rational agents' duty of self-preservation entails a duty of self-destruction when they become non-rational, (2) further neglects Kant's distinction between duties to self and duties to others and wrongly assumes that duties can be owed to rational agents only during the time of their existence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Compelling truth: legal protection of the infosphere against big data spills

PubMed Central

2016-01-01

The paper explores whether legal and ethical concepts that have been used to protect the natural environment can also be leveraged to protect the ‘infosphere’, a neologism used by Luciano Floridi to characterize the totality of the informational environment. We focus, in particular, on the interaction between allocation of (intellectual) property rights and ‘communication duties’, in particular, data breach notification duties. This article is part of the themed issue ‘The ethical impact of data science’. PMID:28336793

Ethical and Moral Courage is Distress among Professional Nurses: A Workplace Issue.

PubMed

Brown, Geraldine

2015-01-01

Ethics and moral issues do impact the manner in which professional nurses perform their major duties. Moral distress often conflict with an ethical appropriate course of action that is known, but cannot be implemented. This distress has been associated with job dissatisfaction, burnout, early retirement, withdrawal from the moral dimensions of direct patient care, and others just leaving the profession altogether. In the workplace, institutions must make an assertive effort in providing resources and addressing situations that cause personal anxiety and depression that adversely affects total patient care. The American Association of Critical Care Nurses (AACN) has addressed ethical issues and moral distress in practices that support nurses with moral courage, when encountering ethical conflicts. Ask, Affirm, Assess and Act are the 4 A's that AACN believes should be a part of an organization's strategic plan to create a healthy workplace environment.

Controversies in nursing ethics: a historical review.

PubMed

Olsen, D P

1992-09-01

The author critiques the dialectic between justice-based ethics and an ethic of caring from a historical perspective (by analogy with the dialectic between agape and friendship). Justice-based ethics have been problematic for nursing because of the decontextualized approach. The ethic of caring is problematic because caring, being contextual, is particularistic and therefore can be based on morally irrelevant factors, such as liking. There is a tradition of writing which seeks to reconcile the particularistic obligations of friendship with the moral duty to all others equally. Ideas from the following authors are reviewed for relevance to nursing: Aristotle, Aelred of Rievaulx, Augustine, John Cassian, Cicero, George Berkeley, Immanuel Kant, Michel de Montaigne, Jeremy Taylor and Max Weber. The authors concludes by noting that both sides of the dialectic are synthesized in the lived experience of individuals. A synthesis in thought is called for on this basis.

[Global aspects of medical ethics: conditions and possibilities].

PubMed

Neitzke, G

2001-01-01

A global or universal code of medical ethics seems paradoxical in the era of pluralism and postmodernism. A different conception of globalisation will be developed in terms of a "procedural universality". According to this philosophical concept, a code of medical ethics does not oblige physicians to accept certain specific, preset, universal values and rules. It rather obliges every culture and society to start a culture-sensitive, continuous, and active discourse on specific issues, mentioned in the codex. This procedure might result in regional, intra-cultural consensus, which should be presented to an inter-cultural dialogue. To exemplify this procedure, current topics of medical ethics (spiritual foundations of medicine, autonomy, definitions concerning life and death, physicians' duties, conduct within therapeutic teams) will be discussed from the point of view of western medicine.

Utilitarian and deontological ethics in medicine

PubMed Central

Mandal, Jharna; Ponnambath, Dinoop Korol; Parija, Subhash Chandra

2016-01-01

Medical ethics is a sensible branch of moral philosophy and deals with conflicts in obligations/duties and their potential outcome. Two strands of thought exist in ethics regarding decision-making: deontological and utilitarian. In deontological approach, outcomes/consequences may not just justify the means to achieve it while in utilitarian approach; outcomes determine the means and greatest benefit expected for the greatest number. In brief, deontology is patient-centered, whereas utilitarianism is society-centered. Although these approaches contradict each other, each of them has their own substantiating advantages and disadvantages in medical practice. Over years, a trend has been observed from deontological practice to utilitarian approach leading to frustration and discontentment. Health care system and practitioners need to balance both these ethical arms to bring congruity in medical practice. PMID:26998430

Ethics and mental illness research.

PubMed

Roberts, Laura Weiss

2002-09-01

There are many tasks ahead in the area of ethics and mental illness research. We face unknown challenges in psychiatric genetics projects, studies of psychopharmacological interventions in children, controversial scientific designs (e.g., symptom challenge, medication-free interval), and cross-disciplinary research incorporating goals and methods of health services, epidemiology, and social and behavioral science endeavors. Boundaries between innovative clinical practices and research-related experimentation will become increasingly difficult to distinguish, as will the roles between clinicians, clinical researchers, and basic scientists. Moreover, the institutions and systems in which research occurs are being rapidly and radically revised, raising new questions about oversight responsibilities and standards. Our ability to identify and respond to the ethical questions arising in this uncharted territory will depend on our willingness to self-reflect, to integrate the observations and insights of the past century, to think with great clarity, and to anticipate novel ethical problems that keep company with scientific advancements. It will also depend on data. Empirical study of ethical dimensions of human research is essential to anchor and attune the intuitions and theoretical constructs that we develop. Science and ethics have changed over the past 100 years, as they will over the next century. It is ironic that the ethical acceptability of psychiatric research is so much in question at this time, when it holds so much promise for advancing our understanding of mental illness and its treatment. The tension between the duty to protect vulnerable individuals and the duty to perform human science will continue to grow, as long as ethics and science are seen as separable, opposing forces with different aims championed by different heroes. The profession of psychiatry is poised to move toward a new, more coherent research ethics paradigm in which scientific and ethical issues are recognized as inextricably linked: science as a human activity carries complex ethical meanings and responsibilities, and ethics itself is subject to scrutiny and amenable to scientific inquiry. Building a broader, more versatile, and more effective repertoire of safeguards will be increasingly important, and safeguards, in this view, represent a modest price for the privilege of studying serious illnesses--diseases that cause grave suffering and yet are a source of both vulnerability and strength. In this paradigm, attention to ethics safeguards is no longer understood as a barrier to scientific advancement, but rather as the means by which psychiatric research may be conducted with broad societal support, honorably and, ultimately, with the expectation of bringing benefit to millions of people with mental illness.

Comparative effectiveness research: what to do when experts disagree about risks.

PubMed

Lie, Reidar K; Chan, Francis K L; Grady, Christine; Ng, Vincent H; Wendler, David

2017-06-19

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees (ERCs) should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when "nothing is known" about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative(s). We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation.

Ethical decision making in pain management: a conceptual framework

PubMed Central

Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

2018-01-01

Introduction The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician–patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding “last-ditch” treatments of severe pain; and 6) failure to be accountable and equitable. Objective The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. Methods This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. Discussion We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Conclusion Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound. PMID:29844699

Professional ethics in nursing: an integrative review.

PubMed

Kangasniemi, Mari; Pakkanen, Piiku; Korhonen, Anne

2015-08-01

To conduct an integrative review and synthesize current primary studies of professional ethics in nursing. Professional ethics is a familiar concept in nursing and provides an ethical code for nursing practice. However, little is known about how professional ethics has been defined and studied in nursing science. Systematic literature searches from 1948-February 2013, using the CINAHL, PubMed and Scopus electronic databases to look at previously published peer-reviewed studies. A modified version of Cooper's five-stage integrative review was used to review and synthesize current knowledge. Fourteen papers were included in this research. According to our synthesis, professional ethics is described as an intra-professional approach to care ethics and professionals commit to it voluntarily. Professional ethics consist of values, duties, rights and responsibilities, regulated by national legislation and international agreements and detailed in professional codes. Professional ethics is well established in nursing, but is constantly changing due to internal and external factors affecting the profession. Despite the obvious importance of professional ethics, it has not been studied much in nursing science. Greater knowledge of professional ethics is needed to understand and support nurses' moral decision-making and to respond to the challenges of current changes in health care and society. © 2015 John Wiley & Sons Ltd.

Business Entity Selection: Why It Matters to Healthcare Practitioners. Part III--Nonprofits, Ethics, Practice Implications, and Conclusions.

PubMed

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvantages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with organizational mission or vision statements, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

76 FR 51128 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... duty; alternate work schedules, standards of conduct and ethics programs; indebtedness; employee... stored on paper, microform, or in electronic media. Retrievability: By name, social security number, or... maceration. Records in electronic media are electronically erased using accepted techniques. System Manager...

Adding justice to the clinical and public health ethics arguments for mandatory seasonal influenza immunisation for healthcare workers.

PubMed

Lee, Lisa M

2015-08-01

Ethical considerations from both the clinical and public health perspectives have been used to examine whether it is ethically permissible to mandate the seasonal influenza vaccine for healthcare workers (HCWs). Both frameworks have resulted in arguments for and against the requirement. Neither perspective resolves the question fully. By adding components of justice to the argument, I seek to provide a more fulsome ethical defence for requiring seasonal influenza immunisation for HCWs. Two critical components of a just society support requiring vaccination: fairness of opportunity and the obligation to follow democratically formulated rules. The fairness of opportunity is informed by Rawls' two principles of justice. The obligation to follow democratically formulated rules allows us to focus simultaneously on freedom, plurality and solidarity. Justice requires equitable participation in and benefit from cooperative schemes to gain or profit socially as individuals and as a community. And to be just, HCW immunisation exemptions should be limited to medical contraindications only. In addition to the HCWs fiduciary duty to do what is best for the patient and the public health duty to protect the community with effective and minimally intrusive interventions, HCWs are members of a just society in which all members have an obligation to participate equitably in order to partake in the benefits of membership. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Locum physicians' professional ethos: a qualitative interview study from Germany.

PubMed

Salloch, Sabine; Apitzsch, Birgit; Wilkesmann, Maximiliane; Ruiner, Caroline

2018-05-08

In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. In this first qualitative study on German locum physicians, the locums' own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups' perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians' role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society? The study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor-patient contact and the sustainability of hiring locums as a remedy in times of staff shortage. Further qualitative and quantitative research on locum physicians' professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector.

[Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol].

PubMed

Takaschima, Augusto Key Karazawa; Sakae, Thiago Mamôru; Takaschima, Alexandre Karazawa; Takaschima, Renata Dos Santos Teodoro; de Lima, Breno José Santiago Bezerra; Benedetti, Roberto Henrique

Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine (FCM), opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. The FCM resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol.

PubMed

Takaschima, Augusto Key Karazawa; Sakae, Thiago Mamôru; Takaschima, Alexandre Karazawa; Takaschima, Renata Dos Santos Teodoro; Lima, Breno José Santiago Bezerra de; Benedetti, Roberto Henrique

Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Pilot Study: The Role of Predeployment Ethics Training, Professional Ethics, and Religious Values on Naval Physicians' Ethical Decision Making.

PubMed

Gaidry, Alicia D; Hoehner, Paul J

2016-08-01

Military physicians serving overseas in cross-cultural settings face the challenge of meeting patients' needs and adhering to their personal and professional ethics while abiding by military obligations and duties. Predeployment ethics training for Naval physicians continues to be received in many forms, if received at all, and has largely not addressed their specific roles as medical providers in the military. This study explores the perceived effectiveness of predeployment ethics training received by Naval physicians. Additionally, it considers the contribution of different types of ethics training, religious values, and the professional ethics on Naval physicians' perceived ability to effectively manage ethically challenging scenarios while on deployment. A total of 49 Naval physicians participated in an online survey. 16.3% reported not receiving any form of ethics training before deployment. Of those that reported receiving ethics training before deployment, 92.7% found the ethics training received was helpful in some way while on deployment. While a medical school course was most contributory overall to their ability to handle ethically difficult situations while on deployment (70.7%), what most Naval physicians felt would help them better handle these types of situations would be a mandatory military training/military course (63.2%) or personal mentorship (57.9%). Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Respect for patient autonomy as a medical virtue.

PubMed

Cook, Thomas; Mavroudis, Constantine D; Jacobs, Jeffrey P; Mavroudis, Constantine

2015-12-01

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognise the centrality of this principle and the inherent right of patients of sound mind - properly informed - to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the physician, and society. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make informed decisions and to offer considered therapeutic options to the patient. We argue in this paper that there is also need for a transition of moral competency from understanding principles to attaining virtue in the classic Aristotelian tradition. Achieving moral virtue is based on a lifetime of learning, practising, and watching how others, who have achieved virtue, act and perform their duties. We further claim that learning moral virtue in medical practice is best realised by incorporating the lessons learnt during daily rounds where frank discussions and considered resolutions can occur under the leadership of senior practitioners who have achieved a semblance of moral excellence.

The Moral Problem of Health Disparities

PubMed Central

2010-01-01

Health disparities exist along lines of race/ethnicity and socioeconomic class in US society. I argue that we should work to eliminate these health disparities because their existence is a moral wrong that needs to be addressed. Health disparities are morally wrong because they exemplify historical injustices. Contractarian ethics, Kantian ethics, and utilitarian ethics all provide theoretical justification for viewing health disparities as a moral wrong, as do several ethical principles of primary importance in bioethics. The moral consequences of health disparities are also troubling and further support the claim that these disparities are a moral wrong. The Universal Declaration of Human Rights provides additional support that health disparities are a moral wrong, as does an analogy with the generally accepted duty to provide equal access to education. In this article, I also consider and respond to 3 objections to my thesis. PMID:20147677

A personalist approach to public-health ethics.

PubMed

Petrini, Carlo; Gainotti, Sabina

2008-08-01

First we give an overview of the historical development of public health. Then we present some public-health deontology codes and some ethical principles. We highlight difficulties in defining ethics for public health, with specific reference to three of them that concern: (i) the adaptability to public health of the classical principles of bioethics; (ii) the duty to respect and safeguard the individual while acting within the community perspective that is typical of public health; and (iii) the application-oriented nature of public health and the general lack of attention towards the ethical implications of collective interventions (compared with research). We then mention some proposals drafted from North American bioethics "principles" and utilitarian, liberal and communitarian views. Drawing from other approaches, personalism is outlined as being the theory that offers a consistent set of values and alternative principles that are relevant for public health.

Commentary: The forensic report--an inevitable nexus for resolving ethics dilemmas.

PubMed

Weinstock, Robert

2013-01-01

Ethics-related dilemmas arise in forensic psychiatry as in all psychiatric practice. Although most can be resolved by following the AAPL Ethics Guidelines and the AAPL Ethics Questions and Answers, the more complex ones inevitably have no easy solutions. Ethics-based duties can conflict without clear guidance on prioritization. Weighing competing factors necessitates more than merely following a rule, since there are potentially conflicting rules, and ethical practitioners may prioritize them differently. Concerns pertaining to the death penalty and defendants who are victims of discrimination are especially difficult. Such considerations usually are in the realm of aspirational ethics, with conclusions open to debate. They need consideration by most practitioners concerned with determining the most ethical course of action. Much as it is insufficient for an ethical citizen merely to avoid breaking the law, it is not enough to avoid violating any one guideline while remaining blind to context. Most such dilemmas need resolution long before testimony and arise first in the way the forensic assessment is conducted and in decisions on the data to be included in a report and how they are presented. Although there can be legitimate differences of opinion about how to weigh and resolve conflicting considerations, ethics-related dilemmas should not be sidestepped.

Ethical Risk Management Education in Engineering: A Systematic Review.

PubMed

Guntzburger, Yoann; Pauchant, Thierry C; Tanguy, Philippe A

2017-04-01

Risk management is certainly one of the most important professional responsibilities of an engineer. As such, this activity needs to be combined with complex ethical reflections, and this requirement should therefore be explicitly integrated in engineering education. In this article, we analyse how this nexus between ethics and risk management is expressed in the engineering education research literature. It was done by reviewing 135 articles published between 1980 and March 1, 2016. These articles have been selected from 21 major journals that specialize in engineering education, engineering ethics and ethics education. Our review suggests that risk management is mostly used as an anecdote or an example when addressing ethics issues in engineering education. Further, it is perceived as an ethical duty or requirement, achieved through rational and technical methods. However, a small number of publications do offer some critical analyses of ethics education in engineering and their implications for ethical risk and safety management. Therefore, we argue in this article that the link between risk management and ethics should be further developed in engineering education in order to promote the progressive change toward more socially and environmentally responsible engineering practices. Several research trends and issues are also identified and discussed in order to support the engineering education community in this project.

5 CFR 5701.102 - Fundraising activities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5701.102 Administrative Personnel FEDERAL TRADE COMMISSION SUPPLEMENTAL STANDARDS OF ETHICAL CONDUCT...-duty hours, seek a contribution from a company that is regulated by the Commission, but not from one... substantially affected by the employee's job. While the Standards of Conduct provide that companies under the...

Adab and its significance for an Islamic medical ethics.

PubMed

Sartell, Elizabeth; Padela, Aasim I

2015-09-01

Discussions of Islamic medical ethics tend to focus on Sharī'ah-based, or obligation-based, ethics. However, limiting Islamic medical ethics discourse to the derivation of religious duties ignores discussions about moulding an inner disposition that inclines towards adherence to the Sharī'ah. In classical Islamic intellectual thought, such writings are the concern of adab literature. In this paper, we call for a renewal of adabi discourse as part of Islamic medical ethics. We argue that adab complements Sharī'ah-based writings to generate a more holistic vision of Islamic medical ethics by supplementing an obligation-based approach with a virtue-based approach. While Sharī'ah-based medical ethics focuses primarily on the moral status of actions, adab literature adds to this genre by addressing the moral formation of the agent. By complementing Sharī'ah-based approaches with adab-focused writings, Islamic medical ethics discourse can describe the relationship between the agent and the action, within a moral universe informed by the Islamic intellectual tradition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Lawyer members of a hospital ethics committee, a training in bioethics?].

PubMed

Mathieu, Géraldine; Rommelaere, Claire

2013-01-01

As lawyer members of a hospital ethics committee, we wanted to address the question if being part of such a committee allowed us to call ourselves "bioethicists". Before answering, it is important to put Belgian hospital ethics committees in context, firstly by explaining their missions: defining general ethical guidelines in order to help physicians in their practice, providing for punctual advice and assessing every clinical research protocol which is proposed to a physician of the hospital. Theoretical information concerning the missions of Belgian hospital ethics committees is the opportunity to develop some thinking elements of about the role and duties of those committees. We can then wonder who are or should be the members of hospital ethics committees: what does the law say and what to think about it? Questions about ethics committees'missions and members allow us to come to the conclusion that the mere fact of being member of a hospital ethics committee is not enough to call oneself a bioethicist. On the one hand, experience should be accompanied by proper training; on the other hand, one should always be aware that "becoming a bioethicist" is a never ending journey.

Theory of protective empowering for balancing patient safety and choices.

PubMed

Chiovitti, Rosalina F

2011-01-01

Registered nurses in psychiatric-mental health nursing continuously balance the ethical principles of duty to do good (beneficence) and no harm (non-maleficence) with the duty to respect patient choices (autonomy). However, the problem of nurses' level of control versus patients' choices remains a challenge. The aim of this article is to discuss how nurses accomplish their simultaneous responsibility for balancing patient safety (beneficence and non-maleficence) with patient choices (autonomy) through the theory of protective empowering. This is done by reflecting on interview excerpts about caring from 17 registered nurses taking part in a grounded theory study conducted in three acute urban psychiatric hospital settings in Canada. The interplay between the protective and empowering dimensions of the theory of protective empowering was found to correspond with international, national, and local nursing codes of ethics and standards. The overall core process of protective empowering, and its associated reflective questions, is offered as a new lens for balancing patient safety with choices.

Images of a 'good nurse' presented by teaching staff.

PubMed

de Araujo Sartorio, Natalia; Pavone Zoboli, Elma Lourdes Campos

2010-11-01

Nursing is at the same time a vocation, a profession and a job. By nature, nursing is a moral endeavor, and being a 'good nurse' is an issue and an aspiration for professionals. The aim of our qualitative research project carried out with 18 nurse teachers at a university nursing school in Brazil was to identify the ethical image of nursing. In semistructured interviews the participants were asked to choose one of several pictures, to justify their choice and explain what they meant by an ethical nurse. Five different perspectives were revealed: good nurses fulfill their duties correctly; they are proactive patient advocates; they are prepared and available to welcome others as persons; they are talented, competent, and carry out professional duties excellently; and they combine authority with power sharing in patient care. The results point to a transition phase from a historical introjection of religious values of obedience and service to a new sense of a secular, proactive, scientific and professional identity.

Pain and the ethics of pain management.

PubMed

Edwards, R B

1984-01-01

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.

An ethics of suffering: does it solve the problems we want to solve?: commentary.

PubMed

Edwards, Barbara Springer

1991-01-01

Erich H. Loewy proposes to elevate the moral obligation to prevent and relieve suffering to the level of a prima facie moral duty by delineating which beings are of primary moral worth and which are of secondary moral worth. Sentient beings have a capacity to suffer and are therefore of primary moral worth. Beings that are insentient cannot suffer; therefore such beings are only of secondary moral worth. Objects of secondary moral worth include patients in a persistent vegetative state (PVS) and brain-dead patients. This proposal, he says, would solve a number of problems in clinical bioethics. First, it would help to clarify our moral duties at the bedside. And secondly, by creating a hierarchy of moral values, it helps to differentiate which patients are owed our primary allegiance and resources. Despite his extensive and painstaking proof, I believe several questions remain about the use of the "capacity of sentient beings to suffer" as a basis for a universal grounding in ethics.

Deontological foundations for medical ethics?

PubMed

Gillon, R

1985-05-04

Gillon outlines the principles of the deontological, or duty-based, group of moral theories in one of a series of British Medical Journal articles on the philosophical foundations of medical ethics. He differentiates between monistic theories, such as Immanuel Kant's, which rely on a single moral principle, and pluralistic theories, such as that of W.D. Ross, which rely on several principles that potentially could conflict. He summarizes the contributions of Kant and Ross to the development of deontological thought, then concludes his essay with brief paragraphs on other deontological approaches to the resolution of conflicting moral principles.

Medicine and the Gulag.

PubMed Central

Kosserev, I.; Crawshaw, R.

1994-01-01

The nature of the medical treatment of prisoners in the Gulag has emerged from accounts published by survivors. Over a period of 70 years some doctors entrusted with the medical care of prisoners failed to discharge their ethical duties, contributing to the prisoners' neglect and suffering. The medical profession must carefully examine what occurred and properly assign responsibility for ethical as well as unethical medical acts. Understanding the history of these ominous events will alert doctors worldwide to the importance of medical autonomy in the support of imprisoned patients. Images p1728-a p1729-a PMID:7820004

49 CFR 1103.14 - Private communications with the Board are prohibited.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Private communications with the Board are prohibited. 1103.14 Section 1103.14 Transportation Other Regulations Relating to Transportation (Continued... Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.14 Private communications...

Acts of Endearment

PubMed Central

Stephens, G. Gayle

1992-01-01

Legitimate and clinically useful affection between physicians and patients can be nurtured by attending to duties enjoined by traditional codes of ethics. Three acts of endearment have special importance for today's family physicians: smoothing the bed of death; keeping patients' secrets; and not abandoning patients on account of incurability. PMID:20469528

49 CFR 1103.20 - Practitioner's fees and related practices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward A Client § 1103.20 Practitioner's fees and related practices... 49 Transportation 8 2010-10-01 2010-10-01 false Practitioner's fees and related practices. 1103.20...

Are High School Students Prepared for a Brave New World?

ERIC Educational Resources Information Center

Blake, Deborah

1984-01-01

Describes Notre Dame High School's (California) integrated bioethics course, which contains units on basic concepts of goals, rights, and duty ethics; reproductive technologies; genetic technologies; death and dying; behavior modification; and experiments with human subjects. Provides a bibliography of student and teacher materials. (DMM)

Be Prepared: The Archeology Merit Badge Is Here.

ERIC Educational Resources Information Center

Skinner, S. Alan; Saunders, Cece; Poirier, David A.; Krofina, Douglas L.; Wheat, Pam

1998-01-01

Describes the new archaeology merit badge of the Boy Scouts of America. Discusses the requirement that scouts recruit a "counselor" who is a hobbyist or working archaeologist, and outlines the duties and ethical responsibilities of such mentors. Includes the scout's requirements for earning the badge. (SV)

Certified Nurses' Aide Job-Related Curriculum.

ERIC Educational Resources Information Center

Massachusetts Career Development Inst., Springfield.

This document, which is designed for students preparing to become a certified nurses' aide, contains instructional text and learning activities organized in nine sections. The following topics are covered: the role of the certified nurse's aide (job duties, personal health, professionalism, code of ethics); infection control (the infection…

5 CFR 4501.103 - Prior approval for certain outside activities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... activities. 4501.103 Section 4501.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT SUPPLEMENTAL STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE OFFICE OF PERSONNEL MANAGEMENT § 4501.103 Prior approval... specialized skills or the same educational background as performance of the employee's official duties; (2...

Activities of an ethics consultation service in a Tertiary Military Medical Center.

PubMed

Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J

2000-07-01

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

"But I didn't do it!": ethical treatment of sex offenders in denial.

PubMed

Levenson, Jill S

2011-09-01

This article addresses ethical questions and issues related to the treatment of sex offenders in denial, using the empirical research literature and the ethical codes of American Psychological Association (APA) and National Association of Social Workers (NASW) to guide the ethical decision-making process. The empirical literature does not provide an unequivocal link between denial and recidivism, though some studies suggest that decreased denial and increased accountability appear to be associated with greater therapeutic engagement and reduced recidivism for some offenders. The ethical codes of APA and NASW value the client's self-determination and autonomy, and psychologists and social workers have a duty to empower individual well-being while doing no harm to clients or others. Clinicians should view denial not as a categorical construct but as a continuum of distorted cognitions requiring clinical attention. Denial might also be considered as a responsivity factor that can interfere with treatment progress. Offering a reasonable time period for therapeutic engagement might provide a better alternative than automatically refusing treatment to categorical deniers.

Changing the paradigm for engineering ethics.

PubMed

Schmidt, Jon Alan

2014-12-01

Modern philosophy recognizes two major ethical theories: deontology, which encourages adherence to rules and fulfillment of duties or obligations; and consequentialism, which evaluates morally significant actions strictly on the basis of their actual or anticipated outcomes. Both involve the systematic application of universal abstract principles, reflecting the culturally dominant paradigm of technical rationality. Professional societies promulgate codes of ethics with which engineers are expected to comply (deontology), while courts and the public generally assign liability to engineers primarily in accordance with the results of their work, whether intended or unintended (consequentialism). A third option, prominent in ancient philosophy, has reemerged recently: virtue ethics, which recognizes that sensitivity to context and practical judgment are indispensable in particular concrete situations, and therefore rightly focuses on the person who acts, rather than the action itself. Beneficial character traits--i.e., virtues--are identified within a specific social practice in light of the internal goods that are unique to it. This paper proposes a comprehensive framework for implementing virtue ethics within engineering.

An unexplored ethical issue in clinical research: disclosure of individual findings in the Creando Posibilidades [Creating Possibilities] study.

PubMed

Stein, Karen Farchaus; Keller, Colleen; Fishstrom, Astrid

2013-06-01

Individual disclosure refers to the presumptive ethical responsibility of an investigator to communicate to a study participant information that was collected as a part of a research study protocol and is specific to the individual. Currently, there are no federal regulatory guidelines specifying the conditions and management of disclosure of health-related individual-specific information. In this report, the authors discuss the challenges associated with individual disclosure in the context of a longitudinal descriptive study. Arguments favoring disclosure and those challenging disclosure as a general ethical duty are presented. Finally, strategies for addressing individual disclosure are discussed using a research exemplar in which risk behaviors related to health outcomes were measured. Copyright © 2013 Wiley Periodicals, Inc.

Young people's views about the purpose and composition of research ethics committees: findings from the PEARL qualitative study.

PubMed

Audrey, Suzanne; Brown, Lindsey; Campbell, Rona; Boyd, Andy; Macleod, John

2016-09-02

Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study within which the Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. PEARL incorporated qualitative research to seek the views of young people about data linkage, including their opinions about appropriate safeguards and research governance. In this paper we focus on views expressed about the purpose and composition of research ethics committees. Digitally recorded interviews were conducted with 48 participants aged 17-19 years. Participants were asked about whether medical research should be monitored and controlled, their knowledge of research ethics committees, who should sit on these committees and what their role should be. Interview recordings were fully transcribed and anonymised. Thematic analysis was undertaken, assisted by the Framework approach to data management. The majority of interviewees had little or no specific knowledge of ethics committees. Once given basic information about research ethics committees, only three respondents suggested there was no need for such bodies to scrutinise research. The key tasks of ethics committees were identified as monitoring the research process and protecting research participants. The difficulty of balancing the potential to inhibit research against the need to protect research participants was acknowledged. The importance of relevant research and professional expertise was identified but it was also considered important to represent wider public opinion, and to counter the bias potentially associated with self-selection possibly through a selection process similar to 'jury duty'. There is a need for more education and public awareness about the role and composition of research ethics committees. Despite an initial lack of knowledge, interviewees were able to contribute their ideas and balance the rights of individuals with the wider benefits from research. The suggestion that public opinion should be represented through random selection similar to jury duty may be worth pursuing in the light of the need to ensure diversity of opinion and establish trust amongst the general public about the use of 'big data' for the wider public good.

[Experience of a research Ethics Committee and the challenges of the new Chilean legislation on research in human beings].

PubMed

Oyarzún G, Manuel; Pinto C, María Eugenia; Raineri B, Gina G; Amigo, Hugo; Cifuentes O, Lucía; González, María Julieta; Horwitz, Nina; Marshall F, Claudia; Orellana V, Gricel

2014-07-01

The welfare of research participants must be guaranteed by international ethical standards. This article communicates the procedures of the Research Ethics Committee of the School of Medicine, University of Chile (CEISH). The new Chilean legislation on research in human beings is also discussed. Law 20.120: "On scientific research in human beings, its genome and forbidding human cloning" establishes the ethical principles that must be accomplished in every research involving human beings. Article 28 of the Law 20.584 "Regulation of the rights and duties of health care users", forbids the participation of handicapped people who cannot express their will in scientific research. Article 13 states that people not related directly with patient care cannot have access to his clinical records (with the exception of people with notarial authorization by the patient). CEISH proposes that, in case of people with intellectual deficiency, the decision to approve a scientific research should be analyzed on an individual basis. If the person is capable of expressing his or her will or has stated his or her consent beforehand, the research can be authorized. If the person cannot express his or her will, the scientific research cannot take place. In prospective studies, a consent from the patient and an authorization of the health authority should be required to access clinical records. In retrospective studies, consent should be obtained from the patient when personal information is going to be used. If the information is nameless, the consent can be disregarded.

Driving behaviors and on-duty road accidents: a French case-control study.

PubMed

Fort, Emmanuel; Chiron, Mireille; Davezies, Philippe; Bergeret, Alain; Charbotel, Barbara

2013-01-01

A case-control study was carried out to identify driving behaviors associated with the risk of on-duty road accident and to compare driving behaviors according to the type of journey (on duty, commuting, and private) for on-duty road accident victims. Cases were recruited from the Rhône Road Trauma Registry between January 2004 and October 2005 and were on duty at the time of the accident. Control subjects were recruited from the electoral rolls of the case subjects' constituencies of residence. Cases' and controls' driving behavior data were collected by self-administered questionnaire. A logistic regression was performed to identify behavioral risk factors for on-duty road accidents, taking into account age, sex, place of residence, road accident risk exposure, socio-occupational category, and type of road user. A second analysis focused specifically on the case subjects, comparing their self-assessed usual behaviors according to the type of journey. Significant factors for multivariate analysis of on-duty road accidents were female gender, history of on-duty road accidents during the previous 10 years, severe time pressure at work, and driving a vehicle not belonging to the driver. On-duty road accident victims reported behavioral risk factors more frequently in relation to driving for work than driving for private reasons or commuting: nonsystematic seat belt use, cell phone use at least once daily while driving, and history of accidents with injury during the previous 10 years. This study provides knowledge on behavioral risk factors for on-duty road accidents and differences in behavior according to the type of journey for subjects who have been on-duty road accident victims. These results will be useful for the design of on-duty road risk prevention.

The relationship between ethical climate at work and job satisfaction among nurses in Tehran.

PubMed

Joolaee, Soodabeh; Jalili, Hamid Reza; Rafii, Forough; Hajibabaee, Fatemeh; Haghani, Hamid

2013-01-01

This study aimed to provide an understanding of the relationship between the ethical climate at the workplace and job satisfaction among nurses. 210 nurses working in selected wards in the Tehran University of Medical Sciences were asked to fill out questionnaires on their work environment and level of job satisfaction. The data collection tools included a questionnaire to obtain demographic data, the Olson moral climate questionnaire and Minnesota job satisfaction questionnaire. The data were analysed using SPSS software version 14. We found a significant positive relationship between the ethical climate and the level of job satisfaction among the nurses. Among the demographic variables, the working shift, income level and type of duties allocated had a significant relationship with job satisfaction. Hospital managements should pay attention to the factors influencing job motivation among nurses, including the ethical climate of the work environment.

Ethical challenges in Emergency Medical Services: controversies and recommendations.

PubMed

Becker, Torben K; Gausche-Hill, Marianne; Aswegan, Andrew L; Baker, Eileen F; Bookman, Kelly J; Bradley, Richard N; De Lorenzo, Robert A; Schoenwetter, David J

2013-10-01

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

Cardinal Virtues of Academic Administration

ERIC Educational Resources Information Center

Curren, Randall

2008-01-01

The aim of this article is to articulate the basic elements of a comprehensive ethic of academic administration, organized around a set of three cardinal virtues: "commitment" to the good of the institution; good administrative "judgment"; and "conscientiousness" in discharging the duties of the office. In addition to explaining this framework and…

Practice Parameter for Child and Adolescent Forensic Evaluations

ERIC Educational Resources Information Center

Journal of the American Academy of Child & Adolescent Psychiatry, 2011

2011-01-01

This Parameter addresses the key concepts that differentiate the forensic evaluation of children and adolescents from a clinical assessment. There are ethical issues unique to the forensic evaluation, because the forensic evaluator's duty is to the person, court, or agency requesting the evaluation, rather than to the patient. The forensic…

Academic Advisors and Their Diverse Advisees: Towards More Ethical Global Universities

ERIC Educational Resources Information Center

Lee, Yuko Ikegami; Metcalfe, Amy Scott

2017-01-01

In this comparative content analysis, job postings for academic advising personnel from U.S. and Canadian higher education institutions were examined to ascertain expectations for job candidates in terms of skills and duties, educational requirements, and compensation. Fifty-three job descriptions from 18 research-intensive, public universities…

Disability and the Moral Point of View.

ERIC Educational Resources Information Center

Hyland, Terry

1987-01-01

Discussions of disability should be within a clearly-defined moral framework if the disabled person's rights are to be translated into society's duty to the disabled. An ethical system based on modern versions of utilitarianism is suggested as a moral framework, supplemented by prescriptions based on social justice and respect. (Author/CB)

Celestial Navigation, with a Moral Compass.

ERIC Educational Resources Information Center

Donovan, Aine

1999-01-01

Kantian reasoning fails to address the needs of a mixed-gender peace-keeping force. A philosophy professor at the U.S. Naval Academy proposes a normative-ethics instructional model based on acceptance of duty and obedience (justice) and cultivation of reflective concern for individual choice and responsibility (caring). (24 references) (MLH)

Groomed for Citizenship

ERIC Educational Resources Information Center

Hutchins, Web

2012-01-01

Graduates of the John Stanford Public Service and Political Science Academy at Franklin High School in Seattle, Washington, leave school with self-confidence and a fiery sense of civic duty, giving back to their communities in crucial ways. Students tackle civic and ethical issues daily in the classroom, and the service-learning projects they…

Loyalty, Harm and Duty: PBL in a Media Ethics Course.

ERIC Educational Resources Information Center

Slattery, Karen L.

2002-01-01

Considers how to teach the various areas of mass media in sufficient depth, without sacrificing breadth. Discusses a variation of problem-based learning (PBL) as one possible solution to that educational conundrum. Focuses on a project developed by a group of public relations students using the PBL method. (SG)

Who should know about our genetic makeup and why?

PubMed Central

Takala, T.; Gylling, H. A.

2000-01-01

Recent developments in biology have made it possible to acquire more and more precise information concerning our genetic makeup. Although the most far-reaching effects of these developments will probably be felt only after the Human Genome Project has been completed in a few years' time, scientists can even today identify a number of genetic disorders which may cause illness and disease in their carriers. The improved knowledge regarding the human genome will, it is predicted, in the near future make diagnoses more accurate and treatments more effective, and thereby considerably reduce and prevent unnecessary suffering. On the other hand, however, the knowledge can also be, depending on the case, futile, distressing or plainly harmful. This is why we propose to answer in this paper the dual question: who should know about our genetic makeup and why? Through an analysis of prudential, moral and legal grounds for acquiring the information, we conclude that, at least on the levels of law and social policy, practically nobody is either duty-bound to receive or entitled to have that knowledge. Key Words: Genetic testing • genetic screening • law • ethics • duties PMID:10860207

Gene therapy, human nature and the churches.

PubMed

Dunstan, G R

1991-12-01

Moral analysis must begin with respect for the empirical features, the "facts of the case". Major advances in genetic knowledge and technology -- as in other sciences -- inevitably change mental attitudes. But they could not change human nature, a product of the distinctively human cerebral cortex. Human capacities like compassion and justice are our own and for us to guard. To ask (as some do) about a "right" to inherit a non-manipulated genome is to ask an unanswerable question: the language of rights is inappropriate in this context. Parents have a duty to safeguard and to serve the interests of their potential child. The medical duty is to help in that task in ways which they have limited freedom to choose. The role of churches is to be faithful to their deposit of faith and their theological principles, including that of freedom of conscience. Churches are too easily led in practice to over-rule conscience on grounds of authority, ecclesiastical or biblical, not sustained by convincing reason. This is most evident in some declarations concerning human reproduction. Better were it for them to help their faithful in moral reasoning, the ethics of choice; to keep consciences tender.

Professional ethics in extreme circumstances: responsibilities of attending physicians and healthcare providers in hunger strikes.

PubMed

Irmak, Nurbay

2015-08-01

Hunger strikes potentially present a serious challenge for attending physicians. Though rare, in certain cases, a conflict can occur between the obligations of beneficence and autonomy. On the one hand, physicians have a duty to preserve life, which entails intervening in a hunger strike before the hunger striker loses his life. On the other hand, physicians' duty to respect autonomy implies that attending physicians have to respect hunger strikers' decisions to refuse nutrition. International medical guidelines state that physicians should follow the strikers' unpressured advance directives. When physicians encounter an unconscious striker, in the absence of reliable advance directives, the guidelines advise physicians to make a decision on the basis of the patient's values, previously expressed wishes, and best interests. I argue that if there are no advance directives and the striker has already lost his competence, the physician has the responsibility to resuscitate the striker. Once the striker regains his decision-making capacity, he should be asked about his decision. If he is determined to continue fasting and refuses treatment, the physician has a moral obligation to respect this decisions and follow his advance directives.

Whistleblowing and the bioethicist's public obligations.

PubMed

MacDougall, D Robert

2014-10-01

Bioethicists are sometimes thought to have heightened obligations by virtue of the fact that their professional role addresses ethics or morals. For this reason it has been argued that bioethicists ought to "whistleblow"--that is, publicly expose the wrongful or potentially harmful activities of their employer--more often than do other kinds of employees. This article argues that bioethicists do indeed have a heightened obligation to whistleblow, but not because bioethicists have heightened moral obligations in general. Rather, the special duties of bioethicists to act as whistleblowers are best understood by examining the nature of the ethical dilemma typically encountered by private employees and showing why bioethicists do not encounter this dilemma in the same way. Whistleblowing is usually understood as a moral dilemma involving conflicting duties to two parties: the public and a private employer. However, this article argues that this way of understanding whistleblowing has the implication that professions whose members identify their employer as the public-such as government employees or public servants--cannot consider whistleblowing a moral dilemma, because obligations are ultimately owed to only one party: the public. The article contends that bioethicists--even when privately employed--are similar to government employees in the sense that they do not have obligations to defer to the judgments of those with private interests. Consequently, bioethicists may be considered to have a special duty to whistleblow, although for different reasons than those usually cited.

Moral Duties of Genomics Researchers: Why Personalized Medicine Requires a Collective Approach.

PubMed

Vos, Shoko; van Delden, Johannes J M; van Diest, Paul J; Bredenoord, Annelien L

2017-02-01

Advances in genome sequencing together with the introduction of personalized medicine offer promising new avenues for research and precision treatment, particularly in the field of oncology. At the same time, the convergence of genomics, bioinformatics, and the collection of human tissues and patient data creates novel moral duties for researchers. After all, unprecedented amounts of potentially sensitive information are being generated. Over time, traditional research ethics principles aimed at protecting individual participants have become supplemented with social obligations related to the interests of society and the research enterprise at large, illustrating that genomic medicine is also a social endeavor. In this review we provide a comprehensive assembly of moral duties that have been attributed to genomics researchers and offer suggestions for responsible advancement of personalized genomic cancer care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Should a Physician Comply with a Parent's Demands for a Forensic Exam on a 16-Year-Old Trauma Patient?

PubMed

Bowdler, Michelle; Kent, Hannah

2018-01-01

Physicians must remain vigilant about their ethical duties to patients, especially in high-stakes situations. The question raised by this case-whether a physician should comply with a parent's demand for treatment against her underage child's wishes-is not one of life or death in which a guardian might more credibly argue her judgment should stand. Given that forcing a rape kit exam on a patient who refuses to give assent could be further traumatizing, we argue that the physician should not comply. Deciding upon a course of action in this situation will involve considering what is in the patient's best interest and what constitutes a physician's appropriate role in gathering evidence for criminal investigations. © 2018 American Medical Association. All Rights Reserved.

Selling health data: de-identification, privacy, and speech.

PubMed

Kaplan, Bonnie

2015-07-01

Two court cases that involve selling prescription data for pharmaceutical marketing affect biomedical informatics, patient and clinician privacy, and regulation. Sorrell v. IMS Health Inc. et al. in the United States and R v. Department of Health, Ex Parte Source Informatics Ltd. in the United Kingdom concern privacy and health data protection, data de-identification and reidentification, drug detailing (marketing), commercial benefit from the required disclosure of personal information, clinician privacy and the duty of confidentiality, beneficial and unsavory uses of health data, regulating health technologies, and considering data as speech. Individuals should, at the very least, be aware of how data about them are collected and used. Taking account of how those data are used is needed so societal norms and law evolve ethically as new technologies affect health data privacy and protection.

Nurse managers' experience with ethical issues in six government hospitals in Malaysia: a cross-sectional study.

PubMed

Musa, Maizura binti; Harun-Or-Rashid, M D; Sakamoto, Junichi

2011-11-16

Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues. A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square. A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics. Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning.

38 CFR 9.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the policy. (g) The term termination of duty means (1) In the case of active duty or active duty for training being performed under a call or order that does not specify a period of less than 31 days-discharge, release or separation from such duty. (2) In the case of other duty—the member's release from his...

38 CFR 9.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the policy. (g) The term termination of duty means (1) In the case of active duty or active duty for training being performed under a call or order that does not specify a period of less than 31 days-discharge, release or separation from such duty. (2) In the case of other duty—the member's release from his...

Ethical triage and scarce resource allocation during public health emergencies: tenets and procedures.

PubMed

Kuschner, Ware G; Pollard, John B; Ezeji-Okoye, Stephen C

2007-01-01

Public health emergencies may result in mass casualties and a surge in demand for hospital-based care. Healthcare standards may need to be altered to respond to an imbalance between demands for care and resources. Clinical decisions that involve triage and scarce resource allocation may present unique ethical challenges. To address these challenges, the authors detailed tenets and procedures to guide triage and scarce resource allocation during public health emergencies. The authors propose health care organizations deploy a Triage and Scarce Resource Allocation Team to over-see and guide ethically challenging clinical decision-making during a crisis period. The authors' goal is to help healthcare organizations and clinicians balance public health responsibilities and their duty to individual patients during emergencies in as equitable and humane a manner as possible.

[Is "mental health" part of the common good? The sociopolitical framework of psychiatric ethics and the responsibility of health-care elites].

PubMed

Bohlken, Eike

2014-07-01

Psychiatric work can only be that ethical as the framework of a health-care system allows. Thus, the responsibility of the health-care elites to establish a sociopolitical framework that suits psychiatric ethics is discussed on the basis of a theory of the common good and of a philosophical and normative elite theory. "Mental health" is demonstrated to be part of a basic sphere of the common good which cannot be denied to any member of a society. The final section discusses which specific duties can be derived for health-care elites on the ground of the aforementioned conception of "mental health" as a part of the common good. © Georg Thieme Verlag KG Stuttgart · New York.

What's the deal with dental records for practicing dentists? Importance in general and forensic dentistry

PubMed Central

Devadiga, Arishka

2014-01-01

Dental records are essential for dentist and patient protection, and its maintenance is considered an ethical and legal obligation of the dentist: Ethical, because it satisfies the duty of care that the dentist has toward his patient and legal, as it is an investment for future protection against medico-legal complications. In addition to its legal and ethical role, the dental fraternity in India is slowly waking up to its importance in forensic dentistry. Dentists could play a vital role in assisting forensic investigators in providing information that would help in the identification of perpetrators or victims of crime and natural or manmade disaster situations. This information would be easily available and accessible through well-maintained patient records under dental care. PMID:24695875

49 CFR 1103.13 - Attempts to exert political or personal influence on the Board are prohibited.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Attempts to exert political or personal influence on the Board are prohibited. 1103.13 Section 1103.13 Transportation Other Regulations Relating to... PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward the Board § 1103.13...

Research Nurse | Center for Cancer Research

Cancer.gov

We are looking for research nurses to join our clinical program to help us manage the care of patients participating in clinical trials. Duties include, but are not limited to, ensuring adherence to ethical practice in the conduct of clinical trials, research protocol compliance and good clinical practice, ensuring patient comprehension of informed consent, management of care

Medical Dictation and Transcription; Business Education: 7707.43.

ERIC Educational Resources Information Center

Hoffman, Carol S.

The course prepares the business education student for the duties and ethics of the medical secretary and involves intensive practice with a high degree of speed and accuracy in taking dictation and transcribing materials related to the medical profession. Included are skills in spelling, pronouncing, and defining the most-used medical terms and…

22 CFR 1203.735-210 - Gambling, betting, and lotteries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Gambling, betting, and lotteries. 1203.735-210... RESPONSIBILITIES AND CONDUCT Ethical and Other Conduct and Responsibilities of Employees § 1203.735-210 Gambling... while on duty for the Government, in any gambling activity including the operation of a gambling device...

Confidentiality and Privileged Communication. The ACA Legal Series. Volume 6.

ERIC Educational Resources Information Center

Arthur, Gibbs L., Jr.; Swanson, Carl D.

This monograph is designed to offer a pragmatic or applied focus to the ethical and legal dilemmas facing practitioners in the area of confidentiality and privileged communication. First a glossary of terms is presented. Next the historical perspective of confidentiality is discussed, focusing on from what the counselor's professional duty and…

22 CFR 1203.735-210 - Gambling, betting, and lotteries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Gambling, betting, and lotteries. 1203.735-210... RESPONSIBILITIES AND CONDUCT Ethical and Other Conduct and Responsibilities of Employees § 1203.735-210 Gambling... while on duty for the Government, in any gambling activity including the operation of a gambling device...

22 CFR 1203.735-210 - Gambling, betting, and lotteries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Gambling, betting, and lotteries. 1203.735-210... RESPONSIBILITIES AND CONDUCT Ethical and Other Conduct and Responsibilities of Employees § 1203.735-210 Gambling... while on duty for the Government, in any gambling activity including the operation of a gambling device...

22 CFR 1203.735-210 - Gambling, betting, and lotteries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Gambling, betting, and lotteries. 1203.735-210... RESPONSIBILITIES AND CONDUCT Ethical and Other Conduct and Responsibilities of Employees § 1203.735-210 Gambling... while on duty for the Government, in any gambling activity including the operation of a gambling device...

42 CFR 460.71 - Oversight of direct participant care.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Oversight of direct participant care. 460.71 Section 460.71 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... plan, ethics, the PACE benefit, and any policies related to the job duties of specific staff. (2) The...

42 CFR 460.71 - Oversight of direct participant care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Oversight of direct participant care. 460.71 Section 460.71 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... plan, ethics, the PACE benefit, and any policies related to the job duties of specific staff. (2) The...

49 CFR 1103.21 - How far a practitioner may go in supporting a client's cause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... client's cause. 1103.21 Section 1103.21 Transportation Other Regulations Relating to Transportation... of Ethics The Practitioner's Duties and Responsibilities Toward A Client § 1103.21 How far a practitioner may go in supporting a client's cause. A practitioner shall put forth his best effort to maintain...

33 CFR 96.440 - How will the Coast Guard decide whether to approve an organization's request to be authorized?

Code of Federal Regulations, 2014 CFR

2014-07-01

... clear assignment of management duties; (2) Ethical standards for managers and auditors; (3) Procedures... recognized industry standards; (4) Procedures for auditing safety management systems that are consistent with... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY VESSEL OPERATING REGULATIONS RULES FOR THE...

33 CFR 96.440 - How will the Coast Guard decide whether to approve an organization's request to be authorized?

Code of Federal Regulations, 2010 CFR

2010-07-01

... clear assignment of management duties; (2) Ethical standards for managers and auditors; (3) Procedures... recognized industry standards; (4) Procedures for auditing safety management systems that are consistent with... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY VESSEL OPERATING REGULATIONS RULES FOR THE...

33 CFR 96.440 - How will the Coast Guard decide whether to approve an organization's request to be authorized?

Code of Federal Regulations, 2011 CFR

2011-07-01

... clear assignment of management duties; (2) Ethical standards for managers and auditors; (3) Procedures... recognized industry standards; (4) Procedures for auditing safety management systems that are consistent with... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY VESSEL OPERATING REGULATIONS RULES FOR THE...

33 CFR 96.440 - How will the Coast Guard decide whether to approve an organization's request to be authorized?

Code of Federal Regulations, 2013 CFR

2013-07-01

... clear assignment of management duties; (2) Ethical standards for managers and auditors; (3) Procedures... recognized industry standards; (4) Procedures for auditing safety management systems that are consistent with... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY VESSEL OPERATING REGULATIONS RULES FOR THE...

33 CFR 96.440 - How will the Coast Guard decide whether to approve an organization's request to be authorized?

Code of Federal Regulations, 2012 CFR

2012-07-01

... clear assignment of management duties; (2) Ethical standards for managers and auditors; (3) Procedures... recognized industry standards; (4) Procedures for auditing safety management systems that are consistent with... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY VESSEL OPERATING REGULATIONS RULES FOR THE...

To Protect and Serve

ERIC Educational Resources Information Center

Panter, Suzanna L.

2015-01-01

School librarians act as servants of the school community and protectors of students' rights, and it is the ethical duty of school librarians to champion student privacy and resist threats to it. This article addresses the legality of this process based upon the 2007 article "How Does the Family Rights and Privacy Act [FERPA] Affect You"…

Bioethics for clinicians: 27. Catholic bioethics

PubMed Central

Markwell, Hazel J.; Brown, Barry F.

2001-01-01

THERE IS A LONG TRADITION OF BIOETHICAL REASONING within the Roman Catholic faith, a tradition expressed in scripture, the writings of the Doctors of the Church, papal encyclical documents and reflections by contemporary Catholic theologians. Catholic bioethics is concerned with a broad range of issues, including social justice and the right to health care, the duty to preserve life and the limits of that duty, the ethics of human reproduction and end-of-life decisions. Fundamental to Catholic bioethics is a belief in the sanctity of life and a metaphysical conception of the person as a composite of body and soul. Although there is considerable consensus among Catholic thinkers, differences in philosophical approach have given rise to some diversity of opinion with respect to specific issues. Given the influential history of Catholic reflection on ethical matters, the number of people in Canada who profess to be Catholic, and the continuing presence of Catholic health care institutions, it is helpful for clinicians to be familiar with the central tenets of this tradition while respecting the differing perspectives of patients who identify themselves as Catholic. PMID:11501460

Open disclosure: ethical, professional and legal obligations, and the way forward for regulation.

PubMed

Finlay, Angus J F; Stewart, Cameron L; Parker, Malcolm

2013-05-06

Open disclosure (OD) after adverse health care events is the subject of a national standard that has been implemented in state health policy documents, and is included in the Medical Board of Australia's code of conduct for doctors. Nevertheless, doctors have been slow to embrace the practice of OD. There is a strong ethical case for implementing OD in the primary interests of patients, and additionally from a medicolegal risk management point of view. There are no statutory requirements in relation to OD, but common law judgments have imposed a duty of OD in tort and contract. There are a number of barriers to the better uptake and implementation of OD, including perceptions of legal risk, lack of education and training, reluctance to admit error, uncertainty concerning what and how much to disclose, and the variations in state and territory "apology laws". The implementation of OD could be improved by making apology laws consistent across jurisdictions, including providing "blanket" cover for admissions of fault; by preventing insurers voiding contracts when apologies are made, either through self-regulation or legislation; and by inserting OD obligations into different structures within the health system.

A physician's exposure to defamation.

PubMed

Mandell, W J

1992-01-01

The article defines defamation, discusses how to avoid a defamation action, and suggests defenses against a defamation action. Several examples are given that demonstrate common situations where liability exists and how a physician should respond. The article explains that at times we have a duty to speak and differentiates between our legal, moral, and ethical duty. Defamation should not be a concern for those involved in the peer review process, as long as they are truthful or act in a good faith belief that what they are saying is true. The article should enhance peer review by encouraging physicians to participate without fear of a retaliatory law suit.

Why "do no harm"?

PubMed

Sharpe, V A

1997-01-01

Edmund Pellegrino has argued that the dramatic changes in American health care call for critical reflection on the traditional norms governing the therapeutic relationship. This paper offers such reflection on the obligation to "do no harm." Drawing on work by Beauchamp and Childress and Pellegrino and Thomasma, I argue that the libertarian model of medical ethics offered by Engelhardt cannot adequately sustain an obligation to "do no harm." Because the obligation to "do no harm" is not based simply on a negative duty of nonmaleficence but also on a positive duty of beneficence, I argue that it is best understood to derive from the fiduciary nature of the healing relationship.

Conscientious Objection to Animal Experimentation in Italian Universities

PubMed Central

Baldelli, Ilaria; Massaro, Alma; Penco, Susanna; Bassi, Anna Maria; Patuzzo, Sara; Ciliberti, Rosagemma

2017-01-01

Simple Summary This paper examines the trend of Italian academic faculties in complying with the obligation to inform university students of their right to exercise their conscientious objection to scientific or educational activities involving animals, hereafter written as “animal CO”, as established by Law 413/1993, “Norme sull’obiezione di coscienza alla sperimentazione animale” (“Rules on conscientious objection to animal experimentation”), thereafter “Law 413/1993”. Despite an increasing interest in the principles of animal ethics by the international community, this law is still largely disregarded more than 20 years after its enactment. The Ethics Committees, Animal Welfare Committees, as well as the Italian Ministry of Education, University and Research should preside over and monitor the Universities’ compliance with the duty to disclose animal CO. Abstract In Italy, Law 413/1993 states that public and private Italian Institutions, including academic faculties, are obliged to fully inform workers and students about their right to conscientious objection to scientific or educational activities involving animals, hereafter written as “animal CO”. However, little monitoring on the faculties’ compliance with this law has been performed either by the government or other institutional bodies. Based on this premise, the authors have critically reviewed the existing data and compared them with those emerging from their own investigation to discuss limitations and inconsistencies. The results of this investigation revealed that less than half of Italian academic faculties comply with their duty to inform on animal CO. Non-compliance may substantially affect the right of students to make ethical choices in the field of animal ethics and undermines the fundamental right to express their own freedom of thought. The Italian Ministry of Education, Universities and Research, ethics committees and animal welfare bodies should cooperate to make faculties respect this law. Further research is needed to better understand the reasons for the current trend, as well as to promote the enforcement of Law 413/1993 with particular regard to information on animal CO. PMID:28335392

Physician 'defiance' towards hand hygiene compliance: Is there a theory-practice-ethics gap?

PubMed

Mortell, Manfred; Balkhy, Hanan H; Tannous, Elias B; Jong, Mei Thiee

2013-07-01

The theory-practice gap has always existed [1,2]. This gap is often cited as a culmination of theory being idealistic and impractical, even if practical and beneficial, is often ignored. Most of the evidence relating to the non-integration of theory and practice assumes that environmental factors are responsible and will affect learning and practice outcomes, hence the gap. Therefore, the author believes that to 'bridge the gap' between theory and practice, an additional dimension is required: ethics. A moral duty and obligation ensuring theory and practice integrate. In order to effectively implement new practices, one must deem these practices as worthy and relevant to their role as healthcare providers (HCP). Hence, this introduces a new concept which the author refers to as the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when reviewing some of the unacceptable outcomes in healthcare practice [3]. The literature suggests that there is a crisis of ethics where theory and practice integrate, and healthcare providers are failing to fulfill our duty as patient advocates. Physician hand hygiene practices and compliance at King Abdulaziz Cardiac Centre (KACC) are consistent with those of other physicians in the global healthcare arena. That is one of noncompliance to King Abdulaziz Medical City (KAMC) organizational expectations and the World Health Organization (WHO) requirements? An observational study was conducted on the compliance of cardiac surgeons, cardiologists and nurses in the authors' cardiac center from January 2010 to December 2011. The hand hygiene (HH) compliance elements that were evaluated pertained to the WHO's five moments of HH recommendations. The data was obtained through direct observation by KAMC infection prevention and control practitioners. Physician hand hygiene compliance at KACC was consistently less than 60%, with nurses regularly encouraging physicians to be diligent with hand hygiene practices in the clinical area. Hand hygiene compliance will not improve unless evidence-based recommendations are adopted and endorsed by all healthcare professionals and providers.

38 CFR 9.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the policy. (g) The term termination of duty means (1) In the case of active duty or active duty for... or her obligation to perform any duty in his or her uniformed service (active duty, or active duty for training or inactive duty training) whether arising from limitations included in a contract of...

38 CFR 9.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the policy. (g) The term termination of duty means (1) In the case of active duty or active duty for... or her obligation to perform any duty in his or her uniformed service (active duty, or active duty for training or inactive duty training) whether arising from limitations included in a contract of...

What ethics for case managers? Literature review and discussion.

PubMed

Corvol, Aline; Moutel, Grégoire; Somme, Dominique

2016-11-01

Little is known about case managers' ethical issues and professional values. This article presents an overview of ethical issues in case managers' current practice. Findings are examined in the light of nursing ethics, social work ethics and principle-based biomedical ethics. A systematic literature review was performed to identify and analyse empirical studies concerning ethical issues in case management programmes. It was completed by systematic content analysis of case managers' national codes of ethics. Only nine empirical studies were identified, eight of them from North America. The main dilemmas were how to balance system goals against the client's interest and client protection against autonomy. Professional codes of ethics shared important similarities, but offered different responses to these two dilemmas. We discuss the respective roles of professional and organizational ethics. Further lines of research are suggested. © The Author(s) 2015.

Facilitating the ethical use of health data for the benefit of society: electronic health records, consent and the duty of easy rescue

PubMed Central

Porsdam Mann, Sebastian; Sahakian, Barbara J.

2016-01-01

Advances in data science allow for sophisticated analysis of increasingly large datasets. In the medical context, large volumes of data collected for healthcare purposes are contained in electronic health records (EHRs). The real-life character and sheer amount of data contained in them make EHRs an attractive resource for public health and biomedical research. However, medical records contain sensitive information that could be misused by third parties. Medical confidentiality and respect for patients' privacy and autonomy protect patient data, barring access to health records unless consent is given by the data subject. This creates a situation in which much of the beneficial records-based research is prevented from being used or is seriously undermined, because the refusal of consent by some patients introduces a systematic deviation, known as selection bias, from a representative sample of the general population, thus distorting research findings. Although research exemptions for the requirement of informed consent exist, they are rarely used in practice due to concerns over liability and a general culture of caution. In this paper, we argue that the problem of research access to sensitive data can be understood as a tension between the medical duties of confidentiality and beneficence. We attempt to show that the requirement of informed consent is not appropriate for all kinds of records-based research by distinguishing studies involving minimal risk from those that feature moderate or greater risks. We argue that the duty of easy rescue—the principle that persons should benefit others when this can be done at no or minimal risk to themselves—grounds the removal of consent requirements for minimally risky records-based research. Drawing on this discussion, we propose a risk-adapted framework for the facilitation of ethical uses of health data for the benefit of society. This article is part of the themed issue ‘The ethical impact of data science’. PMID:28336803

Facilitating the ethical use of health data for the benefit of society: electronic health records, consent and the duty of easy rescue.

PubMed

Porsdam Mann, Sebastian; Savulescu, Julian; Sahakian, Barbara J

2016-12-28

Advances in data science allow for sophisticated analysis of increasingly large datasets. In the medical context, large volumes of data collected for healthcare purposes are contained in electronic health records (EHRs). The real-life character and sheer amount of data contained in them make EHRs an attractive resource for public health and biomedical research. However, medical records contain sensitive information that could be misused by third parties. Medical confidentiality and respect for patients' privacy and autonomy protect patient data, barring access to health records unless consent is given by the data subject. This creates a situation in which much of the beneficial records-based research is prevented from being used or is seriously undermined, because the refusal of consent by some patients introduces a systematic deviation, known as selection bias, from a representative sample of the general population, thus distorting research findings. Although research exemptions for the requirement of informed consent exist, they are rarely used in practice due to concerns over liability and a general culture of caution. In this paper, we argue that the problem of research access to sensitive data can be understood as a tension between the medical duties of confidentiality and beneficence. We attempt to show that the requirement of informed consent is not appropriate for all kinds of records-based research by distinguishing studies involving minimal risk from those that feature moderate or greater risks. We argue that the duty of easy rescue-the principle that persons should benefit others when this can be done at no or minimal risk to themselves-grounds the removal of consent requirements for minimally risky records-based research. Drawing on this discussion, we propose a risk-adapted framework for the facilitation of ethical uses of health data for the benefit of society.This article is part of the themed issue 'The ethical impact of data science'. © 2015 The Authors.

Learning from the legal history of billing for medical fees.

PubMed

Hall, Mark A; Schneider, Carl E

2008-08-01

When patients pay for care out-of-pocket, physicians must balance their professional obligations to serve with the commercial demands of medical practice. Consumer-directed health care makes this problem newly pressing, but law and ethics have thought for millennia about how doctors should bill patients. At various points in European history, the law restricted doctors' ability to bill for their services, but this legal aversion to commercializing medicine did not take root in the American colonies. Rather, US law has always treated selling medical services the way it treats other sales. Yet doctors acted differently in a crucial way. Driven by the economics of medical practice before the spread of health insurance, doctors charged patients according to what they thought each patient could afford. The use of sliding fee scales persisted until widespread health insurance drove a standardization of fees. CURRENT PRACTICE: Today, encouraged by Medicare rules and managed care discounts, providers use a perverse form of a sliding scale that charges the most to patients who can afford the least. Primary care physicians typically charge uninsured patients one third to one half more than they receive from insurers for basic office or hospital visits, and markups are substantially higher (2 to 2.5 times) for high-tech tests and specialists' invasive procedures. Ethical and professional principles might require providers to return to discounting fees for patients in straitened circumstances, but imposing such a duty formally (by law or by ethical code) on doctors would be harder both in principle and in practice than to impose such a duty on hospitals. Still, professional ethics should encourage physicians to give patients in economic trouble at least the benefit of the lowest rate they accept from an established payer.

Learning from the Legal History of Billing for Medical Fees

PubMed Central

Schneider, Carl E.

2008-01-01

INTRODUCTION When patients pay for care out-of-pocket, physicians must balance their professional obligations to serve with the commercial demands of medical practice. Consumer-directed health care makes this problem newly pressing, but law and ethics have thought for millennia about how doctors should bill patients. Historical Background At various points in European history, the law restricted doctors’ ability to bill for their services, but this legal aversion to commercializing medicine did not take root in the American colonies. Rather, US law has always treated selling medical services the way it treats other sales. Yet doctors acted differently in a crucial way. Driven by the economics of medical practice before the spread of health insurance, doctors charged patients according to what they thought each patient could afford. The use of sliding fee scales persisted until widespread health insurance drove a standardization of fees. Current Practice Today, encouraged by Medicare rules and managed care discounts, providers use a perverse form of a sliding scale that charges the most to patients who can afford the least. Primary care physicians typically charge uninsured patients one third to one half more than they receive from insurers for basic office or hospital visits, and markups are substantially higher (2 to 2.5 times) for high-tech tests and specialists’ invasive procedures. CONCLUSION Ethical and professional principles might require providers to return to discounting fees for patients in straitened circumstances, but imposing such a duty formally (by law or by ethical code) on doctors would be harder both in principle and in practice than to impose such a duty on hospitals. Still, professional ethics should encourage physicians to give patients in economic trouble at least the benefit of the lowest rate they accept from an established payer. PMID:18414955

The fiduciary obligation of the physician-researcher in phase IV trials

PubMed Central

2014-01-01

Background In this manuscript, we argue that within the context of phase IV, physician-researchers retain their fiduciary obligation to treat the patient-participants. Discussion We first clarify why the perspective that research ethics ought to be differentiated from clinical ethics is not applicable in phase IV, and therefore, why therapeutic orientation is most convivial in this phase. Next, assuming that ethics guidelines may be representative of common morality, we show that ethics guidelines see physician-researchers primarily as physicians and only secondarily as researchers. We then elaborate on what a fiduciary obligation is and how some of the obligations are default duties. Lastly, we look at the fiduciary obligation of the physician-researcher in phase IV interventional trials. Conclusion The fiduciary obligation to treat is not as easily waived as in earlier trials. Assuming the entwinement of research and practice in phase IV, physician-researchers, in collaboration with other researchers, investigators, and research ethics committees, should ensure that in terms of study design, methodology, and research practice, the therapeutic value of the research to the patient-participants is not diminished. PMID:24507449

[The first deontology dissertation in Croatia (Desković, 1943)].

PubMed

Segota, I

1995-01-01

The first Croatian deontological dissertation, and probably one of the oldest in Europe, was written in Vienna in 1843. It was also published there in German. Our medical historians discovered it 40 years ago. However, its contents have up to now been unknown to our scientific and broader community. The manuscript, titled "About Physician's Duties to the State and to his Fellow-Men" (in German original: Joseph Descovich, Ueber die Pflichten des Artzes, Gegen den Staat uind seine Mitmenschen), is the work of a Dalmatian physician from Omis, Dr. Josip Desković. Nowadays when medical ethics has evolved into an independent academic discipline, and is rapidly spreading on all continents, this dissertation indicates that historical roots of medical ethics in Croats are by more than 150 years older compared to some other European countries, e. g. Sweden. The author presents the content of the dissertation and analyses it from ethical and sociological viewpoints. He relates it to Hippocratic ethics as well as to contemporary medical ethics termed bioethics, which is steadily establishing itself in modern medicine.

A person-centered approach to moral judgment.

PubMed

Uhlmann, Eric Luis; Pizarro, David A; Diermeier, Daniel

2015-01-01

Both normative theories of ethics in philosophy and contemporary models of moral judgment in psychology have focused almost exclusively on the permissibility of acts, in particular whether acts should be judged on the basis of their material outcomes (consequentialist ethics) or on the basis of rules, duties, and obligations (deontological ethics). However, a longstanding third perspective on morality, virtue ethics, may offer a richer descriptive account of a wide range of lay moral judgments. Building on this ethical tradition, we offer a person-centered account of moral judgment, which focuses on individuals as the unit of analysis for moral evaluations rather than on acts. Because social perceivers are fundamentally motivated to acquire information about the moral character of others, features of an act that seem most informative of character often hold more weight than either the consequences of the act or whether a moral rule has been broken. This approach, we argue, can account for numerous empirical findings that are either not predicted by current theories of moral psychology or are simply categorized as biases or irrational quirks in the way individuals make moral judgments. © The Author(s) 2014.

Basing Science Ethics on Respect for Human Dignity.

PubMed

Aközer, Mehmet; Aközer, Emel

2016-12-01

A "no ethics" principle has long been prevalent in science and has demotivated deliberation on scientific ethics. This paper argues the following: (1) An understanding of a scientific "ethos" based on actual "value preferences" and "value repugnances" prevalent in the scientific community permits and demands critical accounts of the "no ethics" principle in science. (2) The roots of this principle may be traced to a repugnance of human dignity, which was instilled at a historical breaking point in the interrelation between science and ethics. This breaking point involved granting science the exclusive mandate to pass judgment on the life worth living. (3) By contrast, respect for human dignity, in its Kantian definition as "the absolute inner worth of being human," should be adopted as the basis to ground science ethics. (4) The pathway from this foundation to the articulation of an ethical duty specific to scientific practice, i.e., respect for objective truth, is charted by Karl Popper's discussion of the ethical principles that form the basis of science. This also permits an integrated account of the "external" and "internal" ethical problems in science. (5) Principles of the respect for human dignity and the respect for objective truth are also safeguards of epistemic integrity. Plain defiance of human dignity by genetic determinism has compromised integrity of claims to knowledge in behavioral genetics and other behavioral sciences. Disregard of the ethical principles that form the basis of science threatens epistemic integrity.

Community without communitarianism: HIV/AIDS research, prevention and treatment in Australia and the developing world.

PubMed

Zion, Deborah

2005-04-01

The advent of HIV focussed broad social attention on the group of people most affected by it in Australia, the so-called 'gay community'. However, what a gay community actually was, and what kind of rights and duties were being attached to it remained unclear. However, it is obvious that such a community--or communities--did not fit the model proposed by communitarian writers like Michael Sandel and Charles Taylor, whereby subjects cannot stand outside their own constitutive attachments. I also consider the common criticism of communitarianism, and see what kinds of collectives can in fact be considered ethical. The first part of the paper looks at the ethical issues surrounding community attachment of this kind in Australia in relation to the ethics of HIV/AIDS clinical research. In particular I examine the way in which certain forms of gay community attachment can be used to strengthen personal autonomy and check exploitation within the prevention and research process. The second part of this paper draws upon the issues just discussed. In particular I focus on the use of 'community' in the research process in developing countries, and suggest ways in which cultural considerations might strengthen autonomy. However, I go on to suggest that in many cases the idea of community has served the opposite purpose, and has in fact been used to oppress certain individuals and groups within the developing world, in the so-called interests of the greater good. In order to avoid this, I suggest a model of social and ethical research whereby all subjects and researchers in the clinical process might stand in greater relationships of equality with each other.

What Does It Take to Establish that a World Is Uninhabited Prior to Exploitation? A Question of Ethics as well as Science

NASA Astrophysics Data System (ADS)

Persson, Erik

2014-08-01

If we find life on another world, it will be an extremely important discovery and we will have to take great care not to do anything that might endanger that life. If the life we find is sentient we will have moral obligations to that life. Whether it is sentient or not, we have a duty to ourselves to preserve it as a study object, and also because it would be commonly seen as valuable in its own right. In addition to this we would also have a duty to our fellow humans and other earthly life forms not to expose them to danger by advertently or inadvertently exposing them to potentially harmful space organisms. When space exploration turns into exploitation it will therefore be important to be able to show that a world that is up for exploitation is uninhabited before the exploitation starts. Showing that a world is uninhabited is, however, a different kind of task than showing that it is inhabited. The latter task can be accomplished through one positive finding but it is! not clear how to go about the former task. In this paper I suggest that it is a gradual process asymptotically approaching certainty rather than a discovery in the traditional sense of the word. It has to be handled in two steps. The first is to connect degree of certainty with research setup. The second is to decide how certain we need to be. The first step is about the number, diversity and quality of observations. The second step is a decision we have to make based on the purpose of the investigation. The purpose and therefore the degree of certainty needed to establish that a world is uninhabited will be different for a world that is up for exploitation than for a world that is not. In the latter case it is only a matter of epistemic values. In the former case also ethical values have to be considered.

Autonomy of children and adolescents in consent to treatment: ethical, jurisprudential and legal considerations.

PubMed

Parsapoor, Alireza; Parsapoor, Mohammad-Bagher; Rezaei, Nima; Asghari, Fariba

2014-06-01

Autonomy is usually considered as a main principle in making decisions about individuals' health. Children and particularly adolescents have the capacity to take part in medical decision-making to some extent. For the most part the parent-doctor-child/adolescent triangle sides are essentially in agreement, but this may not be true in some cases, causing physicians to face problems attempting to determine their professional duties. According to Islamic jurisprudent upon reaching the age of Taklif (15 full lunar years for boys and 9 full lunar years for girls) no one can be treated as incompetent based on mental immaturity unless his or her insanity or mental immaturity is provend Moreover the Islamic Sharia, decrees that parents should lose their authority to make medical decisions for their children, if their bad faith or imprudence is proven, in which case a fit and proper person or an institution will be appointed to make decisions in this respect based on the child's best interests.

Duties to Extraterrestrial Microscopic Organisms

NASA Astrophysics Data System (ADS)

Cockell, C. S.

Formulating a normative axiology for the treatment of extraterrestrial microscopic organisms, should they ever be found, requires an extension of environmental ethics to beyond the Earth. Using an ethical framework for the treatment of terrestrial micro-organisms, this paper elaborates a similar ethic for the treatment of extraterrestrial microscopic organisms. An ethic of `teloempathy' allows for the moral considerability of any organism that has `interests', based on rudimentary qualities of conativism, and therefore allows for an identical treatment of all life, related or not related to life on Earth. Although, according to this ethic, individual extraterrestrial microscopic organisms have a good of their own and even `rights', at this level the ethic can only be theoretical, allowing for the inevitable destruction of many individual organisms during the course of human exploratory missions, similarly to the daily destruction of microbes by humans on Earth. A holistic teloempathy, an operative ethic, not only provides a framework for human exploration, but it also has important implications for planetary protection and proposals to implement planetary-scale atmospheric alterations on other bodies. Even prior to the discovery of extraterrestrial life, or the discovery of a complete absence of such life, this exercise yields important insights into the moral philosophy that guides our treatment of terrestrial micro-organisms.

Caring for Active Duty Military Personnel in the Civilian Sector

PubMed Central

Waitzkin, Howard; Noble, Marylou

2011-01-01

Due to the wars in Iraq and Afghanistan, the unmet medical and psychological needs of military personnel are creating major challenges. Increasingly, active duty military personnel are seeking physical and mental health services from civilian professionals. The Civilian Medical Resources Network attempts to address these unmet needs. Participants in the Network include primary care and mental health practitioners in all regions of the country. Network professionals provide independent assessments, clinical interventions in acute situations, and documentation that assists GIs in obtaining reassignment or discharge. Most clients who use Network services come from low-income backgrounds and manifest psychological rather than physical disorders. Qualitative themes in professional-client encounters have focused on ethical conflicts, the impact of violence without meaning (especially violence against civilians), and perceived problems in military health and mental health policies. Unmet needs of active duty military personnel deserve more concerted attention from medical professionals and policy makers. PMID:21339846

Duties to kin through a tragi-comic lens.

PubMed

Gillett, Grant; Hankey, Robin

2014-06-01

Euripides' Alcestis (1959) raises the issue of ethical duties within families and exposes the romantic postures and rhetoric that can dominate such discussions. Should anybody be asked to sacrifice themselves or even undergo significant health risks for members of their own family? (An issue that is also relevant in considering our duties to future generations in terms of the earth we leave to them.) The issue that is dramatized to a heroic level in Alcestis arises in live organ and tissue donation within a family and challenges the idea that families should be trusted to sort out solutions that they can all live with. Alcestis intensifies the debate because the sacrifice of one life for another is its topic but, in doing so, it exposes many traps lying in wait for ethicists and medical jurists who boldly enter such debates (where emotions create shifting ground on which angels fear to tread).

'If you have a soul, you will volunteer at once': gendered expectations of duty to care during pandemics.

PubMed

Godderis, Rebecca; Rossiter, Kate

2013-02-01

Duty to care has been identified as a pressing ethical issue in contemporary discussions of pandemic preparedness; however, nuanced discussions of this complicated issue are relatively limited. This article presents historical data from the experience of the 1918 influenza pandemic in Brantford, Ontario in Canada, demonstrating that, in the face of an actual pandemic, the particular construction of duty to care as both moral and gendered meant that women were placed at a greater personal risk during this time. Given that women still dominate the front lines of healthcare work, we argue that it is critical for current stakeholders to reflect on how these historical patterns may be replicated in contemporary pandemic planning and response. © 2012 The Authors. Sociology of Health & Illness 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

A right to confidentiality or a duty to disclose? Ethical guidance for conducting prevention research with children and adolescents.

PubMed

Hiriscau, Ioana E; Stingelin-Giles, Nicola; Stadler, Christina; Schmeck, Klaus; Reiter-Theil, Stella

2014-06-01

Conducting prevention research with children and adolescents raises ethical challenges especially regarding confidentiality. Research with children and adolescents often applies methodologies which aims at the disclosure of sensitive information about practices that impact on adolescent mental and physical health such as sexual activity, smoking, alcohol consumption, illegal drug use, self-damaging and suicidal behaviour (ideation and attempts). The scope of the article is to review normative documents that cover topics relevant for confidentiality when conducting research with children and adolescents. A systematic literature search in MEDLINE was performed to identify relevant international and European guidelines and codes of ethics that cover health, behavioural and social science research. Additionally, the European Research Ethics website was consulted for double check. However, none of the documents aimed at biomedical, behavioural or social research offers concrete support in resolving practical research ethics problems regarding confidentiality. The codes show a lack of clarity in any circumstances in which the researcher might have an obligation to breach confidentiality by disclosing sensitive information. Only little information is given on what kind of disclosed information, if disclosed, might justify breaching confidentiality. The findings prove a need for normative documents to address the ethical questions regarding confidentiality arising in research practice explicitly and specifically. Moreover, further forms of ethical guidance should be developed to support ethical research with children and adolescents.

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.

PubMed

Heubel, Friedrich; Biller-Andorno, Nikola

2005-01-01

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

Disclosure of Individual Surgeon's Performance Rates During Informed Consent

PubMed Central

Burger, Ingrid; Schill, Kathryn; Goodman, Steven

2007-01-01

Objective: The purpose of the paper is to examine the ethical arguments for and against disclosing surgeon-specific performance rates to patients during informed consent, and to examine the challenges that generating and using performance rates entail. Methods: Ethical, legal, and statistical theory is explored to approach the question of whether, when, and how surgeons should disclosure their personal performance rates to patients. The main ethical question addressed is what type of information surgeons owe their patients during informed consent. This question comprises 3 related, ethically relevant considerations that are explored in detail: 1) Does surgeon-specific performance information enhance patient decision-making? 2) Do patients want this type of information? 3) How do the potential benefits of disclosure balance against the risks? Results: Calculating individual performance measures requires tradeoffs and involves inherent uncertainty. There is a lack of evidence regarding whether patients want this information, whether it facilitates their decision-making for surgery, and how it is best communicated to them. Disclosure of personal performance rates during informed consent has the potential benefits of enhancing patient autonomy, improving patient decision-making, and improving quality of care. The major risks of disclosure include inaccurate and misleading performance rates, avoidance of high-risk cases, unjust damage to surgeon's reputations, and jeopardized patient trust. Conclusion: At this time, we think that, for most conditions, surgical procedures, and outcomes, the accuracy of surgeon- and patient-specific performance rates is illusory, obviating the ethical obligation to communicate them as part of the informed consent process. Nonetheless, the surgical profession has the duty to develop information systems that allow for performance to be evaluated to a high degree of accuracy. In the meantime, patients should be informed of the quantity of procedures their surgeons have performed, providing an idea of the surgeon's experience and qualitative idea of potential risk. PMID:17414595

Ethical considerations for vaccination programmes in acute humanitarian emergencies

PubMed Central

Hardie, Kate; Selgelid, Michael J; Waldman, Ronald J; Strebel, Peter; Rees, Helen; Durrheim, David N

2013-01-01

Abstract Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice. PMID:23599553

Ethics of clear health communication: applying the CLEAN Look approach to communicate biobanking information for cancer research.

PubMed

Koskan, Alexis; Arevalo, Mariana; Gwede, Clement K; Quinn, Gwendolyn P; Noel-Thomas, Shalewa A; Luque, John S; Wells, Kristen J; Meade, Cathy D

2012-11-01

Cancer innovations, such as biobanking technologies, are continuously evolving to improve our understanding and knowledge about cancer prevention and treatment modalities. However, the public receives little communication about biobanking and is often unaware about this innovation until asked to donate biospecimens. It is the researchers' ethical duty to provide clear communications about biobanking and biospecimen research. Such information allows the public to understand biobanking processes and facilitates informed decision making about biospecimen donation. The aims of this paper are 1) to examine the importance of clear communication as an ethical imperative when conveying information about cancer innovations and 2) to illustrate the use of an organizing framework, the CLEAN ( C ulture, L iteracy, E ducation, A ssessment, and N etworking) Look approach for creating educational priming materials about the topic of biobanking.

The ethics of germ line gene manipulation--a five dimensional debate.

PubMed

Carter, Lucy

2002-10-01

Contributors to the debate surrounding the ethics of germ line gene manipulation have by and large concentrated their efforts on discussions of the potential risks that are associated with the use of this technology. Many international advisory committees have ruled out the acceptability of germ line gene manipulation at least for the time being. The purpose of this work is to generate much needed discussion on the many other ethical issues concerning the implementation of not only germ line gene manipulation but also other related biotechnologies. In this paper I systematically investigate and analyse the most salient issues put forward by proponents and opponents alike. I argue that if germ line manipulation proves to be a safe and effective procedure, then the principle of beneficence imposes on the medical profession a moral duty to pursue the technology.

Bury Your Gays and Social Media Fan Response: Television, LGBTQ Representation, and Communitarian Ethics.

PubMed

Waggoner, Erin B

2017-10-12

Although visibility has increased, there are still television tropes used that can have potentially harmful effects on LGBTQ persons seeking identification through television characters. This essay explores the representation of women-loving women (WLW) on television and how fans respond via social media with regard to their identity and representation. Specifically, by examining the fan culture through a communitarian ethics lens (with an emphasis on duty and mutuality), fans are explored before and after a lesbian character's death and how their responses created a social movement regarding the current television environment's treatment of WLW characters. Media anthropology and virtual ethnographic observations on Twitter and Tumblr were used to answer how fans were responding to WLW representation via social media and how they engaged with communitarian ethics. Implications and criticisms are discussed.

Clarifying perspectives: Ethics case reflection sessions in childhood cancer care.

PubMed

Bartholdson, Cecilia; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

2016-06-01

Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child's growing autonomy are known ethical concerns that involve the whole professional team around the child's care. The purpose of this study was to explore healthcare professionals' experiences of participating in ethics case reflection sessions in childhood cancer care. Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Healthcare professionals working at a publicly funded children's hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. The children's and their parents' integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants' articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals. © The Author(s) 2015.

Medical ethics in times of war and insurrection: rights and duties.

PubMed

Benatar, S R

1993-01-01

In this paper I shall take the Geneva Conventions and Additional Protocols as my point of departure and link these with the International Declaration of Human Rights as a statement of faith and of aspirations.... The second part of my paper will focus on medical morality with brief reference to various languages of moral discourse and to differences in conceptual logic which underpin debates on duties and rights with particular reference to the circumstances of conflict. While acknowledging the value of talking of rights as primary I shall also suggest that the shift away from discourse on duties and obligations as primary undermines the likelihood of super-erogatory moral action. I shall conclude by emphasizing the centrality of acceptance by the State and the military of their duty to the injured and to medical personnel caring for them, if man's inhumanity to man, particularly evident during times of war, is to be kept out of our concern for each other as human beings even when nations are pitted against each other in the ongoing, but hopefully not eternal, struggle for material and ideological power.

A Double Take: The Practical and Ethical Dilemmas of Teaching the Visual Method of Photo Elicitation

ERIC Educational Resources Information Center

Wakefield, Caroline; Watt, Sal

2014-01-01

This paper advocates the teaching of photo elicitation in higher education as a valuable data collection technique and draws on our experience of teaching this visual method across two consecutive postgraduate cohorts. Building on previous work (Watt & Wakefield, 2014) and based on a former concern regarding student duty of care, a…

The Politics of Historiography--Towards an Ethics of Representation

ERIC Educational Resources Information Center

McDonnell, Bill

2005-01-01

What is the relationship of writing to praxis, of historiography and critique to the human experiences and oppressions which are its subject matter? Is there a politics of context, as there is in practice: a duty of solidarity which requires that we bear responsibility for the reproduction of these narratives, for their use and reuse? What…

78 FR 13891 - Persulfates From China; Institution of a Five-Year Review Concerning the Antidumping Duty Order...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-01

... conditions or business cycle for the Domestic Like Product that have occurred in the United States or in the... Carol McCue Verratti, Deputy Agency Ethics Official, at 202- 205-3088. Limited disclosure of business..., a U.S. or foreign trade or business association, or another interested party (including an...

77 FR 24742 - In the Matter of ABSG Consulting Inc. Confirmatory Order (Effective Immediately)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... Compliance to draft an expanded anti-retaliation policy for inclusion in the Company's Code of Ethics. During... following additional actions: 1. The President of ABSG shall issue a communication in writing to those... communication shall also be provided to all new hire employees within thirty days of their assumption of duties...

[Topics of occupational medicine and environment in codes and social accountability standards of business].

PubMed

Denisov, E I; Golovaneva, G V; Potapenko, A A

2005-01-01

The problems of social accountability as applied to the occupational safety, health and environment are discussed. Russian and international codes and standards in the field are reviewed. Legal duties and rights of employers in occupational risk management for workers' health are considered. Some ethical aspects including health protection of female workers are discussed.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part I.

PubMed

O'Donnell, Lolita T

2007-01-01

To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Playing Hockey, Riding Motorcycles, and the Ethics of Protection

PubMed Central

2012-01-01

Ice hockey and motorcycle riding are increasingly popular activities in the United States that are associated with high risks of head and facial injuries. In both, effective head and facial protective equipment are available. Yet the debates about safety policies regarding the use of head protection in these activities have taken different forms, in terms of the influence of epidemiological data as well as of the ethical concerns raised. I examine these debates over injury prevention in the context of leisure activities, in which the public health duty to prevent avoidable harm must be balanced with the freedom to assume voluntary risks. PMID:23078472

[VACCINES].

PubMed

Bellver Capella, Vincente

2015-10-01

Vaccines are an extraordinary instrument of immunization of the population against infectious diseases. Around them there are many ethical issues. One of the most debated is what to do with certain groups opposition to vaccination of their children. States have managed in different ways the conflict between the duty of vaccination and the refusal to use vaccines: some impose the vaccination and others simply promote it. In this article we deal with which of these two approaches is the most suitable from an ethical and legal point of view. We stand up for the second option, which is the current one in Spain, and we propose some measures which should be kept in mind to improve immunization programs.

Ethical and medical dilemmas of space tourism

NASA Astrophysics Data System (ADS)

Marsh, Melinda

Space tourism is an important new venture, however it raises several issues that must be addressed; namely, the medical implications associated with space flight and potential for ethical problems surrounding the safety of such travel. It seems highly likely that businesses involved in space tourism could find themselves liable for any passenger deaths or injuries, if they are found to have been negligent. This paper, therefore, discusses such issues as the medical facilities that need to be made available on board a space facility, and the companies' duty to disclose to potential passengers the risks associated with microgravity and the likelihood of space sickness, loss of bone density, disease, and pregnancy.

Stakeholder Opinions And Ethical Perspectives Support Complete Disclosure Of Incidental Findings In MRI Research.

PubMed

Phillips, John P; Cole, Caitlin; Gluck, John P; Shoemaker, Jody M; Petree, Linda; Helitzer, Deborah; Schrader, Ronald; Holdsworth, Mark

2015-07-01

How far does a researcher's responsibility extend when an incidental finding is identified? Balancing pertinent ethical principles such as beneficence, respect for persons, and duty to rescue is not always straightforward, particularly in neuroimaging research where empirical data that might help guide decision-making is lacking. We conducted a systematic survey of perceptions and preferences of 396 investigators, research participants and IRB members at our institution. Using the partial entrustment model as described by Richardson, we argue that our data supports universal reading by a neuroradiologist of all research MRI scans for incidental findings and providing full disclosure to all participants.

Strategies for Limiting Engineers' Potential Liability for Indoor Air Quality Problems.

PubMed

von Oppenfeld, Rolf R; Freeze, Mark E; Sabo, Sean M

1998-10-01

Engineers face indoor air quality (IAQ) issues at the design phase of building construction as well as during the investigation and mitigation of potential indoor air pollution problems during building operation. IAQ issues that can be identified are "building-related illnesses" that may include problems of volatile organic compounds (VOCs). IAQ issues that cannot be identified are termed "sick building syndrome." Frequently, microorganism-caused illnesses are difficult to confirm. Engineers who provide professional services that directly or indirectly impact IAQ face significant potential liability to clients and third parties when performing these duties. Potential theories supporting liability claims for IAQ problems against engineers include breach of contract and various common law tort theories such as negligence and negligent misrepresentation. Furthermore, an increasing number of federal, state, and local regulations affect IAQ issues and can directly increase the potential liability of engineers. A duty to disclose potential or actual air quality concerns to third parties may apply for engineers in given circumstances. Such a duty may arise from judicial precedent, the Model Guide for Professional Conduct for Engineers, or the Code of Ethics for Engineers. Practical strategies engineers can use to protect themselves from liability include regular training and continuing education in relevant regulatory, scientific, and case law developments; detailed documentation and recordkeeping practices; adequate insurance coverage; contractual indemnity clauses; contractual provisions limiting liability to the scope of work performed; and contractual provisions limiting the extent of liability for engineers' negligence. Furthermore, through the proper use of building materials and construction techniques, an engineer or other design professional can effectively limit the potential for IAQ liability.

Education research: a case-based bioethics curriculum for neurology residents.

PubMed

Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth

2015-03-31

In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.

29 CFR 102.35 - Duties and powers of administrative law judges; stipulations of cases to administrative law...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Duties and powers of administrative law judges; stipulations of cases to administrative law judges or to the Board; assignment and powers of settlement judges... Practices 1 Hearings § 102.35 Duties and powers of administrative law judges; stipulations of cases to...

Case-based ethics instruction: the influence of contextual and individual factors in case content on ethical decision-making.

PubMed

Bagdasarov, Zhanna; Thiel, Chase E; Johnson, James F; Connelly, Shane; Harkrider, Lauren N; Devenport, Lynn D; Mumford, Michael D

2013-09-01

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sense making processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed.

Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

PubMed

Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

2016-03-01

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. © 2016 American Society of Law, Medicine & Ethics.

Effect of the 80-hour work week on resident case coverage.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-05-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern, voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was performed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation performed, number of attending surgeons present, whether a resident was present, and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7% of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases, 15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Effect of the 80-hour work week on resident case coverage: corrected article.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-07-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern,voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was per formed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation per formed, number of attending surgeons present, whether a resident was present,and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7%of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases,15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

The Double Helix: Applying an Ethic of Care to the Duty to Warn Genetic Relatives of Genetic Information.

PubMed

Weaver, Meaghann

2016-03-01

Genetic testing reveals information about a patient's health status and predictions about the patient's future wellness, while also potentially disclosing health information relevant to other family members. With the increasing availability and affordability of genetic testing and the integration of genetics into mainstream medicine, the importance of clarifying the scope of confidentiality and the rules regarding disclosure of genetic findings to genetic relatives is prime. The United Nations International Declaration on Human Genetic Data urges an appreciation for principles of equality, justice, solidarity and responsibility in the context of genetic testing, including a commitment to honoring the privacy and security of the person tested. Considering this global mandate and recent professional statements in the context of a legal amendment to patient privacy policies in Australia, a fresh scrutiny of the legal history of a physician's duty to warn is warranted. This article inquiries whether there may be anything ethically or socially amiss with a potential future recommendation for health professionals or patients to universally disclose particular cancer predisposition genetic diagnosis to genetic family members. While much of the discussion remains applicable to all genetic diagnosis, the article focuses on the practice of disclosure within the context of BRCA1/2 diagnosis. An 'ethic of care' interpretation of legal tradition and current practice will serve to reconcile law and medical policy on the issue of physician disclosure of genetic results to family members without patient consent. © 2015 John Wiley & Sons Ltd.

Ethical Implications of Case-Based Payment in China: A Systematic Analysis.

PubMed

Jin, Pingyue; Biller-Andorno, Nikola; Wild, Verina

2015-12-01

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. © 2014 John Wiley & Sons Ltd.

A Case Study of Engineering Ethics

NASA Astrophysics Data System (ADS)

Shimizu, Kazuo

In Engineering Ethics Class at Shizuoka University, the Code of Ethics and Cases for Electrical Engineers by IEEJ Ethics committee is used to promote for high education effect to correspond large number of students (140students). In this paper, a case study in the class, and survey results for ethics value of students are presented. In addition, some comments for role playing act on the case of virtual experiences by students are described.

Effectiveness of a Case-Based Computer Program on Students' Ethical Decision Making.

PubMed

Park, Eun-Jun; Park, Mihyun

2015-11-01

The aim of this study was to test the effectiveness of a case-based computer program, using an integrative ethical decision-making model, on the ethical decision-making competency of nursing students in South Korea. This study used a pre- and posttest comparison design. Students in the intervention group used a computer program for case analysis assignments, whereas students in the standard group used a traditional paper assignment for case analysis. The findings showed that using the case-based computer program as a complementary tool for the ethics courses offered at the university enhanced students' ethical preparedness and satisfaction with the course. On the basis of the findings, it is recommended that nurse educators use a case-based computer program as a complementary self-study tool in ethics courses to supplement student learning without an increase in course hours, particularly in terms of analyzing ethics cases with dilemma scenarios and exercising ethical decision making. Copyright 2015, SLACK Incorporated.

Teaching global bioethics.

PubMed

Dwyer, James

2003-10-01

We live in a world with enormous disparities in health. The life expectancy in Japan is 80 years; in Malawi, 40 years. The under-five mortality in Norway is 4/1000; in Sierra Leone, 316/1000. The situation is actually worse than these figures suggest because average rates tend to mask inequalities within a country. Several presidents of the IAB have urged bioethicists to attend to global disparities and to broaden the scope of bioethics. For the last six years I have tried to do just that. In this paper, I report and reflect on my attempts to teach bioethics in ways that address global health and justice. I then discuss ways to address key ethical issues in global health: the problem of inequalities; the nature of the duty to assist; the importance of the duty not to harm; the difference between a cosmopolitan and a political view of justice. I also discuss how teaching about global health may help to shift the emphasis in bioethics--from sensational cases to everyday matters, from autonomy and justice, and from access to healthcare to the social determinants of health. At the end of my paper, I reflect on questions that I have not resolved: how to delineate the scope of bioethics, whether my approach over-politicises bioethics, and how to understand the responsibilities of bioethicists.

Near the conflagration: the wide duty to warn.

PubMed

Helminski, F

1993-07-01

The "duty to warn" has become fixed in US law since the 1976 case of Tarasoff v Regents of the University of California. In that case, the California Supreme Court decided that psychotherapists whose patients make a specific, serious threat of violence against a specific, clearly identifiable potential victim have a duty to warn the intended victim, directly or indirectly, of the threat. Tarasoff inspired several successful and unsuccessful lawsuits. A recent Vermont case has extended the duty to warn in that state to a threat of damage to property when persons may be physically harmed. The duty to warn is explicitly based on considerations of social utility and, as such, is attractive for courts to expand because an apparently minimal effort by therapists will often prevent substantial harm to victims. Some states have codified the duty to warn in a statute, but other states have refused to adopt the Tarasoff reasoning. In the absence of clear legal decisions to the contrary, psychotherapists may well anticipate that the duty to warn operates in their states.

Teaching medical students to discern ethical problems in human clinical research studies.

PubMed

Roberts, Laura Weiss; Warner, Teddy D; Green Hammond, Katherine A; Brody, Janet L; Kaminsky, Alexis; Roberts, Brian B

2005-10-01

Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p < .02). Students in the criteria-focused group were better able than students in the control group (p < .03) to discern specific ethical problems, more closely resembling expert assessments. Unexpectedly, the group focused on clinical research participants identified fewer problems than did the control group (p < .05). The criteria-focused intervention produced enhanced ethical evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

Ethics, big data and computing in epidemiology and public health.

PubMed

Salerno, Jennifer; Knoppers, Bartha M; Lee, Lisa M; Hlaing, WayWay M; Goodman, Kenneth W

2017-05-01

This article reflects on the activities of the Ethics Committee of the American College of Epidemiology (ACE). Members of the Ethics Committee identified an opportunity to elaborate on knowledge gained since the inception of the original Ethics Guidelines published by the ACE Ethics and Standards of Practice Committee in 2000. The ACE Ethics Committee presented a symposium session at the 2016 Epidemiology Congress of the Americas in Miami on the evolving complexities of ethics and epidemiology as it pertains to "big data." This article presents a summary and further discussion of that symposium session. Three topic areas were presented: the policy implications of big data and computing, the fallacy of "secondary" data sources, and the duty of citizens to contribute to big data. A balanced perspective is needed that provides safeguards for individuals but also furthers research to improve population health. Our in-depth review offers next steps for teaching of ethics and epidemiology, as well as for epidemiological research, public health practice, and health policy. To address contemporary topics in the area of ethics and epidemiology, the Ethics Committee hosted a symposium session on the timely topic of big data. Technological advancements in clinical medicine and genetic epidemiology research coupled with rapid advancements in data networks, storage, and computation at a lower cost are resulting in the growth of huge data repositories. Big data increases concerns about data integrity; informed consent; protection of individual privacy, confidentiality, and harm; data reidentification; and the reporting of faulty inferences. Copyright © 2017 Elsevier Inc. All rights reserved.

Nurse managers' experience with ethical issues in six government hospitals in Malaysia: A cross-sectional study

PubMed Central

2011-01-01

Background Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues. Methods A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square. Results A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics. Conclusions Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning. PMID:22085735

Moral conflict and competing duties in the initiation of a biomedical HIV prevention trial with minor adolescents.

PubMed

Knopf, Amelia S; Gilbert, Amy Lewis; Zimet, Gregory D; Kapogiannis, Bill G; Hosek, Sybil G; Fortenberry, J Dennis; Ott, Mary A

2017-01-01

Biomedical HIV prevention research with minors is complicated by the requirement of parental consent, which may disclose sensitive information to parents. We examine the experience of principal investigators (PIs) and study personnel who faced this complex ethical issue in the first biomedical HIV prevention study that allowed minors to self-consent for enrollment. We conducted in-depth interviews with PIs and study personnel from 13 medical trial sites in cities across the United States. Data were analyzed using a conventional content analysis. Participants experienced moral conflict as they struggled to fulfill conflicting duties in this trial involving minor adolescents with multiple vulnerabilities. Our participants experienced conflict between the two types of duties-protective and scientific-previously identified by Merritt. Protective duties were owed to the child, the parents, and the institution, and participants expressed tension between the actions that would protect these subgroups and the actions necessary to fulfill their scientific duties. Moral conflict was resolved in a variety of ways, including reflecting on the protocol's alignment with federal regulations, modifying consent language, considering each individual for enrollment carefully, and accepting institutional review board (IRB) decisions. Potential solutions for future studies are discussed, and include flexible protocol consent procedures and centralized IRB reviews.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part II.

PubMed

O'Donnell, Lolita T

2007-01-01

The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part II: interpretation of the Hippocratic Oath-today's perspective.

PubMed

Askitopoulou, Helen; Vgontzas, Antonis N

2018-05-21

This is the second part of a paper on the relevance and significance of the Hippocratic Oath to modern medical ethical and moral values with the aim at answering questions on controversial issues related to the Oath. Part I argued that the general attributes and ethical values of the Oath are relevant to the modern world. Part II attempts to elucidate the interpretation of the specific injunctions of the Oath from today's perspective in relation to ethical values concerning the duties of physicians to patients and society. The objective is to prove that the Oath has established the general context of medical ethics of the physician-patient relationship, which reflects long-lasting moral values that still define the medical profession. The Oath has exemplified the fundamental modern ethical principles of beneficence, non-maleficence and confidentiality. Its foremost message focuses on patients' best interests and not on the prohibition of surgery, euthanasia or abortion, as is generally believed. Furthermore, the Oath as a code of professional identity has had a powerful impact on modem judicial opinions regarding medical ethics. In a lot of ways, it is as relevant of the values of contemporary medicine as it was for ancient medicine. These slides can be retrieved under Electronic Supplementary Material.

A Study of the Effects of Educational and Administrative-Organizational Factors on the Students' Work Commitment

ERIC Educational Resources Information Center

Liaghatdar, Mohammad Javad; Samiee, Fatemeh; Sadeghian, Alireza; Shafaie, Shokouh; Alikhani, Madineh; Hashemi, Bibi Vajiheh

2012-01-01

Work commitment in the organizations is a factor which leads to the development of discipline, sense of duty, morality, and improvement of human relationships at work. The existence of ethics in the organization, having commitment to the tasks and playing professional roles and behaviors in the best way and with no external control, cause inner…

Searching for Mercy Street: Protecting Records after the Client's Death.

ERIC Educational Resources Information Center

Schoener, Gary R.

The duties of a therapist to a deceased client are not directly dealt with in codes of ethics. The issues came into focus following the publication of a biography of Anne Sexton, as it contained information from more than 80 hours of therapy that Ms. Sexton's psychologist released to the biographer. This paper considers the question of whether the…

Physician Assisted Suicide: Knowledge and Views of Fifth-Year Medical Students in Germany

ERIC Educational Resources Information Center

Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

2006-01-01

Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More…

Freedom of Speech under Assault on Campus. Policy Analysis No. 796

ERIC Educational Resources Information Center

Jacobson, Daniel

2016-01-01

John Stuart Mill thought higher education should not tell us what it is our duty to believe, but should "help us to form our own belief in a manner worthy of intelligent beings." He added that "there ought to exist the fullest liberty of professing and discussing, as a matter of ethical conviction, any doctrine," regardless of…

Rationale for Spiritually Oriented Cognitive Processing Therapy for Moral Injury in Active Duty Military and Veterans With Posttraumatic Stress Disorder.

PubMed

Koenig, Harold G; Boucher, Nathan A; Oliver, Rev John P; Youssef, Nagy; Mooney, Scott R; Currier, Joseph M; Pearce, Michelle

2017-02-01

Wartime experiences have long been known to cause ethical conflict, guilt, self-condemnation, difficulty forgiving, loss of trust, lack of meaning and purpose, and spiritual struggles. "Moral injury" (MI) (also sometimes called "inner conflict") is the term used to capture this emotional, cognitive, and behavioral state. In this article, we provide rationale for developing and testing Spiritually Oriented Cognitive Processing Therapy, a version of standard cognitive processing therapy for the treatment of MI in active duty and veteran service members (SMs) with posttraumatic stress disorder symptoms who are spiritual or religious (S/R). Many SMs have S/R beliefs that could increase vulnerability to MI. Because the injury is to deeply held moral standards and ethical values and often adversely affects spiritual beliefs and worldview, we believe that those who are S/R will respond more favorably to a therapy that directly targets this injury from a spiritually oriented perspective. An evidence-based treatment for MI in posttraumatic stress disorder that not only respects but also utilizes SMs' spiritual beliefs/behaviors may open the door to treatment for many S/R military personnel.

Thinking clearly about the FIRST trial: addressing ethical challenges in cluster randomised trials of policy interventions involving health providers.

PubMed

Horn, Austin R; Weijer, Charles; Hey, Spencer Phillips; Brehaut, Jamie; Fergusson, Dean A; Goldstein, Cory E; Grimshaw, Jeremy; Taljaard, Monica

2018-04-27

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials (CRTs) of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Clinical trials in developing countries: who should define ethics?].

PubMed

Béréterbide, F; Hirsch, F

2008-04-01

Many clinical trials have proved much more difficult to implement in developing countries than in the Northern countries if not totally impossible. Should we therefore just observe this situation and approve a "double ethical standard"? Clinical trials in developing countries are also a means for volunteers to have access to medical care, therefore how could the process of informed consent keep its significance? In this context, should the participation in clinical trials be restricted or even stopped? If so, we would thus justify the superiority of an international duty of charity compared with the right of autonomy of these populations. This theoretical analysis cannot be precisely justified. On the contrary, it reveals that while informed consent, international organisations and guidelines have the tendency to play a major role in this debate, local ethics committee are too absent although they represent the more relevant and legitimate discussion partners in this dilemma.

Money and morals: ending clinical trials for financial reasons.

PubMed

Eaton, Margaret L; Kwon, Brian K; Scott, Christopher Thomas

2015-01-01

Too often, biopharmaceutical companies stop their clinical trials solely for financial reasons. In this chapter, we discuss this phenomenon against the backdrop of a 2011 decision by Geron Corporation to abandon its stem cell clinical trial for spinal cord injury (SCI), the preliminary results of which were released in May 2014. We argue that the resultant harms are widespread and are different in nature from the consequences of stopping trials for scientific or medical reasons. We examine the ethical and social effects that arise from such decisions and discuss them in light of ethical frameworks, including duties of individual stakeholders and corporate sponsors. We offer ways that sponsors and clinical sites can ensure that trials are responsibly started, and once started adequately protect the interests of participants. We conclude with recommendations that industry sponsors of clinical trials should adopt in order to advance a collective and patient-centered research ethic.

Ethical Guidelines for Computer Security Researchers: "Be Reasonable"

NASA Astrophysics Data System (ADS)

Sassaman, Len

For most of its existence, the field of computer science has been lucky enough to avoid ethical dilemmas by virtue of its relatively benign nature. The subdisciplines of programming methodology research, microprocessor design, and so forth have little room for the greater questions of human harm. Other, more recently developed sub-disciplines, such as data mining, social network analysis, behavioral profiling, and general computer security, however, open the door to abuse of users by practitioners and researchers. It is therefore the duty of the men and women who chart the course of these fields to set rules for themselves regarding what sorts of actions on their part are to be considered acceptable and what should be avoided or handled with caution out of ethical concerns. This paper deals solely with the issues faced by computer security researchers, be they vulnerability analysts, privacy system designers, malware experts, or reverse engineers.

Commentary: doctors without boundaries: the ethics of teacher-student relationships in academic medicine.

PubMed

Larkin, Gregory Luke; Mello, Michael J

2010-05-01

Possessed of both instinct and intellect, physician teachers are required to be respectful exemplars of professionalism and interpersonal ethics in all environments, be it the hospital, classroom, or outside the educational setting. Sometimes, even while protecting the sanctity of the teacher-student relationship, they may surreptitiously find themselves in the throes of consensual intimacy, boundary violations, student exploitation, or other negative interpersonal and/or departmental dynamics. One may question how an academic can consistently resolve this tension and summon the temperance, humility, charity, and restraint needed to subdue lust, pride, abuse, and incontinence in the workplace. One important answer may lie in an improved understanding of the moral necessity of social cooperation, fairness, reciprocity, and respect that is constitutive of the physician-teacher role. Although normative expectations and duties have been outlined in extant codes of ethics and conduct within academic medicine, to date, few training programs currently teach faculty and residents about the ethics of appropriate pedagogic and intimate relations between teaching staff and students, interns, residents, researchers, and other trainees. This essay highlights examples from history, literature, and medical ethics as one small step toward filling this void.

Nurse leaders' role in medical assistance in dying: A relational ethics approach.

PubMed

Thiele, Tracy; Dunsford, Jennifer

2017-01-01

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID.

When patients are harmed, but are not wronged: ethics, law, and history.

PubMed

Klaas, Paul B; Berge, Keith H; Klaas, Kelsey M; Klaas, James P; Larson, Annalise Noelle

2014-09-01

Iatrogenic injury-injury caused unintentionally by medical treatment-breaks the oldest and most famous rule of medical ethics: primum non nocere, or above all, do no harm. Medical malpractice law, however, focuses on whether an injury was caused by negligence, not on whether an injury was iatrogenic. Iatrogenic injury inflicted without negligence is a common pattern in medical malpractice lawsuits; it is likely the pattern of Jacobs v Cross (Minnesota, 1872), in which Dr W. W. Mayo testified as an expert witness. As a matter of law, the doctor defendants should win all those lawsuits, for iatrogenic injury inflicted without negligence is not a legal wrong in the United States and has not been considered a legal wrong for hundreds of years. However, the medical ethics applicable to doctors' duties to report incompetence in colleagues, including those who inflict excessive iatrogenic injury, have developed dramatically over time. In 1872, the ethical codes in the United States exhorted doctors not to criticize another doctor, even if incompetent. Today, doctors in the United States are ethically required to report an incompetent colleague. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

The role of veterinarians in equestrian sport: A comparative review of ethical issues surrounding human and equine sports medicine☆

PubMed Central

Campbell, Madeleine L.H.

2013-01-01

Veterinarians have a key role in providing medical care for sports horses during and between competitions, but the standard client:veterinarian relationship that exists in companion and production animal medicine is distorted by the involvement of third parties in sports medicine, resulting in distinct ethical dilemmas which warrant focused academic attention. By comparing the existing literature on human sports medicine, this article reviews the ethical dilemmas which face veterinarians treating equine athletes, and the role of regulators in contributing to or resolving those dilemmas. Major ethical dilemmas occur both between and during competitions. These include conflicts of responsibility, conflicts between the need for client confidentiality and the need to share information in order to maximise animal welfare, and the need for an evidence base for treatment. Although many of the ethical problems faced in human and equine sports medicine are similar, the duty conferred upon a veterinarian by the licensing authority to ensure the welfare of animals committed to his or her care requires different obligations to those of a human sports medicine doctor. Suggested improvements to current practice which would help to address ethical dilemmas in equine sports medicine include an enhanced system for recording equine injuries, the use of professional Codes of Conduct and Codes of Ethics to establish acceptable responses to common ethical problems, and insistence that treatment of equine athletes is evidence-based (so far as possible) rather than economics-driven. PMID:23773811

Solicitude: balancing compassion and empowerment in a relational ethics of hope-an empirical-ethical study in palliative care.

PubMed

Olsman, Erik; Willems, Dick; Leget, Carlo

2016-03-01

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of (false) hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships.

Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency.

PubMed

Braverman, Derek W; Marcus, Brian S; Wakim, Paul G; Mercurio, Mark R; Kopf, Gary S

2017-10-01

Health care professionals (HCPs) are crucial to physician-assisted death (PAD) provision. To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms "suicide" and "euthanasia" on their views and their support for three forms of PAD. Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, nonphysician clinicians, and other nonclinical staff at a major academic medical center. Of 221 HCPs, the majority thought that each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, nonabandonment, and saving money for the health care system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. The use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (P < 0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (P < 0.005). HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD. Published by Elsevier Inc.

Case Managers on the Front Lines of Ethical Dilemmas: Advocacy, Autonomy, and Preventing Case Manager Burnout.

PubMed

Sortedahl, Charlotte; Mottern, Nina; Campagna, Vivian

The purpose of this article is to examine how case managers are routinely confronted by ethical dilemmas within a fragmented health care system and given the reality of financial pressures that influence life-changing decisions. The Code of Professional Conduct for Case Managers (Code), published by the Commission for Case Manager Certification, acknowledges "case managers may often confront ethical dilemmas" (Code 1996, Rev. 2015). The Code and expectations that professional case managers, particularly those who are board certified, will uphold ethical and legal practice apply to case managers in every practice setting across the full continuum of health care. This discussion acknowledges the ethical dilemmas that case managers routinely confront, which empowers them to seek support, guidance, and resources to support ethical practice. In addition, the article seeks to raise awareness of the effects of burnout and moral distress on case managers and others with whom they work closely on interdisciplinary teams.

Medical ethics at Guantanamo Bay and Abu Ghraib: the problem of dual loyalty.

PubMed

Clark, Peter A

2006-01-01

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.

Returning to history: the ethics of researching asylum seeker health in Australia.

PubMed

Zion, Deborah; Briskman, Linda; Loff, Bebe

2010-02-01

Australia's policy of mandatory indefinite detention of those seeking asylum and arriving without valid documents has led to terrible human rights abuses and cumulative deterioration in health for those incarcerated. We argue that there is an imperative to research and document the plight of those who have suffered at the hands of the Australian government and its agents. However, the normal tools available to those engaged in health research may further erode the rights and well being of this population, requiring a rethink of existing research ethics paradigms to approaches that foster advocacy research and drawing on the voices of those directly affected, including those bestowed with duty of care for this population.

Perceiving Sympathetically: Moral Perception, Embodiment, and Medical Ethics.

PubMed

Wisnewski, J Jeremy

2015-12-01

In recent literature on moral perception, much attention has been paid to questions about the relationship between metaethical commitments and moral experience. Far less attention has been paid to the nature of moral perception, its context-sensitivity, and the role it might play in carrying out everyday tasks with decency and care. I would like to reflect on just these features of moral perception in the context of healthcare. I will argue that healthcare providers do in fact have at least an imperfect duty (in Kant's sense) to develop their capacities to perceive with sympathy. I will further suggest, for some familiar reasons, that this development is not best accomplished through the model of adherence to 'ethics codes.'

Business Entity Selection: Why It Matters to Healthcare Practitioners. Part II--Corporations, Limited Liability Companies, and Professional Entities.

PubMed

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvantages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with organizational mission or vision statements, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India.

PubMed

Suri, Ashish; Roy, Tara Sankar; Lalwani, Sanjeev; Deo, Rama Chandra; Tripathi, Manjul; Dhingra, Renu; Bhardwaj, Daya Nand; Sharma, Bhawani Shankar

2014-01-01

Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

Expanding the bounds of military psychiatry: three clinical encounters.

PubMed

Moldavsky, Daniel

2008-12-01

This paper deals with clinical situations frequently encountered in military psychiatry. Using three narratives of soldiers assessed at the Israeli Defence Forces (IDF) during a period of marked conflict between Israel and the Palestinian Authority, the author portrays ethical dilemmas generated during assessments for fitness to go to combat. When the focus of the assessment is the soldier's refusal to serve in the army, particularly during periods of increased conflict, the psychiatrist faces a dilemma because of double loyalties, to the army of which he is a part, and to the soldier and his right to live. Based on previous literature and experience, some cases of refusal to serve may be understood going beyond the boundaries imposed by the medical model. The author discusses these issues in the context of Israeli society. In Israel, conscription is universal, and the army is not professional. However, given the lack of social legitimacy in Israel for refusal to serve in the IDF due to conscientious objection, soldiers who are otherwise aware of the ethical dilemmas imposed upon them by the harsh Israeli reality are left with no option other than to get exempted from military duties on psychiatric grounds. The author discusses how social and historical factors contribute to the construction of psychiatric and psychological symptoms.

Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza.

PubMed

Laar, Amos; DeBruin, Debra

2015-05-07

Many commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI). We critically analyzed the Ghana NISPPI's sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks. This paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI's text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them. Our analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan's content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.

Cautionary Tales: Ethics and Case Studies in Science

PubMed Central

Herreid, Clyde Freeman

2014-01-01

Ethical concerns are normally avoided in science classrooms in spite of the fact that many of our discoveries impinge directly on personal and societal values. We should not leave the ethical problems for another day, but deal with them using realistic case studies that challenge students at their ethical core. In this article we illustrate how case studies can be used to teach STEM students principles of ethics. PMID:25574280

The Lavelle Affair: An Air Force Case Study in Ethics

DTIC Science & Technology

2016-06-01

THE LAVELLE AFFAIR: AN AIR FORCE CASE STUDY IN ETHICS BY KRISTINA ELLIS A THESIS PRESENTED TO THE FACULTY OF THE SCHOOL OF... ethical transgressions. As such, the story of General Lavelle’s wartime command experiences became a case study in ethics and integrity within Air...1 1 THE LIFE AND CAREER OF GENERAL LAVELLE 8 1 VIETNAM 14 2 CIVIL-MILITARY RELATIONS 25 2 ETHICAL

Resident duty hours in Canada: a survey and national statement

PubMed Central

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n = 1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n = 1598). Only 52% (830) had received training in handover (n = 1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models. PMID:25559388

Resident duty hours in Canada: a survey and national statement.

PubMed

Masterson, Mark F; Shrichand, Pankaj; Maniate, Jerry M

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n=1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n=1598). Only 52% (830) had received training in handover (n=1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models.

Ethical considerations surrounding the response to Ebola: the Spanish experience.

PubMed

Royo-Bordonada, Miguel Ángel; García López, Fernando J

2016-08-18

The recent Ebola virus disease (EVD) outbreak, with 28,646 reported cases and 11,323 deaths, was declared a public health emergency of international interest by the World Health Organisation. In Spain, a single reported case triggered a public health crisis of a markedly media-centred nature. The approach to the first EVD epidemic has given rise to various ethical considerations around the world. We address the most relevant ethical considerations emanating from the management of EVD in Spain. Firstly, for reasons of global justice and humanitarian assistance, rich countries have the duty to support poorer countries in building up their core public-health capacities. Secondly, quarantine for high-risk contacts might have been a disproportionate and not properly justified measure, which could have contributed to stigmatising contacts and spreading panic. Thirdly, when the first secondary case was reported in Spain, it is doubtful whether informed consent requirements were strictly complied with when disclosing information concerning the alleged accident potentially causing the contagion. Moreover, this information was used by the Regional Health Minister to blame the patient, evading his responsibility to ensure safe medical procedures for health workers. Finally, the patient received convalescent plasma for compassionate use from a colleague of the first missionary repatriated, who also participated in a research study in Spain, despite having previously been denied the chance of being transferred to Spain to receive treatment. This fact highlights the asymmetry in the relationship between rich and poor countries. The management of this crisis highlighted the technical capacity of the health system and its professionals to respond effectively to public health emergencies caused by emerging diseases. This said, the failures in the protection of the EVD patient's privacy remind us that this aspect has to be borne in mind from the outset in crisis situations. Certain coercive measures, such as quarantine, should only be applied where there is some evidence that the benefit-risk balance could be favourable. Lastly, it is essential that research and interventions targeted at combating the fragility of the health systems in poor countries respond to reasons of global justice.

Ethical issues with informed consent from potential living kidney donors.

PubMed

Petrini, C

2010-05-01

Living organ donation and participation in clinical research trials have several features in common from an ethical perspective. The primary similarity is risk justification: the risk of harm to living organ donors and clinical research participants is justified by a resulting benefit to one or more other individuals. Some authors hold that organ donation and clinical trial participation are full-fledged duties. Such an implicit likening of the two leads to several considerations regarding informed consent in each situation. Informed consent raises ethical concerns in every medical context, and some of those concerns, such as competence, understanding, autonomy, and free or voluntary choice, are uniquely relevant to living organ donation and clinical trial participation. Most countries regulate informed consent procedures for living organ donation in great detail, and although informed consent procedures for clinical trial participation are somewhat less detailed, their rules are subject to review by ethics committees. It would be constructive for research participation informed consent procedures and living organ donation informed consent procedures to learn from one another. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Do disk drives dream of buffer cache hits?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Holt, A.

1994-12-31

G.E. Moore, in his book Principia Ethica, examines the popular view of ethics that deals with {open_quotes}what we ought to do{close_quotes} as well as using ethics to cover the general inquiry: {open_quotes}what is good?{close_quotes} This paper utilises Moore`s view of Ethics to examine computer systems performance. Moore asserts that {open_quotes}good{close_quotes} in itself is indefinable. It is argued in this report that, although we describe computer systems as good (or bad) a computer system cannot be good in itself, rather a means to good! In terms of {open_quotes}what we ought to do{close_quotes} this paper looks at what actions (would) bring aboutmore » good computer system performance according to computer science and engineering literature. In particular we look at duties, responsibilities and {open_quotes}to do what is right{close_quotes} in terms of system administration, design and usage. We further argue that in order to first make ethical observations with respect computer system performance and then apply them, requires technical knowledge which is typically limited to industry specialists and experts.« less

Duties to stakeholders amidst pressures from shareholders: lessons from an advisory panel on transplant policy.

PubMed

Mongoven, Ann M

2003-08-01

The distinction between stakeholders and shareholders frequently employed in business ethics can illuminate challenges faced by a bioethics advisory panel. I use the distinction to reflect back on the work of an advisory panel on which I served, a panel on US transplant policy. The panel hearings were akin to a shareholders' meeting, with many stakeholders absent. In addition to 'hearing out' the shareholders who were present, the panel had duties to absent stakeholders to insure their interests were included in public discussion. While panel efforts to include stakeholder perspectives rightfully framed its report, such duties should have framed its operating procedures more robustly. The stakeholder/shareholder distinction also offers a critical prism on the actual evolution of organ allocation policy, which the panel failed to influence. Current policy embodies a compromise among shareholders that obscures major stakeholder interests. This results in under-attention to likely medical benefit of transplant, compared to other allocation criteria. Recognition of duties to stakeholders amidst pressures of shareholders complicates the notion of 'consensus' for an advisory panel. Consensus framed on terms defined only by shareholders, not stakeholders, may be an inadequate measure of public interest.

Law Enforcement and Emergency Medicine: An Ethical Analysis.

PubMed

Baker, Eileen F; Moskop, John C; Geiderman, Joel M; Iserson, Kenneth V; Marco, Catherine A; Derse, Arthur R

2016-11-01

Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

On lying and deceiving.

PubMed Central

Bakhurst, D

1992-01-01

This article challenges Jennifer Jackson's recent defence of doctors' rights to deceive patients. Jackson maintains there is a general moral difference between lying and intentional deception: while doctors have a prima facie duty not to lie, there is no such obligation to avoid deception. This paper argues 1) that an examination of cases shows that lying and deception are often morally equivalent, and 2) that Jackson's position is premised on a species of moral functionalism that misconstrues the nature of moral obligation. Against Jackson, it is argued that both lying and intentional deception are wrong where they infringe a patient's right to autonomy or his/her right to be treated with dignity. These rights represent 'deontological constraints' on action, defining what we must not do whatever the functional value of the consequences. Medical ethics must recognise such constraints if it is to contribute to the moral integrity of medical practice. PMID:1619626

[Ethical considerations of organ transplantation].

PubMed

Steigleder, Klaus

2008-08-01

For the moral evaluation of organ transplantations, it is not only relevant that they are potentially live-saving or significantly life-improving procedures. It is also relevant that they may have an impact on the integrity or even dignity of possible donors and are a potential strain on the donors' relatives. In order to find out how the different impacts of organ transplantation on the parties involved are to be morally weighed against one other, the concepts of dignity and of negative and positive moral rights are clarified. Against the widely held view that the procurement of organs from brain dead donors is morally suspect while living organ donation is the morally superior option, it is argued that there is a prima facie moral duty to postmortem organ donation. On the other hand, since in the procurement of organs from living donors physicians systematically injure and endanger healthy persons, this practice can only be morally justified in well-defined exceptional cases.

Control of corruption in healthcare.

PubMed

Ahmed, Armin; Azim, Afzal

2015-01-01

A recently published article on corruption in Indian healthcare in the BMJ has triggered a hot debate and numerous responses (1, 2, 3, 4). We do agree that corruption in Indian healthcare is a colossal issue and needs to be tackled urgently (5). However, we want to highlight that corruption in healthcare is not a local phenomenon confined to the Indian subcontinent, though India does serve as a good case study and intervention area due to the magnitude of the problem and the country's large population (6). Good governance, strict rules, transparency and zero tolerance are some of the strategies prescribed everywhere to tackle corruption. However, those entrusted with implementing good governance and strict rules in India need to go through a process of introspection to carry out their duties in a responsible fashion. At present, it looks like a no-win situation. In this article, we recommend education in medical ethics as the major intervention for dealing with corruption in healthcare.

Biologically Based Restorative Management of Tooth Wear

PubMed Central

Kelleher, Martin G. D.; Bomfim, Deborah I.; Austin, Rupert S.

2012-01-01

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles. PMID:22315608

Participants' responsibilities in clinical research.

PubMed

Resnik, David B; Ness, Elizabeth

2012-12-01

Discussions on the ethics and regulation of clinical research have a great deal to say about the responsibilities of investigators, sponsors, research institutions and institutional review boards, but very little about the responsibilities of research participants. In this article, we discuss the responsibilities of participants in clinical research. We argue that competent adult participants are responsible for complying with study requirements and fulfilling other obligations they undertake when they make an informed choice to enroll in a study. These responsibilities are based on duties related to promise-keeping, avoiding harm to one's self or others, beneficence and reciprocity. Investigators and research staff should inform participants about their responsibilities during the consent process, and should stress the importance of fulfilling study requirements. They should address any impediments to compliance, and they may provide participants with financial incentives for meeting study requirements. In very rare cases, coercive measures may be justified to prevent immanent harm to others resulting from non-compliance with study requirements.

On lying and deceiving.

PubMed

Bakhurst, D

1992-06-01

This article challenges Jennifer Jackson's recent defence of doctors' rights to deceive patients. Jackson maintains there is a general moral difference between lying and intentional deception: while doctors have a prima facie duty not to lie, there is no such obligation to avoid deception. This paper argues 1) that an examination of cases shows that lying and deception are often morally equivalent, and 2) that Jackson's position is premised on a species of moral functionalism that misconstrues the nature of moral obligation. Against Jackson, it is argued that both lying and intentional deception are wrong where they infringe a patient's right to autonomy or his/her right to be treated with dignity. These rights represent 'deontological constraints' on action, defining what we must not do whatever the functional value of the consequences. Medical ethics must recognise such constraints if it is to contribute to the moral integrity of medical practice.

Conflicts Between Parents and Health Professionals About a Child's Medical Treatment: Using Clinical Ethics Records to Find Gaps in the Bioethics Literature.

PubMed

McDougall, Rosalind; Notini, Lauren; Phillips, Jessica

2015-09-01

Clinical ethics records offer bioethics researchers a rich source of cases that clinicians have identified as ethically complex. In this paper, we suggest that clinical ethics records can be used to point to types of cases that lack attention in the current bioethics literature, identifying new areas in need of more detailed bioethical work. We conducted an analysis of the clinical ethics records of one paediatric hospital in Australia, focusing specifically on conflicts between parents and health professionals about a child's medical treatment. We identified, analysed, and compared cases of this type from the clinical ethics records with cases of this type discussed in bioethics journals. While the cases from journals tended to describe situations involving imminent risk to the child's life, a significant proportion of the clinical ethics records cases involved different stakes for the child involved. These included distress, poorer functional outcome, poorer psychosocial outcome, or increased risk of surgical complications. Our analysis suggests that one type of case that warrants more detailed ethics research is parental refusal of recommended treatment, where the refusal does not endanger the child's life but rather some other aspect of the child's well-being.

Value of cancer care: ethical considerations for the practicing oncologist.

PubMed

Jagsi, Reshma; Sulmasy, Daniel P; Moy, Beverly

2014-01-01

The value of cancer care has emerged at the center of a national discourse on fiscal responsibility and resource allocation. The cost of cancer care is rising at a higher pace than any other area of health care. As we struggle to address this unsustainable rise in cancer expenditures, oncology providers are forced to examine our practice patterns and our contributions to the overall health care cost burden. This article provides an oncologist-centered examination of our duties to individual patients and how they may seem at odds with our duties to society. It also discusses how oncology providers can do their part to contain health care costs while honoring their professional obligation to do their best for each patient.

Aid-in-dying laws and the physician's duty to inform.

PubMed

Buchbinder, Mara

2017-10-01

On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont's law pertaining to patients' rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient-provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Duty to Inform and Informed Consent in Diagnostic Radiology: How Ethics and Law can Better Guide Practice.

PubMed

Doudenkova, Victoria; Bélisle Pipon, Jean-Christophe

2016-03-01

Although there is consensus on the fact that ionizing radiation used in radiological examinations can affect health, the stochastic (random) nature of risk makes it difficult to anticipate and assess specific health implications for patients. The issue of radiation protection is peculiar as any dosage received in life is cumulative, the sensitivity to radiation is highly variable from one person to another, and between 20 % and 50 % of radiological examinations appear not to be necessary. In this context, one might reasonably assume that information and patient consent would play an important role in regulating radiological practice. However, there is to date no clear consensus regarding the nature and content of-or even need for-consent by patients exposed to ionizing radiation. While law and ethics support the same principles for respecting the dignity of the person (inviolability and integrity), in the context of radiology practice, they do not provide a consistent message to guide clinical decision-making. This article analyzes the issue of healthcare professionals' duty to inform and obtain patient consent for radiological examinations. Considering that both law and ethics have as one of their aims to protect vulnerable populations, it is important that they begin to give greater attention to issues raised by the use of ionizing radiation in medicine. While the situation in Canada serves as a backdrop for a reflective analysis of the problem, the conclusions are pertinent for professional practice in other jurisdictions because the principles underlying health law and jurisprudence are fairly general.

Applying Cases to Solve Ethical Problems: The Significance of Positive and Process-Oriented Reflection

PubMed Central

Antes, Alison L.; Thiel, Chase E.; Martin, Laura E.; Stenmark, Cheryl K.; Connelly, Shane; Devenport, Lynn D.; Mumford, Michael D.

2015-01-01

This study examined the role of reflection on personal cases for making ethical decisions with regard to new ethical problems. Participants assumed the position of a business manager in a hypothetical organization and solved ethical problems that might be encountered. Prior to making a decision for the business problems, participants reflected on a relevant ethical experience. The findings revealed that application of material garnered from reflection on a personal experience was associated with decisions of higher ethicality. However, whether the case was viewed as positive or negative, and whether the outcomes, process, or outcomes and processes embedded in the experience were examined, influenced the application of case material to the new problem. As expected, examining positive experiences and the processes involved in those positive experiences resulted in greater application of case material to new problems. Future directions and implications for understanding ethical decision-making are discussed. PMID:26257506

Abortion and compelled physician speech.

PubMed

Orentlicher, David

2015-01-01

Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. © 2015 American Society of Law, Medicine & Ethics, Inc.

Ethics in an operations management course.

PubMed

Rudnicka, Ewa A

2005-10-01

Graduates of the management major at the University of Pittsburgh at Greensburg find employment in a variety of organizations. As future managers with employees from different professions, students expressed an interest in discussing ethics cases in the operations management class. The semester starts with students familiarizing themselves with various professional and corporate codes of ethics. Throughout the semester a number of short ethics' cases in operations' areas such as inventory management, scheduling, facility location, and product design are introduced to illustrate ethical issues that a manager and his/her employees might face. Students prepare individual responses before the in-class discussions. The semester ends with a long group ethics case discussion and formal case presentations. In the end-of-semester survey, students responded very favorably to an ethics component in the operations management class.

29 CFR 783.47 - Off-duty periods.

Code of Federal Regulations, 2011 CFR

2011-07-01

... purpose. The fact that during such off-duty periods the employee is subject to call in case of emergency... 29 Labor 3 2011-07-01 2011-07-01 false Off-duty periods. 783.47 Section 783.47 Labor Regulations... EMPLOYED AS SEAMEN Computation of Wages and Hours § 783.47 Off-duty periods. Off-duty periods include not...

The eighty-hour workweek: surgical attendings' perspectives.

PubMed

Griner, Devan; Menon, Rema P; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

2010-01-01

The year 2008 was a sentinel year in resident education; this was the first graduating general surgery class trained entirely under the 80-hour workweek. The purpose of this study was to evaluate attending surgeon perceptions of surgical resident attitudes and performance before and after duty-hour restrictions. An electronic survey was sent to all surgical teaching institutions in North Carolina. Both surgeon and hospital characteristics were documented. The survey consisted of questions designed to assess residents' attitudes/performance before and after the implementation of the work-hour restriction. In all, 77 surveys were returned (33% response rate). The survey demonstrated that 92% of educators who responded to the survey recognized a difference between the restricted residents (RRs) and the nonrestricted residents (NRRs), and most respondents (67%) attributed this to both the work-hour restrictions and the work ethic of current residents. Most attending surgeons reported no difference between the RRs and the NRRs in most categories; however, they identified a negative change in the areas of work ethic, technical skills development, decision-making/critical-thinking skills, and patient ownership among the RR group. Most surgeons expressed less trust (55%) with patient care and less confidence (68%) in residents' ability to operate independently in the RR group. Eighty-nine percent indicated that additional decreases in work hours would continue to hamper the mission of timely and comprehensive resident education. The perception of surgical educators was that RRs are clearly different from the NRRs and that the primary difference is in work ethic and duty-hour restrictions. Although similar in most attributes, RRs are perceived as having a lower baseline work ethic and a less developed technical skill set, decision-making ability, and sense of patient ownership. Subsequent study is needed to evaluate these concerns. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Between Scylla and Charybdis: reconciling competing data management demands in the life sciences.

PubMed

Bezuidenhout, Louise M; Morrison, Michael

2016-05-17

The widespread sharing of biologicaConcluding Comments: Teaching Responsible Datal and biomedical data is recognised as a key element in facilitating translation of scientific discoveries into novel clinical applications and services. At the same time, twenty-first century states are increasingly concerned that this data could also be used for purposes of bioterrorism. There is thus a tension between the desire to promote the sharing of data, as encapsulated by the Open Data movement, and the desire to prevent this data from 'falling into the wrong hands' as represented by 'dual use' policies. Both frameworks posit a moral duty for life sciences researchers with respect to how they should make their data available. However, Open data and dual use concerns are rarely discussed in concert and their implementation can present scientists with potentially conflicting ethical requirements. Both dual use and Open data policies frame scientific data and data dissemination in particular, though different, ways. As such they contain implicit models for how data is translated. Both approaches are limited by a focus on abstract conceptions of data and data sharing. This works to impede consensus-building between the two ethical frameworks. As an alternative, this paper proposes that an ethics of responsible management of scientific data should be based on a more nuanced understanding of the everyday data practices of life scientists. Responsibility for these 'micromovements' of data must consider the needs and duties of scientists as individuals and as collectively-organised groups. Researchers in the life sciences are faced with conflicting ethical responsibilities to share data as widely as possible, but prevent it being used for bioterrorist purposes. In order to reconcile the responsibilities posed by the Open Data and dual use frameworks, approaches should focus more on the everyday practices of laboratory scientists and less on abstract conceptions of data.

A qualitative analysis of student-written law and ethics cases: A snapshot of PY2 student experience.

PubMed

Karwaki, Tanya E; Hazlet, Thomas K

2017-05-01

This study was designed to better understand pharmacy students' experiences and recognition of legal and ethical tensions existing in pharmacy practice as demonstrated in student-written law and ethics cases. A qualitative analysis of 132 student-written cases representing the team efforts of 1053 students over a 12-year time period was conducted. Student-written cases were coded and analyzed thematically. Our results demonstrate the types of ethical and legal issues our students have experienced in pharmacy practice during the first five quarters of their professional education. Our data highlight three themes: 1) ethical dilemmas presented when the law is misapplied; 2) ethical dilemmas presented when an institutional policy or law was viewed as insufficient; and 3) ethical dilemmas presented as provider distress. The third theme was further subdivided into five subthemes. The themes that emerged from this study represent some of the ethical dilemmas that second professional year students have encountered and how these dilemmas may intersect with legal boundaries. Educators can use cases demonstrating these themes to reinforce law and ethics education in the curriculum, thus helping prepare students for pharmacy practice. This article recommends how and when to use case examples. Copyright © 2017 Elsevier Inc. All rights reserved.

Perspective: creating an ethical workplace: reverberations of resident work hours reform.

PubMed

Lopez, Lenny; Katz, Joel T

2009-03-01

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The development of ethical physicians is highly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The consequence of long duty hours on the moral development of physicians is less understood. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. The dynamic relationship between individual character traits and the situational dependence of their expression suggests that a systems approach will help promote and nurture moral development. Ethical behavior can be supported by systems that make it more difficult to veer from the ideal. Work hours limits are a structural change that will help preserve public safety by preventing physicians from taking the moral shortcuts that can occur with increasing work and time pressures. Work hours rules are beneficial but insufficient to optimize an ethical work and training environment. Additional measures need to be put in place to ensure that ethical tensions are not created between the patient's well-being and the resident's adherence to work hours rules. The ethical ideals of physician autonomy, selflessness, and accountability to the patient must be protected through the judicious and flexible use of work hours limits, physician extenders, census caps, nonteaching services, and high-quality handoffs.

Nontherapeutic quality improvement: The conflict of organizational ethics and societal rule of law.

PubMed

Rie, Michael A; Kofke, W Andrew

2007-02-01

Critical care ethics focuses largely on patient autonomy. Cost containment is necessary but requires rationing and limitations on a patient's right to consume beneficial services. No laws address a process of autonomy rights limitation to consume resources in the intensive care unit. We analyzed the frictional interface between necessary cost containment as a quality improvement activity contrasted with individual autonomy in the context of the evolution of research ethics. Scholarly books, peer-reviewed articles, congressional record, legal sources, the World Wide Web, and the National Archives and Records Administration were evaluated in the context of current cost-containment-driven nontherapeutic quality improvement activities. Three generations in the evolution of human research ethics are identified: 1) Hippocrates to Nuremberg Code, 2) Nuremberg to Belmont, and 3) Belmont to present. Similar ethical lapses, which place the individual at risk without disclosure for the good of future patients, have arisen recurrently in the course of history and continue presently when nontherapeutic quality improvement activities are framed as a human research activity with essentially no ethical oversight. Consequently, fiduciary obligations of professionals and their employer-institutions to their mutual patients may be at odds, creating complex layers of conflicted decision making. Nonetheless, professional Hippocratic duty to "the patient" must be congruent with the organizational ethos of limited funding "stewardship" to produce meaningful patient care. Medicine's integrity is legally protected and mandated under the state interests (parens patria doctrine) of the common law. When hospitals (society and its health insurance methods) fail to ration transparently under "cost-containment ethics," they threaten the ethical integrity of the medical profession.

Ethical analysis of non-medical fetal ultrasound.

PubMed

Leung, John Lai Yin; Pang, Samantha Mei Che

2009-09-01

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as 'keepsake' ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed.

Model-Based Policymaking: A Framework to Promote Ethical "Good Practice" in Mathematical Modeling for Public Health Policymaking.

PubMed

Boden, Lisa A; McKendrick, Iain J

2017-01-01

Mathematical models are increasingly relied upon as decision support tools, which estimate risks and generate recommendations to underpin public health policies. However, there are no formal agreements about what constitutes professional competencies or duties in mathematical modeling for public health. In this article, we propose a framework to evaluate whether mathematical models that assess human and animal disease risks and control strategies meet standards consistent with ethical "good practice" and are thus "fit for purpose" as evidence in support of policy. This framework is derived from principles of biomedical ethics: independence, transparency (autonomy), beneficence/non-maleficence, and justice. We identify ethical risks associated with model development and implementation and consider the extent to which scientists are accountable for the translation and communication of model results to policymakers so that the strengths and weaknesses of the scientific evidence base and any socioeconomic and ethical impacts of biased or uncertain predictions are clearly understood. We propose principles to operationalize a framework for ethically sound model development and risk communication between scientists and policymakers. These include the creation of science-policy partnerships to mutually define policy questions and communicate results; development of harmonized international standards for model development; and data stewardship and improvement of the traceability and transparency of models via a searchable archive of policy-relevant models. Finally, we suggest that bespoke ethical advisory groups, with relevant expertise and access to these resources, would be beneficial as a bridge between science and policy, advising modelers of potential ethical risks and providing overview of the translation of modeling advice into policy.

The role of veterinarians in equestrian sport: a comparative review of ethical issues surrounding human and equine sports medicine.

PubMed

Campbell, Madeleine L H

2013-09-01

Veterinarians have a key role in providing medical care for sports horses during and between competitions, but the standard client:veterinarian relationship that exists in companion and production animal medicine is distorted by the involvement of third parties in sports medicine, resulting in distinct ethical dilemmas which warrant focused academic attention. By comparing the existing literature on human sports medicine, this article reviews the ethical dilemmas which face veterinarians treating equine athletes, and the role of regulators in contributing to or resolving those dilemmas. Major ethical dilemmas occur both between and during competitions. These include conflicts of responsibility, conflicts between the need for client confidentiality and the need to share information in order to maximise animal welfare, and the need for an evidence base for treatment. Although many of the ethical problems faced in human and equine sports medicine are similar, the duty conferred upon a veterinarian by the licensing authority to ensure the welfare of animals committed to his or her care requires different obligations to those of a human sports medicine doctor. Suggested improvements to current practice which would help to address ethical dilemmas in equine sports medicine include an enhanced system for recording equine injuries, the use of professional Codes of Conduct and Codes of Ethics to establish acceptable responses to common ethical problems, and insistence that treatment of equine athletes is evidence-based (so far as possible) rather than economics-driven. Copyright © 2013 The Author. Published by Elsevier Ltd.. All rights reserved.

Alcohol, duty-of-care and common law--where do the consequences of drunken behaviour lie?

PubMed

Brett, Francesca; Tormey, William

2014-09-01

Legal issues around the duty of care in common law with regard to addictive legal drugs are evolving. Two recent cases came before the Irish courts dealing with the issue of duty of care of alcohol suppliers to intoxicated individuals. In both cases the intoxication was self-induced and the consequences were lethal. The juxtaposition of personal autonomy and duty of care cannot ignore personal responsibility. Do we need protection from ourselves? © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Trainee and training issues.

PubMed

Redfern, Nancy; Bartley, Catherine

2006-12-01

This chapter deals with the obligations of trainers and trainees to each other, the responsibilities of the programme and the conflicts of providing a service while training. Management of trainees with differing needs, such as those working part-time or returning to training after sickness, is reviewed. Assessment of performance and the obligation of consultants to identify, manage and support struggling trainees are discussed. Ethical discussion is based on the principles of autonomy, non-maleficence, beneficence, and justice to which fidelity is added. Case studies illustrating the application of ethical principles to work and decision-making are presented to stimulate debate. Opinions vary as to which principle carries more weight in individual cases, and how best to balance the conflicting requirements of the parties involved (patient, trainee,.trainer, employer, society). For all healthcare practitioners, the needs of patients remain our first concern. Acting in a consequentialist way, we must "maximise the good" and minimise the attendant harms in training. However, deontology states that certain sacrosanct rules and principles should never be breached. Doctors must abide by the duties of a doctor described in Good Medical Practice, maintaining standards in a way that ensures professional qualifications are respected. For the patient, there are advantages and disadvantages to receiving care in an educational setting. A 'teaching environment' tends to encourage and maintain high standards of practice from senior clinicians, but it also exposes patients to new learners, who are less efficient and polished and perhaps more prone to make errors. Learning has to fit round and complement the clinical and emotional needs of patients.

Ethical Values in the Classroom: How College Students Responded

ERIC Educational Resources Information Center

Humbarger, Michele; DeVaney, Sharon A.

2005-01-01

It is important to understand the ethical values of college students because they will be the leaders of the future. As part of an undergraduate honors project, a survey was developed that consisted of eight cases depicting ethical dilemmas in the classroom. Each case included a choice of four actions ranging from most ethical to least ethical.…

What kinds of cases do paediatricians refer to clinical ethics? Insights from 184 case referrals at an Australian paediatric hospital.

PubMed

McDougall, Rosalind J; Notini, Lauren

2016-09-01

Clinical ethics has been developing in paediatric healthcare for several decades. However, information about how paediatricians use clinical ethics case consultation services is extremely limited. In this project, we analysed a large set of case records from the clinical ethics service of one paediatric hospital in Australia. We applied a paediatric-specific typology to the case referrals, based on the triadic doctor-patient-parent relationship. We reviewed the 184 cases referred to the service in the period 2005-2014, noting features including the type of case, the referring department(s) and the patient's age at referral. The two most common types of referral involved clinician uncertainty about the appropriate care pathway for the child (26% of total referrals) and situations where the child's parents disagreed with the doctors' recommendations for the child's care (22% of total referrals). Referrals came from 28 different departments. Cancer, cardiology/cardiac surgery and general medicine referred the highest numbers of cases. The most common patient age groups were children under 1, and 14-15 years old. For three controversial areas of paediatric healthcare, clinicians had initiated processes of routine review of cases by the clinical ethics service. These insights into the way in which one very active paediatric clinical ethics service is used further our understanding of the work of paediatric clinical ethics, particularly the kinds of ethically challenging cases that paediatricians view as appropriate to refer for clinical ethics support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Inherited medullary thyroid cancer and the duty to warn: revisiting Pate v. Threlkel in light of HIPAA.

PubMed

Rosenthal, M Sara; Pierce, Heather Hanson

2005-02-01

Familial medullary thyroid cancer (FMTC) is one of the few autosomal dominant cancers for which genetic testing provides a clear medical indication for prophylactic and/or curative therapy, and for which prophylactic thyroidectomy, followed by thyroid hormone replacement, presents a relatively low morbidity risk. Medullary thyroid cancer (MTC) is a particularly aggressive type of thyroid cancer, and screening by traditional biochemical markers yields a high proportion of advanced stage diagnoses in individuals from FMTC families. This is particularly hazardous since there are no curative systemic treatments for MTC. Genetic testing for germline mutations of the RET proto-oncogene provides a reliable method of identifying at-risk family members in those FMTC families in which a mutation has been identified in the proband. Prophylactic thyroidectomy in such at-risk family members has significantly reduced the proportion of advanced stage MTC diagnoses in MTC families. Since a clear medical benefit exists for genetic testing in family members, and a clear danger to family members exists in the absence of genetic counseling, establishing genetic diagnosis as standard of care has critical legal and ethical implications for medical providers caring for probands and family members. The "duty to warn," reinforced by the courts in the legal case of Pate v. Threlkel, may override recent confidentiality legislation, known as the HIPAA Privacy Rules, which came into effect April 12, 2003.

Chemistry, Courtrooms, and Common Sense. Part I: Negligence and Duty.

ERIC Educational Resources Information Center

Gass, J. Ric

1990-01-01

Discussed are concepts involved in legal liability for laboratory accidents. The focus of this article is on negligence, duty, and responsibility issues. Highlighted are the basis of a lawsuit, negligent tort, duty and breech of duty, and cause and harm. Thirty-one cases are cited. (CW)

Global Health Opportunities in Obstetrics and Gynecology Training: Examining Engagement through an Ethical Lens

PubMed Central

Zaidi, Mohammad Y.; Haddad, Lisa; Lathrop, Eva

2015-01-01

This study aims to describe global health training (GHT) programs through the ethical lens suggested by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). A total of 35 GHT programs were identified, and general information was obtained online. Semi-structured telephone interviews of key members of 19 programs were then conducted and transcribed. The interview guide was constructed using WEIGHT recommendations. Transcript data were grouped according to domains: reciprocity, trainee selection and preparedness, needs assessments, and ethical questions. Many programs expressed difficulty in building reciprocal relationships due to imbalanced power structures. Eleven programs reported no formal application process for selecting trainees. Twelve (63%) programs reported only a single day of preparation. Nine (47%) programs did not conduct a formalized needs assessment of partner sites. Ethical considerations varied from concerns for safety to inadequate training for residents. This study reveals the limited preparedness curricula and lack of formalized needs assessments among several programs. Although many programs make an effort to build reciprocal exchanges with host partners, experiences for foreign trainees within the United States are limited, and U.S. residents are often tasked with duties above their training level abroad. This study demonstrates the need to restructure how GHT programs are formed and operated. PMID:26324736

Nurse leaders' perceptions of the ethical recruitment of study subjects in clinical research.

PubMed

Nurmi, Sanna-Maria; Pietilä, Anna-Maija; Kangasniemi, Mari; Halkoaho, Arja

2015-11-01

The aim of this study was to describe nurse leaders' perceptions of ethical recruitment in clinical research. Nurse leaders are expected to get involved in clinical research, but there are few studies that focus on their role, particularly the ethical issues. Qualitative data were collected from ten nurse leaders using thematic one-to-one interviews and analysed with content analysis. Nurse leaders considered clinical research at their workplace in relation to the key issues that enabled ethical recruitment of study subjects in clinical research. These were: early information and collaboration for incorporating clinical research in everyday work, an opportune and peaceful recruitment moment and positive research culture. Getting involved in clinical research is part of the nurse leader's professional responsibility in current health care. They have an essential role to play in ensuring that recruitment is ethical and that the dignity of study subjects is maintained. The duty of nurse leaders is to maintain good contact with other collaborators and to ensure good conditions for implementing clinical research at their site. This requires a comprehensive understanding of the overall situation on their wards. Implementing clinical research requires careful planning, together with educating, supporting and motivating nursing staff. © 2014 John Wiley & Sons Ltd.

BNCI systems as a potential assistive technology: ethical issues and participatory research in the BrainAble project.

PubMed

Carmichael, Clare; Carmichael, Patrick

2014-01-01

This paper highlights aspects related to current research and thinking about ethical issues in relation to Brain Computer Interface (BCI) and Brain-Neuronal Computer Interfaces (BNCI) research through the experience of one particular project, BrainAble, which is exploring and developing the potential of these technologies to enable people with complex disabilities to control computers. It describes how ethical practice has been developed both within the multidisciplinary research team and with participants. The paper presents findings in which participants shared their views of the project prototypes, of the potential of BCI/BNCI systems as an assistive technology, and of their other possible applications. This draws attention to the importance of ethical practice in projects where high expectations of technologies, and representations of "ideal types" of disabled users may reinforce stereotypes or drown out participant "voices". Ethical frameworks for research and development in emergent areas such as BCI/BNCI systems should be based on broad notions of a "duty of care" while being sufficiently flexible that researchers can adapt project procedures according to participant needs. They need to be frequently revisited, not only in the light of experience, but also to ensure they reflect new research findings and ever more complex and powerful technologies.

The Affordable Care Act: the ethical call to transform the organizational culture.

PubMed

Piper, Llewellyn E

2014-01-01

The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture.

Business entity selection: why it matters to healthcare practitioners--part I--Conceptual framework, sole proprietorships, and partnerships.

PubMed

Nithman, Robert W

2015-01-01

The Bureau of Labor statistics indicates only a 50% four-year survivability rate among businesses classified as "education and health services." Gaining knowledge of IRS business entities can result in cost savings, operational efficiency, reduced liability, and enhanced sustainability. Each entity has unique disadvan- tages, depending on size, diversity of ownership, desire to expand, and profitability. Business structures should be compatible with the organizational mission or vision statement, services and products, and professional codes of ethics. Healthcare reform will require greater business acumen. We have an ethical duty to disseminate and acquire the knowledge to properly establish and manage healthcare practices to ensure sustainable services that protect and serve the community.

Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates.

PubMed

Chiumento, Anna; Rahman, Atif; Frith, Lucy; Snider, Leslie; Tol, Wietse A

2017-02-08

Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.

Plan for Moral and Ethical Decision-Making Program of Research

DTIC Science & Technology

2007-02-01

to combatants and non-combatants alike, safely and from great distances (Duty with Honor), including long -range precision weapons, using uninhabited...to the legitimization of any procedures, including extreme actions, such as terrorism or political executions, so long as the mandated end is...person they wanted to be or the role they wanted to enact (actual/own versus ideal/own). They also faced the additional struggle of having strong

Freedom and the State: Kant on Revolution and International Interface

DTIC Science & Technology

1999-11-11

physical and psychological nature and many of them make us selfish and disagreeable beings. In fact, Kant contends that human beings are naturally...circumstances include a "defective education, bad company,... the viciousness of a natural disposition insensitive to shame,... levity and thoughtlessness...possibility of ethical action. Unless we are capable of choosing duty over inclinations, we cannot be held responsible for our actions (GMM 49). This

40 CFR 86.1110-87 - Sample selection.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Penalties for Gasoline-Fueled and Diesel Heavy-Duty Engines and Heavy-Duty Vehicles, Including Light-Duty... mass production processes for engines or vehicles to be distributed into commerce. In the case of heavy...

The cultural context of patient's autonomy and doctor's duty: passive euthanasia and advance directives in Germany and Israel.

PubMed

Schicktanz, Silke; Raz, Aviad; Shalev, Carmel

2010-11-01

The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient's autonomy and doctor's duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive.

The ethical duty to preserve the quality of scientific information

NASA Astrophysics Data System (ADS)

Arattano, Massimo; Gatti, Albertina; Eusebio, Elisa

2016-04-01

The commitment to communicate and divulge the knowledge acquired during his/her professional activity is certainly one of the ethical duties of the geologist. However nowadays, in the Internet era, the spreading of knowledge involves potential risks that the geologist should be aware of. These risks require a careful analysis aimed to mitigate their effects. The Internet may in fact contribute to spread (e.g. through websites like Wikipedia) information badly or even incorrectly presented. The final result could be an impediment to the diffusion of knowledge and a reduction of its effectiveness, which is precisely the opposite of the goal that a geologist should pursue. Specific criteria aimed to recognize incorrect or inadequate information would be, therefore, extremely useful. Their development and application might avoid, or at least reduce, the above mentioned risk. Ideally, such criteria could be also used to develop specific algorithms to automatically verify the quality of information available all over the Internet. A possible criterion will be here presented for the quality control of knowledge and scientific information. An example of its application in the field of geology will be provided, to verify and correct a piece of information available on the Internet. The proposed criterion could be also used for the simplification of the scientific information and the increase of its informative efficacy.

CRIS Case Study Materials in Ethical Decision Making.

ERIC Educational Resources Information Center

Blanning, James R.

Designed for secondary-level classroom discussion, these materials contain nine, short case studies of ethical dilemmas. The cast studies focus mainly on incidents and issues relevant to high school students. Discussion questions for each case study require students to examine the case, discuss the issue, and make an ethical decision about how…

An analysis on the research ethics cases managed by the Committee on Publication Ethics (COPE) between 1997 and 2010.

PubMed

Foo, Jong Yong Abdiel; Wilson, Stephen James

2012-12-01

The growing emphasis on the importance of publishing scientific findings in the academic world has led to increasing prevalence of potentially significant publications in which scientific and ethical rigour may be questioned. This has not only hindered research progress, but also eroded public trust in all scientific advances. In view of the increasing concern and the complexity of research misconduct, the Committee on Publication Ethics (COPE) was established in 1997 to manage cases with ethical implications. In order to review the outcomes of cases investigated by COPE, a total of 408 cases that had been managed by COPE were successfully extracted and analysed with respect to 7 distinct criteria. The results obtained indicate that the number of ethical implications per case has not changed significantly (p > 0.01) since the year COPE was instigated. Interestingly, the number of ethical cases, and to some extent, research misconduct, is not diminishing. Therefore, journal editors and publishers need to work closely together with COPE to inculcate adoption of appropriate research ethics and values in younger researchers while discouraging others from lowering standards. It is hoped that with a more concerted effort from the academic community and better public awareness, there will be fewer incidences of ethically and scientifically challenged publications. The ultimate aim being to enhance the quality of published works with concomittant public trust in the results.

Ethical issues in caring for patients with dementia.

PubMed

Hughes, Julian; Common, Jill

2015-08-05

This article discusses issues that might count as 'ethical' in the care of people with dementia and some of the dilemmas that occur. Ethical theories, such as virtue ethics, deontology and consequentialism are discussed, and ethical approaches that can be useful are outlined. Thinking about matters case-by-case is another approach, one that forms the first component of the Nuffield Council's ethical framework for dementia care, which is described. Case examples are provided, raising issues of autonomy, diagnosis, restraint and withholding treatment. The notion of personhood and the need to understand the person with dementia as broadly as possible are emphasised. Recommendations for nursing practice are included.

Why Are There So Few Ethics Consults in Children's Hospitals?

PubMed

Carter, Brian; Brockman, Manuel; Garrett, Jeremy; Knackstedt, Angie; Lantos, John

2018-06-01

In most children's hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children's hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are (1) ethics committee meetings, (2) Nursing Ethics Forum, (3) ethics Brown Bag workshops, (4) PICU ethics rounds, (5) Grand Rounds, (6) NICU Comprehensive Care Rounds, (7) Palliative Care Team (PaCT) case conferences, (8) multidisciplinary consults in Fetal Health Center, and (9) ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of "core competencies" than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple "moral spaces" in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today.

The role of ethics in information technology decisions: a case-based approach to biomedical informatics education.

PubMed

Anderson, James G

2004-03-18

The purpose of this paper is to propose a case-based approach to instruction regarding ethical issues raised by the use of information technology (IT) in healthcare. These issues are rarely addressed in graduate degree and continuing professional education programs in health informatics. There are important reasons why ethical issues need to be addressed in informatics training. Ethical issues raised by the introduction of information technology affect practice and are ubiquitous. These issues are frequently among the most challenging to young practitioners who are ill prepared to deal with them in practice. First, the paper provides an overview of methods of moral reasoning that can be used to identify and analyze ethical problems in health informatics. Second, we provide a framework for defining cases that involve ethical issues and outline major issues raised by the use of information technology. Specific cases are used as examples of new dilemmas that are posed by the introduction of information technology in healthcare. These cases are used to illustrate how ethics can be integrated with the other elements of informatics training. The cases discussed here reflect day-to-day situations that arise in health settings that require decisions. Third, an approach that can be used to teach ethics in health informatics programs is outlined and illustrated.

How to deal with neglected tropical diseases in the light of an African ethic.

PubMed

Metz, Thaddeus

2017-11-07

Many countries in Africa, and more generally those in the Global South with tropical areas, are plagued by illnesses that the wealthier parts of the world (mainly 'the West') neither suffer from nor put systematic effort into preventing, treating or curing. What does an ethic with a recognizably African pedigree entail for the ways various agents ought to respond to such neglected diseases? As many readers will know, a characteristically African ethic prescribes weighty duties to aid on the part of those in a position to do so, and it therefore entails that there should have been much more contribution from the Western, 'developed' world. However, what else does it prescribe, say, on the part of sub-Saharan governments and the African Union, and are they in fact doing it? I particularly seek to answer these questions here, by using the 2013-16 Ebola crisis in West Africa to illustrate what should have happened but what by and large did not. © 2017 John Wiley & Sons Ltd.

Taha Jabir Al-'Alwani: A Study of His Views on Ethics of Disagreement in Islam.

PubMed

Majid, Khalida

2017-02-01

This paper is an attempt to provide its readers/listeners the views of Taha Jabir Al-'Alwani on Ethics of Disagreement in Islam. Taha Jabir Al-'Alwani is one of the renowned scholars and reformists of the contemporary Muslim world. He presented in terms of views on the ethics of disagreement in Islam, an explanation of the etiquette envisioned by Islam for all those engaged in discourse and intellectual dialogue, and he also exposes a higher number of principles and purposes of the Shariah which provide Muslims with perspectives far vaster than those afforded by pedantic debate over points of law and procedure or fine distinctions between conflicting theological arguments. Above all, he analyzes that what today is going in the world is totally a contrast trend to the teachings of Qur'an and Sunnah. After stressing the paramount duty of affirming the oneness of Allah (Tawhid), both the Qur'an and the Sunnah stress on one thing above all: the unity of Muslim Ummah.

The ethical framing of personalized medicine.

PubMed

Joly, Yann; Saulnier, Katie M; Osien, Gladys; Knoppers, Bartha M

2014-10-01

Personalized medicine encompasses the use of biological information such as genomics to provide tailored interventions for patients. The review explores the ethical, legal, and social issues that have emerged with personalized medicine and must be considered because of the complex nature of providing individualized care within a clinical setting. Recent studies found that the use of personalized medicine presents challenges in multiple areas: biobanking and informed consent, confidentiality, genetic discrimination, return of results, access to treatment, clinical translation, direct-to-consumer genetic testing, emerging duties, and knowledge mobilization. Although personalized medicine provides benefits in treating patients in a manner that is more suited to their genetic profile, there are challenges that must be discussed to ensure the protection and fair treatment of individuals. The issues concerning personalized medicine are widespread, and range from individual privacy to the stratification and discrimination of sub-populations based on ethnicity. These issues have considerable impact on the individual and society. A thorough exploration of these ethical issues may identify novel challenges as well as potential avenues for resolution.

It Is a Small World after All: Teaching Business Ethics in a Global Environment

ERIC Educational Resources Information Center

Budden, Connie B.; Budden, Michael C.

2011-01-01

Increasingly, managers and employees are facing ethical issues when conducting business in the global marketplace. Business educators attempting to teach appropriate ethical behavior and develop skills for dealing with complex ethical situations need to incorporate realistic case scenarios to challenge students. Such cases should appropriately…

Ethics: A Bridge for Studying the Social Contexts of Professional Communication.

ERIC Educational Resources Information Center

Speck, Bruce W.

1989-01-01

Describes a method for helping students evaluate ethical issues in a systematic way, based on Lawrence Kohlberg's stages of moral development. Recommends the case-study approach for creating social constructs in which students face ethical dilemmas, and outlines a case-study ethics unit using Kohlberg's model. (MM)

Teaching Business Ethics: A Practical Guide and Case Studies. SBDC Professional Enrichment.

ERIC Educational Resources Information Center

Collins, Denis; Page, Laura V.

This teaching guide is for instructors who wish to include a discussion of ethical dilemmas in their regular business seminars and workshops. It discusses why it is essential to teach ethics and how to do so. It reviews the format of specially annotated ethics cases that are designed to help teach business ethics and shows how to use them. These…

Commentary: so the pendulum swings--making sense of the duty to protect.

PubMed

Fox, Patrick K

2010-01-01

Psychiatry has been struggling for nearly 40 years to make sense of the duty to protect. The great jurisdictional disparity as to what constitutes the duty has been a significant contributing factor. The American Psychiatric Association (APA) released the Model Statute in 1987 to establish a framework to guide legislators and courts toward consensus, to some effect. In response to case law and statutory requirements in most states, psychiatric practice has incorporated the assessment of risk to third parties by patients as an essential element of psychiatric assessment and care. Although court cases shortly after the Tarasoff decision expanded the scope and breadth of the duty to protect, in recent years there appears to have been a shift toward a more narrow interpretation as to what conditions must exist to find a defendant psychiatrist guilty of failing to exercise the duty properly. The threshold for the duty to warn or protect often rests precariously beside the criteria permitting an exception to confidentiality, placing the psychiatrist in a tenuous position. If appellate verdicts continue to find for the defendant psychiatrist in cases claiming a breach of the duty to protect, it could have an impact on how psychiatrists assess and manage threats made by patients toward third parties.

What should we say?

PubMed Central

Savulescu, J; Foddy, B; Rogers, J

2006-01-01

Abstract ethics mostly focuses on what we do. One form of action is a speech act. What we say can have profound effects. We can and should choose our words and how we speak wisely. When someone close to us suffers an injury or serious illness, a duty of beneficence requires that we support that person through beneficial words or actions. Though our intentions are most often benign, by what we say we often make the unfortunate person feel worse. Beginning with two personal accounts, this article explains what can go wrong in the compassionate speech of wellwishers, and uncovers some of the reasons why people say things that are hurtful or harmful. Despite a large body of clinical evidence, there is no perfect strategy for comforting a friend or relative who is ill, and sometimes even the best thing to say can still be perceived as insensitive and hurtful. In some cases, we may have good reason to knowingly say a hurtful or insensitive thing. Saying these 'wrong' things can sometimes be the best way to help a person in the long term. To complicate matters, there can be moral reasons for overriding what is good for the patient. What kind of admonishments should we make to a badly behaved patient? What is the value of authenticity in our communication with the people we love? These questions demand an ethical defence of those speech acts which are painful to hear but which need to be said, and of those which go wrong despite the best efforts of the wellwisher. We offer an ethical account, identifying permissible and impermissible justifications for the things we say to a person with a serious injury or illness. PMID:16373515

[Patients' rights--doctors' duties].

PubMed

Jaeger, L; Bertram, E; Grate, S; Mischkowsky, T; Paul, D; Probst, J; Scala, E; Wbllenweber, H D

2015-06-01

On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information (sec. 630e BGB). Comprehensive documentation obligations regarding all procedures are stipulated in sec. 630f BGB. As before, the burden of proof still rests with the patient, unless a severe malpractice has been established (sec. 630h BGB). The definition of "severe malpractice" remains unchanged and is based on the case law of the Federal Court of Justice (BGH). The patient's obligations to preserve his or her health and to actively support the process of recovery and securing a positive outcome of the treatment are not explicitly mentioned in the Law. Nevertheless, the patient and the physician need to work closely together to achieve a successful result of the treatment. In case the patient does not give his or her cooperation, the physician should consider terminating the treatment relationship.

Teaching ethics in the clinic. The theory and practice of moral case deliberation.

PubMed

Molewijk, A C; Abma, T; Stolper, M; Widdershoven, G

2008-02-01

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on (teaching) ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation.

The President's Physician: An African Play : Emmanuel Babatunde Omobowale, 2004, All Saints' Publishers (Ibadan, 978-978-37727-3-1, 77 pp.).

PubMed

Mayaki, Joseph Ajagunmolu

2017-12-01

This review examines issues relating to biomedical ethics and literature in the African drama The President's Physician by Emmanuel Babatunde Omobowale. The play investigates the psychological dilemma of Doctor Bituki Warunga, a personal physician to General Kalunga Ntibantunganyah who brutally and inhumanely rules Wavaria, a fictional African country. The doctor is faced with deciding to uphold the ethics of his profession versus terminating the tyrant's life to set the nation free. The play aims to help budding medical doctors rightly inculcate the principles of medical ethics-autonomy, beneficence, competence, and power-by providing a fictional platform to investigate difficult issues that can arise in clinical practice. The play highlights Warunga's complex dilemma as he struggles to uphold the Hippocratic Oath and at the same time satisfy his conscience towards his contribution to his country's freedom. This review explores the difficulties in decision-making when professional duties not only clash with personal preferences but also with the well-being of an entire nation. This discussion is done alongside the ethical concept of utilitarianism and also highlights significant literary concepts such as satire, symbolism, intertextuality, utopian aesthetics, and authorial vision as conveyed in the text.

Failing ethics 101: psychologists, the U.S. military establishment, and human rights.

PubMed

Boyd, J Wesley; LoCicero, Alice; Malowney, Monica; Aldis, Rajendra; Marlin, Robert P

2014-01-01

The American Psychological Association (APA) has long maintained a close, even symbiotic, relationship with the Department of Defense (DOD) and the Veterans Administration (VA). Herein we highlight these close ties and describe psychologists' participation in interrogations by U.S. military and intelligence entities. We then review the APA's statements about the permissibility of psychologist participation in the interrogation and torture of suspected terrorists. These issues are significant in and of themselves and because the VA and DOD have been described as "growth careers" for psychologists of the future (1). Additionally, the Health Care Personnel Delivery System allows the drafting of civilian clinical psychologists into military service even in the absence of a general draft. In light of psychologists' extensive involvement in the interrogation process of suspected terrorists, and the possibility that psychologists without prior military experience may be drafted, we wondered how much psychologists have been taught about their ethical duties should they find themselves in military settings. The results of our pilot study of U.S. psychology graduate students, which assessed their knowledge of military ethics, raise concerns that psychologists receive inadequate formal training in these matters. This may leave psychologists vulnerable to misinformation about proper ethical conduct in their future work.

Medical professionalism and the social contract.

PubMed

Reid, Lynette

2011-01-01

Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.

Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study

PubMed Central

Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J

2014-01-01

Objective To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Design Case distribution study (case series with survey information on referent exposures). Setting United States law enforcement. Participants Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010. Main outcome measures Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses. Results 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses. Conclusions Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law enforcement officers. PMID:25406189

Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study.

PubMed

Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J; Kales, Stefanos N

2014-11-18

To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Case distribution study (case series with survey information on referent exposures). United States law enforcement. Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010. Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses. 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses. Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law enforcement officers. © Varvarigou et al 2014.

Developing an Evaluation Tool for Assessing Clinical Ethics Consultation Skills in Simulation Based Education: The ACES Project.

PubMed

Wasson, Katherine; Parsi, Kayhan; McCarthy, Michael; Siddall, Viva Jo; Kuczewski, Mark

2016-06-01

The American Society for Bioethics and Humanities has created a quality attestation (QA) process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (ACES) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described.

Ethical analyses of institutional measures to increase health care worker influenza vaccination rates.

PubMed

Zimmerman, Richard K

2013-12-16

Health care worker (HCW) influenza vaccination rates are modest. This paper provides a detailed ethical analysis of the major options to increase HCW vaccination rates, comparing how major ethical theories would address the options. The main categories of interventions to raise rates include education, incentives, easy access, competition with rewards, assessment and feedback, declination, mandates with alternative infection control measures, and mandates with administrative action as consequences. The aforementioned interventions, except mandates, arouse little ethical controversy. However, these efforts are time and work intensive and rarely achieve vaccination rates higher than about 70%. The primary concerns voiced about mandates are loss of autonomy, injustice, lack of due process, and subsuming the individual for institutional ends. Proponents of mandates argue that they are ethical based on beneficence, non-maleficence, and duty. A number of professional associations support mandates. Arguments by analogy can be made by mandates for HCW vaccination against other diseases. The ethical systems used in the analyses include evolutionary ethics, utilitarianism, principalism (autonomy, beneficence, non-maleficence, and justice), Kantism, and altruism. Across these systems, the most commonly preferred options are easy access, assessment and feedback, declinations, and mandates with infection control measures as consequences for non-compliance. Given the ethical imperatives of non-maleficence and beneficence, the limited success of lower intensive interventions, and the need for putting patient safety ahead of HCW convenience, mandates with additional infection control measures as consequences for non-compliance are preferred. For those who opt out of vaccination due to conscience concerns, such mandates provide a means to remain employed but not put patient safety at risk. Copyright © 2013 Elsevier Ltd. All rights reserved.

Model-Based Policymaking: A Framework to Promote Ethical “Good Practice” in Mathematical Modeling for Public Health Policymaking

PubMed Central

Boden, Lisa A.; McKendrick, Iain J.

2017-01-01

Mathematical models are increasingly relied upon as decision support tools, which estimate risks and generate recommendations to underpin public health policies. However, there are no formal agreements about what constitutes professional competencies or duties in mathematical modeling for public health. In this article, we propose a framework to evaluate whether mathematical models that assess human and animal disease risks and control strategies meet standards consistent with ethical “good practice” and are thus “fit for purpose” as evidence in support of policy. This framework is derived from principles of biomedical ethics: independence, transparency (autonomy), beneficence/non-maleficence, and justice. We identify ethical risks associated with model development and implementation and consider the extent to which scientists are accountable for the translation and communication of model results to policymakers so that the strengths and weaknesses of the scientific evidence base and any socioeconomic and ethical impacts of biased or uncertain predictions are clearly understood. We propose principles to operationalize a framework for ethically sound model development and risk communication between scientists and policymakers. These include the creation of science–policy partnerships to mutually define policy questions and communicate results; development of harmonized international standards for model development; and data stewardship and improvement of the traceability and transparency of models via a searchable archive of policy-relevant models. Finally, we suggest that bespoke ethical advisory groups, with relevant expertise and access to these resources, would be beneficial as a bridge between science and policy, advising modelers of potential ethical risks and providing overview of the translation of modeling advice into policy. PMID:28424768

Ethics in dermatology: toward a new paradigm.

PubMed

López-Martín, S; Galera-Martin, C; Guerra-Tapia, A

2013-01-01

Medical ethics have evolved over time, and ethical responsibilities have often been shared by priests, the governing classes, and physicians. The emergence of scientific medicine led to the separation of functions, yet physicians have nonetheless continued to enjoy an extraordinary degree of moral authority and great social privilege. From this starting point, professional medical ethics developed as a specific moral system based on special rights and duties (paternalism and medical confidentiality). Various historical events brought this longstanding situation to a point of crisis toward the middle of the 20th century, and for several decades since, medical ethics have been based on freedom of choice for the patient with regard to decisions about his or her own body and health. Recent developments have created a new, still poorly defined model that takes into consideration such matters as euthanasia, abortion, provision of information on the benefits and harm of treatments, the sharing of therapeutic decision-making with the patient and/or family members, the choice of public or private medical providers, therapeutic guidelines, and the extension of the scope of practice to include preventive measures and cosmetic procedures. What is needed now is a new ethical system for plural societies that harbor different religions, beliefs and lifestyles, but that is also rational, universal and subject to ongoing revision-a system always striving for scientific, technical and moral excellence. Such an ethical system would have to be taught in medical schools, as it would need to bear fruit beyond mere good intentions. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

Is risk stratification ever the same as 'profiling'?

PubMed

Braithwaite, R Scott; Stevens, Elizabeth R; Caplan, Arthur

2016-05-01

Physicians engage in risk stratification as a normative part of their professional duties. Risk stratification has the potential to be beneficial in many ways, and implicit recognition of this potential benefit underlies its acceptance as a cornerstone of the medical profession. However, risk stratification also has the potential to be harmful. We argue that 'profiling' is a term that corresponds to risk stratification strategies in which there is concern that ethical harms exceed likely or proven benefits. In the case of risk stratification for health goals, this would occur most frequently if benefits were obtained by threats to justice, autonomy or privacy. We discuss implications of the potential overlap between risk stratification and profiling for researchers and for clinicians, and we consider whether there are salient characteristics that make a particular risk stratification algorithm more or less likely to overlap with profiling, such as whether the risk stratification algorithm is based on voluntary versus non-voluntary characteristics, based on causal versus non-causal characteristics, or based on signifiers of historical disadvantage. We also discuss the ethical challenges created when a risk stratification scheme helps all subgroups but some more than others, or when risk stratification harms some subgroups but benefits the aggregate group. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

5 CFR 2422.21 - Duties and powers of the Hearing Officer.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Duties and powers of the Hearing Officer... Duties and powers of the Hearing Officer. (a) Duties of the Hearing Officer. The Hearing Officer will...) Powers of the Hearing Officer. During the period a case is assigned to a Hearing Officer by the Regional...

5 CFR 2422.21 - Duties and powers of the Hearing Officer.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Duties and powers of the Hearing Officer... Duties and powers of the Hearing Officer. (a) Duties of the Hearing Officer. The Hearing Officer will...) Powers of the Hearing Officer. During the period a case is assigned to a Hearing Officer by the Regional...

32 CFR 935.21 - Civil rights, powers, and duties.

Code of Federal Regulations, 2010 CFR

2010-07-01

... INSULAR REGULATIONS WAKE ISLAND CODE Civil Law § 935.21 Civil rights, powers, and duties. In any case in... the laws of the United States or this part, the civil rights, powers, and duties as they obtain under... 32 National Defense 6 2010-07-01 2010-07-01 false Civil rights, powers, and duties. 935.21 Section...

32 CFR 935.21 - Civil rights, powers, and duties.

Code of Federal Regulations, 2011 CFR

2011-07-01

... INSULAR REGULATIONS WAKE ISLAND CODE Civil Law § 935.21 Civil rights, powers, and duties. In any case in... the laws of the United States or this part, the civil rights, powers, and duties as they obtain under... 32 National Defense 6 2011-07-01 2011-07-01 false Civil rights, powers, and duties. 935.21 Section...

32 CFR 935.21 - Civil rights, powers, and duties.

Code of Federal Regulations, 2012 CFR

2012-07-01

... INSULAR REGULATIONS WAKE ISLAND CODE Civil Law § 935.21 Civil rights, powers, and duties. In any case in... the laws of the United States or this part, the civil rights, powers, and duties as they obtain under... 32 National Defense 6 2012-07-01 2012-07-01 false Civil rights, powers, and duties. 935.21 Section...

32 CFR 935.21 - Civil rights, powers, and duties.

Code of Federal Regulations, 2014 CFR

2014-07-01

... INSULAR REGULATIONS WAKE ISLAND CODE Civil Law § 935.21 Civil rights, powers, and duties. In any case in... the laws of the United States or this part, the civil rights, powers, and duties as they obtain under... 32 National Defense 6 2014-07-01 2014-07-01 false Civil rights, powers, and duties. 935.21 Section...

32 CFR 935.21 - Civil rights, powers, and duties.

Code of Federal Regulations, 2013 CFR

2013-07-01

... INSULAR REGULATIONS WAKE ISLAND CODE Civil Law § 935.21 Civil rights, powers, and duties. In any case in... the laws of the United States or this part, the civil rights, powers, and duties as they obtain under... 32 National Defense 6 2013-07-01 2013-07-01 false Civil rights, powers, and duties. 935.21 Section...

40 CFR 1039.505 - How do I test engines using steady-state duty cycles, including ramped-modal testing?

Code of Federal Regulations, 2010 CFR

2010-07-01

...-state duty cycles, including ramped-modal testing? 1039.505 Section 1039.505 Protection of Environment... duty cycles, including ramped-modal testing? This section describes how to test engines under steady-state conditions. In some cases, we allow you to choose the appropriate steady-state duty cycle for an...

A World of Locked-In System: The Pivot & U.S. Military Power

DTIC Science & Technology

2013-03-01

scientific and industrial espionage, bribery , and theft of intellectual property.21 At the same time, China bought foreign companies and traded products to...failure to make clear that the institution demands absolute integrity of its people can lead to unethical 10 behavior and compromise of the...make hard, ethical decisions and having the duty to report unethical behavior. Service members must never take for granted the legacy of public support

The Battalion Surgeon: A Background Study and Analysis of His Military Training.

DTIC Science & Technology

1985-06-07

commissioned officers who are qualified doctors of medicine or doctors of osteopathy . The Medical Corps encompasses those specialties filled by officers who...1981) states, stresses the "ethics of self-interest.ൈ Physicians were ඎgle, Military and Civilian Medicine, p. 1119. "mRichard A. Gabriel, "Modernism...Battalion Surgeon needs to in order to accomplish his duties and responsibilities. . Professionalism The literature findings continuously stressed the

Physician alert: the legal risks associated with 'on-call' duties in the USA.

PubMed

Paterick, Zachary R; Patel, Nachiket J; Paterick, Timothy Edward

2018-06-13

On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor-patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Patients' autonomy and doctors' duties according to the Andalusian bill of "dignified dead"].

PubMed

Díez Fernández, José Antonio

2010-01-01

The provisions of the andalusian Law on rights and guarantees of the dignity of persons in the process of death, also known as "act of dignified death", are based on two pillars: the right to the autonomy of the patient, supported, if it be, in a will expressed in instructions given in advance and the duties of doctors and health centers to give satisfaction, to the extent of their potential and respecting the law, those demands. the core of the question is to find the point of necessary balance between the wishes of the patient and the freedom and responsibility of the doctor. Together with positive aspects, such as the recognition of the right and the implementation of the palliative care, there are other questionable proposals, affecting the rights of doctors: a lack of understanding of freedom and professional responsibility, recognition of the objection of conscience and certain ethics duties, etc. As expressed by the law, remain committed substantial rights of doctors and might favor, in the care activity, introducing practices of defensive medicine.

Teaching ethical analysis in occupational therapy.

PubMed

Haddad, A M

1988-05-01

Ethical decision making is a cognitive skill requiring education in ethical principles and an understanding of specific ethical issues. It is also a psychodynamic process involving personalities, values, opinions, and perceptions. This article proposes the use of case studies and role-playing techniques in teaching ethics in occupational therapy to supplement conventional methods of presenting ethical theories and principles. These two approaches invite students to discuss and analyze crucial issues in occupational therapy from a variety of viewpoints. Methodology of developing case studies and role-playing exercises are discussed. The techniques are evaluated and their application to the teaching of ethics is examined.

Towards a richer debate on tissue engineering: a consideration on the basis of NEST-ethics.

PubMed

Oerlemans, A J M; van Hoek, M E C; van Leeuwen, E; van der Burg, S; Dekkers, W J M

2013-09-01

In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or "NEST-ethics"). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some "good life" arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second "level" arguments-those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called "hard impacts"-quantifiable risks and benefits of the technology. Its "soft impacts"-effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention.

Ethics Committees and Mental Health.

PubMed

Yepes Delgado, Carlos Enrique; Ocampo Montoya, Andrea

Although research processes are covered by the objectivity of science, they are still influenced by the interests of those who conduct them. This is why high level committees have been tasked with defining the scope of the studies and performing a thorough assessment of them, since these imply great dilemmas. This premise leads to the emergence of Ethics Committees, where liaison psychiatry has an important place due to its communication abilities and knowledge of the human behavior. This paper attempts to provide some observations to take into account when discussing the link between ethics and mental health. In this work, the authors approach the question of ethics committees and the importance that psychiatrist performance has within them. This is done through a review of relevant papers on the subject. A detailed description on research ethics is provided in terms of justification, purpose and duties. Likewise, emphasis is placed on each of the areas in which psychiatrists are involved and bear great responsibilities in the medical decision-making process. Similarly, this description also includes the moment in which participants give their informed consent when taking part in medical research. Finally, we conclude that there are several questions regarding the relevance given to these committees in the methodological and ethical assessment of research projects. This in turn implies greater effort in the search for a culture of quality which highlights the emphasis on research subjects. Copyright © 2017 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

The international criminal tribunal for the former Yugoslavia (ICTY) and the forensic pathologist: ethical considerations

PubMed Central

Lorin De La Grandmaison, Geoffroy; Durigon, Michel; Moutel, Grégoire; Hervé, Christian

2006-01-01

War crimes in the former Yugoslavia since 1991 have been subjected to several international medico-legal investigations of mass graves within the framework of inquiries led by the ICTY. Forensic pathologists involved in the ICTY missions could be subjected to ethical tensions due to the difficulties of the missions, the emergent conflicts between forensic scientists of the teams and the original nature of the ICTY proceedings. In order to study the nature of such ethical tensions, we sent a questionnaire to 65 forensic pathologists who have been involved in the ICTY missions. The rate of answer was 38%. The majority of the forensic pathologists questioned (n=18) did not know how the medico-legal data were exploited by the ICTY. Three of them have been subjected to pressures. Three of them were aware of mass grave sites wittingly not investigated by the ICTY. Fifteen considered that the ICTY respected the elementary rules of the law and four of them questioned the impartiality of the justice led by the ICTY. Two conflicting types of ethics can be drawn from these results: a conviction ethics which is shared by most of the forensic pathologists questioned and a responsibility ethics. In the first, the forensic pathologist completely agrees with the need for an international war crime tribunal even if such justice can be challenged regarding the respect of human rights and impartiality. In the second, he or she needs to conduct himself in ways that do not infringe impartiality. As medical deontology duty requires an impartiality ethics, discursive ethics are needed to ease ethical tensions and to suggest ethical guidelines. Alternatives to international justice through a truth and reconciliation commission and by the way of humanitarian mission of victims’ identification combined with forensic investigations for historical purposes could be considered. PMID:16909642

The international criminal tribunal for the former Yugoslavia (ICTY) and the forensic pathologist: ethical considerations.

PubMed

Lorin de la Grandmaison, G; Durigon, M; Moutel, G; Herve, C

2006-07-01

Since 1991, war crimes in the former Yugoslavia have been the subject of several international medico-legal investigations of mass graves within the framework of inquiries led by the International Criminal Tribunal for the former Yugoslavia (ICTY). Forensic pathologists involved in the ICTY missions could be subjected to ethical tensions due to the difficulties of the missions, the emergent conflicts between forensic scientists of the investigating teams and the original nature of the ICTY proceedings. In order to study the nature of such ethical tensions, we sent a questionnaire to 65 forensic pathologists who have been involved in the ICTY missions. The rate of response was 38%. The majority of forensic pathologists questioned (n=18) did not know how the medico-legal data was exploited by the ICTY. Three of them have been subjected to pressures. Three of them were aware of mass grave sites knowingly not investigated by the ICTY. Fifteen considered that the ICTY respected the elementary rules of the law and four of them questioned the impartiality of the justice led by the ICTY. Two conflicting types of ethics can be drawn from these results: conviction ethics, which are shared by most of the forensic pathologists questioned, and responsibility ethics. In the former, the forensic pathologist completely agrees with the need for an international war crimes tribunal, even if such justice can be challenged regarding the respect of human rights and impartiality. In the latter, he or she needs to conduct him or herself in ways that do not infringe impartiality. As medical deontology duty requires impartiality ethics, discursive ethics are needed to ease ethical tensions and to suggest ethical guidelines. Alternatives to international justice, through a truth and reconciliation commission and by way of humanitarian missions combining victims' identification with forensic investigations for historical purposes, could be considered.

A Survey of Hospital Ethics Structures in Ontario.

PubMed

Breslin, Jonathan

2017-01-01

In response to the growing recognition of the prevalence of ethical issues in clinical care, hospitals in Canada began forming ethics committees in the 1980s. Studies showed significant growth in the prevalence of ethics committees over the ensuing decade. Although the limited studies available suggest that ethics committees have become very prevalent in Canadian hospitals, hospital ethics services have evolved in recent years to include a wider range of structures. In some cases, these structures may work in conjunction with an ethics committee, but in other cases they may replace ethics committees. They include on-staff ethicists, external ethics consultants, "hub-and-spokes" structures and regional ethics programs. What is not known, however, is how prevalent these other structures are and whether ethics committees continue to function as the main delivery mechanism for ethics services in Canadian hospitals. This paper reports on the results of a survey of hospitals in Ontario to answer those questions.

The role of professional knowledge in case-based reasoning in practical ethics.

PubMed

Pinkus, Rosa Lynn; Gloeckner, Claire; Fortunato, Angela

2015-06-01

The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is a general consensus that case studies play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one's professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: (1) Experts in a research domain in bioengineering. (2) Novices in a research domain in bioengineering. (3) The non-research group--students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student's level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills.