Education and the improvement of clinical ethics services

PubMed Central

2013-01-01

The proliferation of clinical ethics in health care institutions around the world has raised the question about the qualifications of those who serve on ethics committees and ethics consultation services. This paper discusses some of weaknesses associated with the most common educational responses to this concern and proposes a complementary approach. Since the majority of those involved in clinical ethics are practicing health professionals, the question of qualification is especially challenging as the role of ethics committees and, increasingly, ethics consultation services are becoming increasingly important to the functioning of health care institutions. Since the challenging nature of health care finances often leads institutions to rely on voluntary participation of committed health professional with only token administrative or clerical support to provide the needed ethics services, significant challenges are created for attaining competence and functional effectiveness. The article suggests that a complementary approach should be adopted for sustaining and building capacity in clinical ethics. Ethics committees and consultation services should systematically adopt quality improvement techniques to effect designed changes in clinical ethics performance and to build ethical capacity within targeted clinical units and services. Demonstrating improvements in functioning can go a long way to build confidence and capacity for clinical ethics and can help in justifying the need for support. To do so, however, requires that ethics committees and consultation services first shift attention to those areas that demonstrate weak or questionable ethical performance, including the established practices of the ethics committee and consultation service, and second seek collaboration with the involved health care providers to pursue demonstrable change. Such an approach has a much better chance of improving the capacity for clinical ethics in health care institutions than relying on educational approaches alone. PMID:23517735

A trial of a reproductive ethics and law curriculum for obstetrics and gynaecology residents.

PubMed

Arora, Kavita Shah

2014-12-01

Prior ethics educational interventions for residents have shown improvement in confidence and knowledge scores strictly in an internal medical resident population. Baseline knowledge and attitudes regarding reproductive ethics and law of obstetrics and gynaecology (ob/gyn) residents were assessed via a survey. Then, after completion of a 20-h curriculum for the residents, the residents were resurveyed in order to assess impact of the curriculum. An online survey with both multiple-choice and open-ended questions was administered to residents both prior to and after curriculum completion. A total of 39 residents (85% of the total ob/gyn residents) completed the survey. 67% of respondents thought ethics was very important in clinical practice, but only 3% considered themselves very familiar with medical ethics. Respondents were asked five case-based questions to assess baseline knowledge and only 10% answered all questions correctly prior to the curriculum. After the residents completed the curriculum, 31 subjects (79% of the original 39 resident respondents) responded to the same survey. 52% of respondents answered all five questions correctly and 31% considered themselves very familiar with medical ethics. Despite the importance placed on reproductive ethics and law by survey respondents including its impact on their clinical practices, there continues to be a deficiency in formal ethics education in ob/gyn. Our curriculum demonstrated both improvement in confidence as well as knowledge of residents towards issues of reproductive ethics and law. 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.

Palliative sedation versus euthanasia: an ethical assessment.

PubMed

ten Have, Henk; Welie, Jos V M

2014-01-01

The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Responsibility after the apparent end: 'following-up' in clinical ethics consultation.

PubMed

Finder, Stuart G; Bliton, Mark J

2011-09-01

Clinical ethics literature typically presents ethics consultations as having clear beginnings and clear ends. Experience in actual clinical ethics practice, however, reflects a different characterization, particularly when the moral experiences of ethics consultants are included in the discussion. In response, this article emphasizes listening and learning about moral experience as core activities associated with clinical ethics consultation. This focus reveals that responsibility in actual clinical ethics practice is generated within the moral scope of an ethics consultant's activities as she or he encounters the unique and specific features that emerge from interactions with a specific patient, or family, or practitioner within a given situation and over time. A long-form narrative about an ethics consultant's interactions is interwoven with a more didactic discussion to highlight the theme of responsibility and to probe questions that arise regarding follow-up within the practice of clinical ethics consultation. © 2011 Blackwell Publishing Ltd.

A Framework for Professional Ethics Courses in Teacher Education

ERIC Educational Resources Information Center

Warnick, Bryan R.; Silverman, Sarah K.

2011-01-01

Evidence suggests that professional ethics is currently a neglected topic in teacher education programs. In this article, the authors revisit the question of ethics education for teachers. The authors propose an approach to the professional ethics of teaching that employs a case-analysis framework specifically tailored to address the practice of…

Teaching medical ethics and law.

PubMed

Parker, Malcolm

2012-03-01

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.

In Defense of the Questionable: Defining the Basis of Research Scientists' Engagement in Questionable Research Practices.

PubMed

Sacco, Donald F; Bruton, Samuel V; Brown, Mitch

2018-02-01

National Institutes of Health principal investigators reported their perceptions of the ethical defensibility, prevalence in their field, and their personal willingness to engage in questionable research practices (QRPs). Using ethical defensibility ratings, an exploratory factor analysis yielded a two-factor solution: behaviors considered unambiguously ethically indefensible and behaviors whose ethical defensibility was more ambiguous. In addition, increasing perceptions that QRPs affect science predicted reduced acceptability of QRPs, whereas increasing beliefs that QRPs are normative or necessary for career success predicted increased acceptability of QRPs. Perceptions that QRPs are risky were unrelated to QRP acceptability but predicted reduced extramural funding (i.e., researchers' lifetime extramural grants and total funding secured). These results identify risk (i.e., beliefs that QRPs are normative to stay competitive in one's field) and protective factors (i.e., beliefs that QRPs have a significant negative impact on society) related to QRP endorsement that could inform educational interventions for training research scientists.

Professional Ethics in Teaching: Towards the Development of a Code of Practice.

ERIC Educational Resources Information Center

Campbell, Elizabeth

2000-01-01

Provides a theoretical discussion about the process of creating a professional code of ethics for educators. Discusses six key issues and questions, introducing the development of a code of professional ethics and the complexities the code should address. Includes references. (CMK)

Towards an ethics of authentic practice.

PubMed

Murray, Stuart J; Holmes, Dave; Perron, Amélie; Rail, Geneviève

2008-10-01

This essay asks how we might best elaborate an ethics of authentic practice. Will we be able to agree on a set of shared terms through which ethical practice will be understood? How will we define ethics and the subject's relation to authoritative structures of power and knowledge? We begin by further clarifying our critique of evidence-based medicine (EBM), reflecting on the intimate relation between theory and practice. We challenge the charge that our position amounts to no more than 'subjectivism' and 'antiauthoritarian' theory. We argue that an ethical practice ought to question the authority of EBM without falling into the trap of dogmatic antiauthoritarianism. In this, we take up the work of Hannah Arendt, who offers terms to help understand our difficult political relation to authority in an authentic ethical practice. We continue with a discussion of Michel Foucault's use of 'free speech' or parrhesia, which he adopts from Ancient Greek philosophy. Foucault demonstrates that authentic ethical practice demands that we 'speak truth to power.' We conclude with a consideration of recent biotechnologies, and suggest that these biomedical practices force us to re-evaluate our theoretical understanding of the ethical subject. We believe that we are at a crucial juncture: we must develop an ethics of authentic practice that will be commensurable with new and emergent biomedical subjectivities.

Can Neuroscience Contribute to Practical Ethics? A Critical Review and Discussion of the Methodological and Translational Challenges of the Neuroscience of Ethics.

PubMed

Racine, Eric; Dubljević, Veljko; Jox, Ralf J; Baertschi, Bernard; Christensen, Julia F; Farisco, Michele; Jotterand, Fabrice; Kahane, Guy; Müller, Sabine

2017-06-01

Neuroethics is an interdisciplinary field that arose in response to novel ethical challenges posed by advances in neuroscience. Historically, neuroethics has provided an opportunity to synergize different disciplines, notably proposing a two-way dialogue between an 'ethics of neuroscience' and a 'neuroscience of ethics'. However, questions surface as to whether a 'neuroscience of ethics' is a useful and unified branch of research and whether it can actually inform or lead to theoretical insights and transferable practical knowledge to help resolve ethical questions. In this article, we examine why the neuroscience of ethics is a promising area of research and summarize what we have learned so far regarding its most promising goals and contributions. We then review some of the key methodological challenges which may have hindered the use of results generated thus far by the neuroscience of ethics. Strategies are suggested to address these challenges and improve the quality of research and increase neuroscience's usefulness for applied ethics and society at large. Finally, we reflect on potential outcomes of a neuroscience of ethics and discuss the different strategies that could be used to support knowledge transfer to help different stakeholders integrate knowledge from the neuroscience of ethics. © 2017 John Wiley & Sons Ltd.

A Research Agenda for Humanitarian Health Ethics

PubMed Central

Hunt, Matthew; Schwartz, Lisa; Pringle, John; Boulanger, Renaud; Nouvet, Elysée; O'Mathúna, Dónal; Arya, Neil; Bernard, Carrie; Beukeboom, Carolyn; Calain, Philippe; de Laat, Sonya; Eckenwiler, Lisa; Elit, Laurie; Fraser, Veronique; Gillespie, Leigh-Anne; Johnson, Kirsten; Meagher, Rachel; Nixon, Stephanie; Olivier, Catherine; Pakes, Barry; Redwood-Campbell, Lynda; Reis, Andreas; Renaldi, Teuku; Singh, Jerome; Smith, Maxwell; Von Schreeb, Johan

2014-01-01

This paper maps key research questions for humanitarian health ethics: the ethical dimensions of healthcare provision and public health activities during international responses to situations of humanitarian crisis. Development of this research agenda was initiated at the Humanitarian Health Ethics Forum (HHE Forum) convened in Hamilton, Canada in November 2012. The HHE Forum identified priority avenues for advancing policy and practice for ethics in humanitarian health action. The main topic areas examined were: experiences and perceptions of humanitarian health ethics; training and professional development initiatives for humanitarian health ethics; ethics support for humanitarian health workers; impact of policies and project structures on humanitarian health ethics; and theoretical frameworks and ethics lenses. Key research questions for each topic area are presented, as well as proposed strategies for advancing this research agenda. Pursuing the research agenda will help strengthen the ethical foundations of humanitarian health action. PMID:25687273

Levinas's ethics as a basis of healthcare - challenges and dilemmas.

PubMed

Nordtug, Birgit

2015-01-01

Levinas's ethics has in the last decades exerted a significant influence on Nursing and Caring Science. The core of Levinas's ethics - his analyses of how our subjectivity is established in the ethical encounter with our neighbour or the Other - is applied both to healthcare practice and in the project of building an identity of Nursing and Caring Science. Levinas's analyses are highly abstract and metaphysical, and also non-normative. Thus, his analyses cannot be applied directly to practical problems and questions. Theorists in Nursing and Caring Science are generally aware of this. Nevertheless, many of them use Levinas's analyses to explore and solve questions of practical and normative character. This article focuses on the challenges and dilemmas of using Levinas in this manner. The article is divided into two parts. The first part presents some central ideas of Levinas's ethics based on the latter part of his authorship. The main focus is on the radicalism of Levinas's critique of the symbolic order (which includes concepts, categories, knowledge, etc.) - or as he puts it 'the said' - as a basis for subjectivity and responsibility. Levinas's notions of saying, anarchy, and singularity accentuate this point of view. These notions refer to conditions in the language, which counteract the symbolic order in the ethical encounter to such an extent that it becomes an incomprehensible. Levinas gives the argumentation a metaphysical frame: The encounter with the incomprehensible is an encounter with the Holy, which is not the ontological God, but a metaphysical desire. It is a mystery as to what this means, and herein lies possibly the main challenge when using Levinas's ethics in science and research: How to maintain the radicalism of his critique of the symbolic order when this is to be communicated in a scientific context that expects clarification of statements and ideas? The second part of the article explores this question by examining how some theorists use Levinas's ethics on questions and problems in the area of healthcare and Nursing and Caring Science. The focus is especially on the theorists' reception and use of the just mentioned notions. The study reveals that these theorists to a large extent transform Levinas's ethics according to their own approaches, with the result that his ethics loses its critical radicalism. Thus, I question the reason why they use Levinas. © 2014 John Wiley & Sons Ltd.

Organ donation after assisted death: Is it more or less ethically-problematic than donation after circulatory death?

PubMed

Kirby, Jeffrey

2016-12-01

A provocative question has emerged since the Supreme Court of Canada's decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cDCD that are of relevance to this research question are explored, and morally-relevant distinctions between cDAD and cDCD are identified. In addition, a set of morally-relevant advantages of one practice over the other is uncovered, and a few potential, theoretical issues specifically related to cDAD practice are articulated. Despite these concerns, the analysis suggests a counterintuitive conclusion: cDAD is, overall, less ethically-problematic than cDCDD. The former practice better respects the autonomy interests of the potential donor, and a claim regarding irreversibility of cessation of the donor's circulatory function in the cDAD context can be supported. Further, with cDAD, there is no possibility that the donor will have negative sensory experiences during organ procurement surgery. Although the development of appropriate policy-decision and regulatory approaches in this domain will be complex and challenging, the comparative ethical analysis of these two organ donation practices has the potential to constructively inform the deliberations of relevant stakeholders, resource persons and decision makers.

Beyond procedural ethics: foregrounding questions of justice in global health research ethics training for students.

PubMed

Hunt, Matthew R; Godard, Beatrice

2013-07-01

Interest in global health is growing among students across many disciplines and fields of study. In response, an increasing number of academic programmes integrate and promote opportunities for international research, service or clinical placements. These activities raise a range of ethical issues and are associated with important training needs for those who participate. In this paper, we focus on research fieldwork conducted in lower income nations by students from more affluent countries and the ethics preparation they would benefit from receiving prior to embarking on these projects. Global health research is closely associated with questions of justice and equity that extend beyond concerns of procedural ethics. Research takes place in and is shaped by matrices of political, social and cultural contexts and concerns. These realities warrant analysis and discussion during research ethics training. Training activities present an opportunity to encourage students to link global health research to questions of global justice, account for issues of justice in planning their own research, and prepare for 'ethics-in-practice' issues when conducting research in contexts of widespread inequality. Sustained engagement with questions of justice and equity during research ethics training will help support students for involvement in global health research.

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.

Capitalism's New Handmaiden: The Biotechnical World Negotiated through Children's Fiction

ERIC Educational Resources Information Center

Sawers, Naarah

2009-01-01

In an era when the merger between capitalism and science becomes an accepted norm, new questions need to be asked about the ethical implications of scientific practices. One such practice is organ transplantation. However, potent debates surround the just distribution and ethical implications of organ transplantation. This paper examines the ways…

Some Suggestions for Teaching Ethics in Business

ERIC Educational Resources Information Center

Gritsch, Martin

2007-01-01

No one can doubt nowadays that ethics in business is an important issue. Recent corporate scandals involving corporations such as Enron, WorldCom, and Freddie Mac, to name just a few, have exposed highly questionable business practices and criminal behavior. In this paper, the author would like to distinguish between illegal practices and legal,…

Using Eight Key Questions as an Inquiry-Based Framework for Ethical Reasoning Issues in a General Education Earth Systems and Climate Change Course

NASA Astrophysics Data System (ADS)

Johnson, E. A.; Ball, T. C.

2014-12-01

An important objective in general education geoscience courses is to help students evaluate social and ethical issues based upon scientific knowledge. It can be difficult for instructors trained in the physical sciences to design effective ways of including ethical issues in large lecture courses where whole-class discussions are not practical. The Quality Enhancement Plan for James Madison University, "The Madison Collaborative: Ethical Reasoning in Action," (http://www.jmu.edu/mc/index.shtml) has identified eight key questions to be used as a framework for developing ethical reasoning exercises and evaluating student learning. These eight questions are represented by the acronym FOR CLEAR and are represented by the concepts of Fairness, Outcomes, Responsibilities, Character, Liberty, Empathy, Authority, and Rights. In this study, we use the eight key questions as an inquiry-based framework for addressing ethical issues in a 100-student general education Earth systems and climate change course. Ethical reasoning exercises are presented throughout the course and range from questions of personal behavior to issues regarding potential future generations and global natural resources. In the first few exercises, key questions are identified for the students and calibrated responses are provided as examples. By the end of the semester, students are expected to identify key questions themselves and justify their own ethical and scientific reasoning. Evaluation rubrics are customized to this scaffolding approach to the exercises. Student feedback and course data will be presented to encourage discussion of this and other approaches to explicitly incorporating ethical reasoning in general education geoscience courses.

Integrating Ethics in Community Colleges' Accounting Programs.

ERIC Educational Resources Information Center

Clarke, Clifton

1990-01-01

Argues that two-year college business programs need to provide moral guidance and leadership to students to help stem the proliferation of fraudulent and questionable financial reporting practices. Reviews amoral and moral unity theories of business ethics. Discusses barriers to ethical instruction in business curricula, and ways to overcome them.…

Towards an empirical ethics in care: relations with technologies in health care.

PubMed

Pols, Jeannette

2015-02-01

This paper describes the approach of empirical ethics, a form of ethics that integrates non-positivist ethnographic empirical research and philosophy. Empirical ethics as it is discussed here builds on the 'empirical turn' in epistemology. It radicalizes the relational approach that care ethics introduced to think about care between people by drawing in relations between people and technologies as things people relate to. Empirical ethics studies care practices by analysing their intra-normativity, or the ways of living together the actors within these practices strive for or bring about as good practices. Different from care ethics, what care is and if it is good is not defined beforehand. A care practice may be contested by comparing it to alternative practices with different notions of good care. By contrasting practices as different ways of living together that are normatively oriented, suggestions for the best possible care may be argued for. Whether these suggestions will actually be put to practice is, however, again a relational question; new actors need to re-localize suggestions, to make them work in new practices and fit them in with local intra-normativities with their particular routines, material infrastructures, know-how and strivings.

Reflections on Ethics and Humanity in Pediatric Neurology: the Value of Recognizing Ethical Issues in Common Clinical Practice.

PubMed

Ronen, Gabriel M; Rosenbaum, Peter L

2017-05-01

Our goals in this reflection are to (i) identify the ethical dimensions inherent in any clinical encounter and (ii) bring to the forefront of our pediatric neurology practice the myriad of opportunities to explore and learn from these ethical questions. We highlight specifically Beauchamp and Childress's principles of biomedical ethics. We use the terms ethics in common clinical practice and an ethical lens to remind people of the ubiquity of ethical situations and the usefulness of using existing ethical principles to analyze and resolve difficult situations in clinical practice. We start with a few common situations with which many of us tend to struggle. We describe what we understand as ethics and how and why developments in technology, novel potential interventions, policies, and societal perspectives challenge us to think about and debate ethical issues. Individual patients are not a singular population; each patient has their own unique life situations, culture, goals, and expectations that need to be considered with a good dose of humanity and humility. We believe that using an ethical lens-by which we mean making an explicit effort to identify and consider these issues openly-will help us to achieve this goal in practice, education, and research.

Steps toward improving ethical evaluation in health technology assessment: a proposed framework.

PubMed

Assasi, Nazila; Tarride, Jean-Eric; O'Reilly, Daria; Schwartz, Lisa

2016-06-06

While evaluation of ethical aspects in health technology assessment (HTA) has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response to the increasing demand for expansion of health technology assessment (HTA) methodology to include ethical issues more systematically, this article reports on a multi-stage study that aimed at construction of a framework for improving the integration of ethics in HTA. The framework was developed through the following phases: 1) a systematic review and content analysis of guidance documents for ethics in HTA; 2) identification of factors influencing the integration of ethical considerations in HTA; 3) preparation of an action-oriented framework based on the key elements of the existing guidance documents and identified barriers to and facilitators of their implementation; and 4) expert consultation and revision of the framework. The proposed framework consists of three main components: an algorithmic flowchart, which exhibits the different steps of an ethical inquiry throughout the HTA process, including: defining the objectives and scope of the evaluation, stakeholder analysis, assessing organizational capacity, framing ethical evaluation questions, ethical analysis, deliberation, and knowledge translation; a stepwise guide, which focuses on the task objectives and potential questions that are required to be addressed at each step; and a list of some commonly recommended or used tools to help facilitate the evaluation process. The proposed framework can be used to support and promote good practice in integration of ethics into HTA. However, further validation of the framework through case studies and expert consultation is required to establish its utility for HTA practice.

How do we know that research ethics committees are really working? The neglected role of outcomes assessment in research ethics review

PubMed Central

Coleman, Carl H; Bouësseau, Marie-Charlotte

2008-01-01

Background Countries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants. Discussion Research ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices. The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals. Conclusion Outcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? PMID:18373857

Still Human: A Call for Increased Focus on Ethical Standards in Cadaver Research.

PubMed

Bach, Michelle C

2016-12-01

Research on human cadavers is an important mechanism of scientific progress and comprises a large industry in the United States. However, despite its importance and influence, there is little ethical or regulatory oversight of cadaver-based research. This lack of transparency raises important ethical questions. Thus, this paper serves as a call for ethicists and regulators to pay increased attention to cadaver research. I argue that cadaver research ought to be considered a subset of human subjects research and held accountable to higher ethical standards. After describing current practices, I argue that oversight of cadaver research as a form of human subjects research is appropriate because cadaver research is similar to other types of human research, participants in cadaver research incur risks of harm, and a current lack of oversight has allowed the cadaver industry to entice research participation through ethically questionable practices. This paper urges greater dialogue among human subjects research ethicists and regulators about what constitutes appropriate protections for participants in cadaver research.

NASA and Ethics: Training and Practice

NASA Technical Reports Server (NTRS)

Bruce, Willa Marie (Editor); Russell, Valerie (Editor)

1997-01-01

This paper is about the National Aeronautics and Space Administration(NASA) and the practice of professional ethics. It has been eleven years(Jan. 28, 1986) since the Challenger accident and the past decade has been a time of investigation, assessment, and finger-pointing, as well as a time for introspection and internal reform. While there has been a lot of rhetoric about ethical commitments at NASA, there has also been a dearth of empirically-based knowledge about what NASA and its various contractors are doing about professional ethics and what decisionmaking criteria are being used. It has been a decade of cost-cutting and personnel cut-backs. One has to wonder what, in all this time, NASA has done to create an ethical climate in which events like the Challenger accident are less likely to happen. In the fall of 1995, as part of competition for a mini-grant from NASA, a request for funding to complete an ethical profile of the agency was submitted. This papeR contributes to knowledge about NASA and ethics by reporting on the results of the first year of research which was spent in doing a comprehensive literature and web-site review along with phone interviews and e-mail correspondence with NASA ethics officers. The goal of this first year was to see what ethics activity has been documented and to ascertain what work is being done to raise the ethical question with NASA. Questions for which answers were sought include: (1) What is NASA now doing regarding ethics?; (2) What training is being provided? By whom? For whom?; (3) Are the answers to these questions different at different NASA installations?

Ethics in age estimation of unaccompanied minors.

PubMed

Thevissen, P W; Kvaal, S I; Willems, G

2012-11-30

Children absconding from countries of conflict and war are often not able to document their age. When an age is given, it is frequently untraceable or poorly documented and therefore questioned by immigration authorities. Consequently many countries perform age estimations on these children. Provision of ethical practice during the age estimation investigation of unaccompanied minors is considered from different angles: (1) The UN convention on children's rights, formulating specific rights, protection, support, healthcare and education for unaccompanied minors. (2) Since most age estimation investigations are based on medical examination, the four basic principles of biomedical ethics, namely autonomy, beneficence, non-malevolence, justice. (3) The use of medicine for non treatment purposes. (4) How age estimates with highest accuracy in age prediction can be obtained. Ethical practice in age estimation of unaccompanied minors is achieved when different but related aspects are searched, evaluated, weighted in importance and subsequently combined. However this is not always feasible and unanswered questions remain.

Philosophy for Teachers (P4T)--Developing New Teachers' Applied Ethical Decision-Making

ERIC Educational Resources Information Center

Orchard, Janet; Heilbronn, Ruth; Winstanley, Carrie

2016-01-01

Teaching, irrespective of its geographical location, is fundamentally a relational practice in which unique ethically complex situations arise to which teachers need to respond at different levels of ethical decision-making. These range from "big" abstract questions about whether or not what they teach is inherently good, through to…

Ethical Challenges of Military Social Workers Serving in a Combat Zone

ERIC Educational Resources Information Center

Simmons, Catherine A.; Rycraft, Joan R.

2010-01-01

Often faced with ethical challenges that may appear extraordinary, military social workers comprise a distinctive subgroup of the social work profession. From the unique paradigms in which they practice their craft, obvious questions about how military social workers address the ethical challenges inherent to their wartime mission arise. Using a…

The role of ethics in science and engineering.

PubMed

Johnson, Deborah G

2010-12-01

It is generally thought that science and engineering should never cross certain ethical lines. The idea connects ethics to science and engineering, but it frames the relationship in a misleading way. Moral notions and practices inevitably influence and are influenced by science and engineering. The important question is how such interactions should take place. Anticipatory ethics is a new approach that integrates ethics into technological development. Copyright © 2010 Elsevier Ltd. All rights reserved.

The Ethics of Teaching for Social Justice: A Framework for Exploring the Intellectual and Moral Virtues of Social Justice Educators

ERIC Educational Resources Information Center

Taylor, Rebecca M.

2015-01-01

Pursuing social justice in education raises ethical questions about teaching practice that have not been fully addressed in the social justice literature. Hytten (2015) initiated a valuable way forward in developing an ethics of social justice educators, drawing on virtue ethics. In this paper, I provide additional support to this effort by…

Ethical issues in health philanthropy.

PubMed

Reid, Lynette

2017-11-01

Health leaders in Canada face a myriad of challenges with healthcare philanthropy-not just the practical question of how to be successful but also ethical questions. Is fundraising in partnership with companies that are implicated in the so-called lifestyle diseases appropriate? When does appropriate recognition for donors or volunteers cross the line into facilitating preferential access to care? Ethical decision-making in health philanthropy considers appropriate recognition or partnership in donor relations in the context of the public good with which healthcare institutions are entrusted and the fiduciary responsibilities of hospitals and clinicians to patients.

Trends In Geoscience Professional Ethics Indicated By National Association of State Boards of Geology (ASBOG®) Surveys of The Practicing Profession

NASA Astrophysics Data System (ADS)

Williams, J. W.; Warner, J. L.

2016-12-01

ASBOG® was founded in 1988 to facilitate cooperation and coordination among states with licensing of practicing professional geologists-currently 29 states and Puerto Rico. ASBOG® creates national exams which are used by all of the states granting licensure. Periodic surveys of the practicing profession every 5 years are used to determine the skills and knowledge needed for professional practice and are used to generate the exam blueprints. Currently questions on professional ethics are included on the national licensing exams. Thirteen professional ethics issues in the geosciences were included on the Task Analysis Surveys (TAS) in 2005, 2010 and 2015. Professional geologists rate the seriousness of and the frequency of contact with these ethics issues. Topics include such items as gift-giving, whistleblowing, plagiarism, etc. The respondents are grouped into one of three categories: practicing licensed geologists in the United States, practicing licensed geologists in Canada, and geologists employed in the academic sector. Regardless of the employment sector, the responses to the professional ethics questions were statistically very similar (r values - Seriousness - USA vs. Academic +0.81, USA vs. Canada +0.94, Academic vs. Canada +0.86: Frequency - USA vs. Academic +0.71, USA vs. Canada +0.85, Academic vs. Canada +0.72). Some differences were detected. For example, plagiarism is regarded by practitioners in the academic sector as more important than this issue among licensed practicing geologists in the United States and Canada. The professional ethics issues asked on the 2010 and 2015 surveys are identical to facilitate detection of any temporal changes in response patterns. Statistically, the responses from practicing geologists in the USA in the 2010 and 2015 surveys are nearly identical, indicating that the profession has maintained virtually the same attitudes with regard to professional ethics (Seriousness r = +0.99, Frequency r = +0.99).

A practical perspective on remedial ethics: Minnesota Board of Dentistry.

PubMed

Mensing, Candace; Shragg, Marshall

2009-01-01

The President and Executive Director of the Minnesota Board of Dentistry describe how the Bebeau course in ethics, for dentists referred because of ethical lapses, is used as part of the disciplinary process in the state. It is understood that breaches of ethical standards are a complex phenomenon, often engaged in by practitioners who know that they are doing wrong but nevertheless choose to do so. Typical patterns of transgression that result in referral to Dr. Bebeau's course include inappropriate billing practices, improper relations with staff or patients, questionable advertising, substandard care, "rough behavior," and gaps in infection control.

Empirical ethics, context-sensitivity, and contextualism.

PubMed

Musschenga, Albert W

2005-10-01

In medical ethics, business ethics, and some branches of political philosophy (multi-culturalism, issues of just allocation, and equitable distribution) the literature increasingly combines insights from ethics and the social sciences. Some authors in medical ethics even speak of a new phase in the history of ethics, hailing "empirical ethics" as a logical next step in the development of practical ethics after the turn to "applied ethics." The name empirical ethics is ill-chosen because of its associations with "descriptive ethics." Unlike descriptive ethics, however, empirical ethics aims to be both descriptive and normative. The first question on which I focus is what kind of empirical research is used by empirical ethics and for which purposes. I argue that the ultimate aim of all empirical ethics is to improve the context-sensitivity of ethics. The second question is whether empirical ethics is essentially connected with specific positions in meta-ethics. I show that in some kinds of meta-ethical theories, which I categorize as broad contextualist theories, there is an intrinsic need for connecting normative ethics with empirical social research. But context-sensitivity is a goal that can be aimed for from any meta-ethical position.

Mandatory Personal Therapy: Does the Evidence Justify the Practice? In Debate

ERIC Educational Resources Information Center

Chaturvedi, Surabhi

2013-01-01

The article addresses the question of whether the practice of mandatory personal therapy, followed by several training organisations, is justified by existing research and evidence. In doing so, it discusses some implications of this training requirement from an ethical and ideological standpoint, raising questions of import for training…

The Principle-Based Method of Practical Ethics.

PubMed

Spielthenner, Georg

2017-09-01

This paper is about the methodology of doing practical ethics. There is a variety of methods employed in ethics. One of them is the principle-based approach, which has an established place in ethical reasoning. In everyday life, we often judge the rightness and wrongness of actions by their conformity to principles, and the appeal to principles plays a significant role in practical ethics, too. In this paper, I try to provide a better understanding of the nature of principle-based reasoning. To accomplish this, I show in the first section that these principles can be applied to cases in a meaningful and sufficiently precise way. The second section discusses the question how relevant applying principles is to the resolution of ethical issues. This depends on their nature. I argue that the principles under consideration in this paper should be interpreted as presumptive principles and I conclude that although they cannot be expected to bear the weight of definitely resolving ethical problems, these principles can nevertheless play a considerable role in ethical research.

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.

Female genital mutilation: when a cultural practice generates clinical and ethical dilemmas.

PubMed

Gibeau, A M

1998-01-01

Female genital mutilation (FGM) is of growing concern to health care providers in the United States and Canada as more women from countries where the procedure is practiced emigrate to North America. An introduction to the demographics of FGM, including prevalence rates, is a necessary antecedent for understanding the cultural rationales for this widespread practice. Considering the health consequences of this practice promotes questions about legal and ethical aspects of care as North Americans approach FGM from their own individual cultural frameworks.

Ethical checklist for dental practice.

PubMed

Rinchuse, D J; Rinchuse, D J; Deluzio, C

1995-01-01

A checklist for verification of unethical business practices, originally formulated by Drs. Blanchard and Peale, is adapted to dental practice. A scenario is used as a model to demonstrate the applicability of this instrument to dental practice. The instrument asks three questions in regards to an ethical dilemma: 1) Is it legal? 2) Is it fair? 3) How does it make you feel? The paper concludes the giving of gifts to general dentists by dental specialists for the referral of patients is unethical.

A Comparative Study of Government and Non-Government Ethics Programs, Practices, and Policies

DTIC Science & Technology

1992-06-01

felt to be a foundation for answering the survey questions. The Ethics Resource Center conducted a survey of American business schools and...and under- graduate business school programs. Although ninety percent of the business schools responding indicated that ethics is included in their...there is already some impetus towards standardization. 2. Emphasis« formal ethics training in all undergraduate and graduate business schools . Core

The Teaching of Ethics and Professionalism in Plastic Surgery Residency: A Cross-Sectional Survey.

PubMed

Bennett, Katelyn G; Ingraham, John M; Schneider, Lisa F; Saadeh, Pierre B; Vercler, Christian J

2017-05-01

The ethical practice of medicine has always been of utmost importance, and plastic surgery is no exception. The literature is devoid of information on the teaching of ethics and professionalism in plastic surgery. In light of this, a survey was sent to ascertain the status of ethics training in plastic surgery residencies. A 21-question survey was sent from the American Council of Academic Plastic Surgeons meeting to 180 plastic surgery program directors and coordinators via email. Survey questions inquired about practice environment, number of residents, presence of a formal ethics training program, among others. Binary regression was used to determine if any relationships existed between categorical variables, and Poisson linear regression was used to assess relationships between continuous variables. Statistical significance was set at a P value of 0.05. A total of 104 members responded to the survey (58% response rate). Sixty-three percent were program directors, and most (89%) practiced in academic settings. Sixty-two percent in academics reported having a formal training program, and 60% in private practice reported having one. Only 40% of programs with fewer than 10 residents had ethics training, whereas 78% of programs with more than 20 residents did. The odds of having a training program were slightly higher (odds ratio, 1.1) with more residents (P = 0.17). Despite the lack of information in the literature, formal ethics and professionalism training does exist in many plastic surgery residencies, although barriers to implementation do exist. Plastic surgery leadership should be involved in the development of standardized curricula to help overcome these barriers.

Ethical decision-making in hospice care.

PubMed

Walker, Andreas; Breitsameter, Christof

2015-05-01

Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care. Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory. The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent. Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse's individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse's own style of administering care. The nurse's decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework. An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care - namely, physical, psychological, social and spiritual care - into the practice of her daily work. Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted. © The Author(s) 2014.

The Need for Systematic Reviews of Reasons

PubMed Central

Sofaer, Neema; Strech, Daniel

2012-01-01

There are many ethical decisions in the practice of health research and care, and in the creation of policy and guidelines. We argue that those charged with making such decisions need a new genre of review. The new genre is an application of the systematic review, which was developed over decades to inform medical decision-makers about what the totality of studies that investigate links between smoking and cancer, for example, implies about whether smoking causes cancer. We argue that there is a need for similarly inclusive and rigorous reviews of reason-based bioethics, which uses reasoning to address ethical questions. After presenting a brief history of the systematic review, we reject the only existing model for writing a systematic review of reason-based bioethics, which holds that such a review should address an ethical question. We argue that such a systematic review may mislead decision-makers when a literature is incomplete, or when there are mutually incompatible but individually reasonable answers to the ethical question. Furthermore, such a review can be written without identifying all the reasons given when the ethical questions are discussed, their alleged implications for the ethical question, and the attitudes taken to the reasons. The reviews we propose address instead the empirical question of which reasons have been given when addressing a specified ethical question, and present such detailed information on the reasons. We argue that this information is likely to improve decision-making, both directly and indirectly, and also the academic literature. We explain the limitations of our alternative model for systematic reviews. PMID:21521251

History and theory in "applied ethics".

PubMed

Beauchamp, Tom L

2007-03-01

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical grounds in dealing with two problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics.

Ethical challenges in the use of social service robots for elderly people.

PubMed

Körtner, T

2016-06-01

Socially assistive robots are increasingly discussed as solutions in care and domestic use for the support of senior adults; however, this raises ethical questions which hitherto have not been considered or were not predictable. The most important questions are those of privacy and data protection, safety and responsibility as well as involvement of vulnerable persons and deception. Consequently, the ethical principles of nonmaleficence, beneficence, autonomy and fairness should be transposed to robotics. Clear answers and solutions are not yet available for every ethical challenge in robotics; however, the development of ethical guidelines for deployment of robots and research in the field of social service robots (SSR) are essential steps in order to embed ethics into dealing with socially assistive robots. This article provides some practical suggestions on this issue from a robotics project.

Reflective equilibrium and empirical data: third person moral experiences in empirical medical ethics.

PubMed

De Vries, Martine; Van Leeuwen, Evert

2010-11-01

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This 'empirical turn' is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self-justification and bias and can increase the credibility of the RE reached. © 2009 Blackwell Publishing Ltd.

Ethical issues in nanomedicine: Tempest in a teapot?

PubMed

Allon, Irit; Ben-Yehudah, Ahmi; Dekel, Raz; Solbakk, Jan-Helge; Weltring, Klaus-Michael; Siegal, Gil

2017-03-01

Nanomedicine offers remarkable options for new therapeutic avenues. As methods in nanomedicine advance, ethical questions conjunctly arise. Nanomedicine is an exceptional niche in several aspects as it reflects risks and uncertainties not encountered in other areas of medical research or practice. Nanomedicine partially overlaps, partially interlocks and partially exceeds other medical disciplines. Some interpreters agree that advances in nanotechnology may pose varied ethical challenges, whilst others argue that these challenges are not new and that nanotechnology basically echoes recurrent bioethical dilemmas. The purpose of this article is to discuss some of the ethical issues related to nanomedicine and to reflect on the question whether nanomedicine generates ethical challenges of new and unique nature. Such a determination should have implications on regulatory processes and professional conducts and protocols in the future.

Ethical issues in trauma-related research: a review.

PubMed

Newman, Elana; Risch, Elizabeth; Kassam-Adams, Nancy

2006-09-01

ETHICAL DECISION-MAKING ABOUT TRAUMA-RELATED STUDIES requires a flexible approach that counters assumptions and biases about victims, assures a favorable ethical cost-benefit ratio, and promotes advancement of knowledge that can benefit survivors of traumatic stress. This paper reviews several ethical issues in the field of traumatic stress: benefit and risks in trauma-related research, whether trauma-related research poses unique risks and if so what those might be, informed consent and mandatory reporting, and supervision of trauma-related research. For each topic, we review potential ethical issues, summarize the research conducted thus far to inform ethical practice, and recommend future practice, research questions and policies to advance the field so that research on trauma can continue to be a win-win situation for all stakeholders in the research enterprise.

Ethical issues in pragmatic randomized controlled trials: a review of the recent literature identifies gaps in ethical argumentation.

PubMed

Goldstein, Cory E; Weijer, Charles; Brehaut, Jamie C; Fergusson, Dean A; Grimshaw, Jeremy M; Horn, Austin R; Taljaard, Monica

2018-02-27

Pragmatic randomized controlled trials (RCTs) are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Our review identified four major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs.

[Ethical dilemmas of contemporary psychiatry].

PubMed

Filaković, Pavo; Pozgain, Ivan

2008-01-01

Ethics in the contemporary psychiatry, as well as in medicine in general, is based on the two core ethical traditions: deontological and theological. Good ethical decision takes into the consideration both traditions, and is preceded with ethical dilemmas to provide the best possible care to the patients in that moment. In the article are presented most recent research results of the literature about ethical dilemmas in psychiatry. Ethical dilemmas in everyday practice as well as compliance with the patients, psychiatric consultations, informed consent, treatment of personality disorders, pharmacological investigations, forensic psychiatry, forced hospitalisation, promotion of mental health, and dealing with the stigma of the mental diseases are showed in the article. The authors emphasize the necessity of constant questioning of ethical dilemmas in the contemporary psychiatry, because of the special status of psychiatry as a potentially risky field in practice, and because of intensive pharmacological investigations in psychiatric patients.

The Role of Ethics Committees and Ethics Consultation in Allocation Decisions

PubMed Central

Strech, Daniel; Hurst, Samia; Danis, Marion

2013-01-01

Background Decisions about the allocation and rationing of medical interventions likely occur in all health care systems worldwide. So far very little attention has been given to the question of what role ethics consultation and ethics committees could or should play in questions of allocation at the hospital level. Objectives and Methods This article argues for the need for ethics consultation in rationing decisions using empirical data about the status quo and the inherent nature of bedside rationing. Subsequently, it introduces a 4-stage process for establishing and conducting ethics consultation in rationing questions with systematic reference to core elements of procedural justice. Results Qualitative and quantitative findings show a significant demand for ethics consultation expressed directly by doctors, as well as additional indirect evidence of such a need as indicated by ethically challenging circumstances of inconsistent and structurally disadvantaging rationing decisions. To address this need, we suggest 4 stages for establishing and conducting ethics consultation in rationing questions we recommend: (1) training, (2) identifying actual scarcity-related problems at clinics, (3) supporting decision-making, and (4) evaluation. Conclusion This process of ethics consultation regarding rationing decisions would facilitate the achievement of several practical goals: (i) encouragement of an awareness and understanding of ethical problems in bedside rationing, (ii) encouragement of achieving efficiency along with rationing, (iii) reinforcement of consistency in inter- and intraindvidual decision-making, (iv) encouragement of explicit reflection and justification of the prioritization criteria taken into consideration, (v) improvement in internal (in-house) and external transparency, and (vi) prevention of the misuse of the corresponding consulting structures. PMID:20706163

Publication ethics from the ground up.

PubMed

DeTora, Lisa; Foster, Cate; Nori, Mukund; Simcoe, Donna; Skobe, Catherine; Toroser, Dikran

2018-02-01

It is relatively easy to begin policy documents with a general assertion that ethics will be followed. Less obvious is how to ensure that day-to-day activities are consonant with ethical standards. We suggest that using day-to-day publication activities as the driver for building policies and procedures can promote ethical practices from the ground up. Although basic principles of ethical publication practice may seem straightforward to some, for others this information may require explanation, interpretation and context. Effective policy development includes big-picture items as well as more day-to-day tactical responsibilities such as those discussed below. Research questions, disciplinary practices, applications and team structures may vary. Thus, no single publication plan or policy solution is right for all teams. It is up to team members to review guidelines for best practices and find the optimal implementation for their situations. Experts in publication management, planning and writing can help large teams manage publication activities. These experts have an obligation to maintain and enhance their skills continually. A strong acumen in publication best practices will allow these publication professionals to better address any possible ethical dilemmas in the future. © 2018 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Deep and continuous palliative sedation (terminal sedation): clinical-ethical and philosophical aspects.

PubMed

Materstvedt, Lars Johan; Bosshard, Georg

2009-06-01

Terminal sedation continues to fuel debate. When confronted with a patient for whom terminal sedation is considered a possible treatment option, decision making can be difficult. In this paper we focus on the clinical-ethical issues, with an aim to provide clinicians with ways of framing the issue from an ethical point of view. In addition to the clinical-ethical issues, terminal sedation touches upon interesting and complex questions of an essentially philosophical nature. What it means to be a "person" is one such question, and is a topic that is relevant to clinical, daily practice. Accordingly, in the latter part of this paper we draw briefly on selected philosophical positions to elucidate this question. A doctor's belief of what it means to be a "person" might well affect their actions. For example, if a doctor believes terminal sedation involves the destruction of the person, they might not be willing to proceed with it.

Medical ethics research between theory and practice.

PubMed

ten Have, H A; Lelie, A

1998-06-01

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illness of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.

[Dentists' Knowledge of Ethical Questions Regarding Dental Medicine - A Survey of Dentists from Saxony, Saxony-Anhalt and Thuringia (Germany)].

PubMed

Schochow, M; Christel, A; Lautenschläger, C; Steger, F

2016-12-01

Background: Subjects regarding ethical questions in dental medicine are only slightly touched in the study of dental medicine or in the working regulations of the dentists' association. However, dentists are confronted with these matters in everyday working life. The empirical study at hand collects current data regarding the ethical knowledge about dental medicine in the practical experience of dentists in Saxony, Saxony-Anhalt, and Thuringia. Methods: The tool used in the survey was a structured questionnaire. Out of 600 randomly chosen and contacted dentists from Saxony, Saxony-Anhalt, and Thuringia, 290 replied (response rate: 48.3%). The anonymised assessment took place between June and November 2013. Results: Dentists frequently encounter ethical questions regarding dental matters. The dentists interviewed in the study are in favour of a participative relationship between patient and dentist. Simultaneously, the patient's health is predominantly seen as the good of higher value than his or her self-determination. The dentists show competent knowledge of ethical dental subjects, although increased uncertainties could be observed in more complex situations, e. g. considering contact with patients who are HIV-positive. Conclusions: Questions dealing with dental ethical questions do play a major role in the daily professional life of dentists. In order to further support and strengthen dentists in their individual dental ethical competence, we see a need for advanced training and further education regarding questions and problems in the area of ethics in dental medicine. Also, these topics should become a component in the curriculum of the study of dental medicine. © Georg Thieme Verlag KG Stuttgart · New York.

The ties that bind. What you should know about the operational, ethical issues of restrictive covenants.

PubMed

Cameron, Elizabeth; Ealey, Tom

2007-07-01

Restrictive covenants--also called noncompete clauses--in physician contracts can be a contentious issue, sometimes inspiring litigation. They pose many questions for medical practice administrators. Are restrictive covenants really necessary to protect a medical group? Are they ethical? Does their use deny medical care to patients? And how do they apply to medical practice administrators? This article reviews restrictive covenants from all these perspectives and provides a worksheet to figure your practice's protectable interests.

Escaping the Malaise: First-Hand Guidance for Ethical Behavior.

ERIC Educational Resources Information Center

Mijares, Al

1996-01-01

To maintain the highest degree of ethical conduct, superintendents must avoid illegal practices, favoritism, questionable affiliations, and abuses of power. They must be transparent in business dealings, follow board policies and bylaws carefully, encourage participative decision making, treat everyone equally, and be highly visible and…

[The Christian virtues medical practice].

PubMed

de Santiago, Manuel

2014-01-01

The return to an ethic of virtues in dialogue with the moral tradition of Medicine and biomedical ethics is the backbone of Pellegrino's proposed reform of medical ethics. The question why this author proposes this reform is answered in this paper that summarizes his book "The Christian Virtues in Medical Practice". Perceiving the changes in the practice of medicine in their country, Pellegrino and Thomasma, men of deep faith, concerned about the darkening of medical conscience and the intuition of danger to the Christian faith, they address the commitment of Christian physicians and those who join them in the mode and form of practicing medicine. Deeply loyal to the Gospel message, the book represents a wake-up call to the conscience of believing professionals, leading to a demanding, enriching and committed vision of the practice of medicine.

Evaluation of Viewpoints of Health Care Professionals on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas Based on Practice Environment.

PubMed

Marcus, Brian S; Carlson, Jestin N; Hegde, Gajanan G; Shang, Jennifer; Venkat, Arvind

2016-03-01

We sought to evaluate whether health care professionals' viewpoints differed on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas based on practice location. We conducted a survey study from December 21, 2013 to March 15, 2014 of health care professionals at six hospitals (one tertiary care academic medical center, three large community hospitals and two small community hospitals). The survey consisted of eight clinical ethics cases followed by statements on whether there was a role for the ethics committee or hospital in their resolution, what that role might be and case specific queries. Respondents used a 5-point Likert scale to express their degree of agreement with the premises posed. We used the ANOVA test to evaluate whether respondent views significantly varied based on practice location. 240 health care professionals (108-tertiary care center, 92-large community hospitals, 40-small community hospitals) completed the survey (response rate: 63.6 %). Only three individual queries of 32 showed any significant response variations across practice locations. Overall, viewpoints did not vary across practice locations within question categories on whether the ethics committee or hospital had a role in case resolution, what that role might be and case specific queries. In this multicenter survey study, the viewpoints of health care professionals on the role of ethics committees or hospitals in the resolution of clinical ethics cases varied little based on practice location.

Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party.

PubMed

Grimm, Herwig; Bergadano, Alessandra; Musk, Gabrielle C; Otto, Klaus; Taylor, Polly M; Duncan, Juliet Clare

2018-06-09

Modern veterinary medicine offers numerous options for treatment and clinicians must decide on the best one to use. Interventions causing short-term harm but ultimately benefitting the animal are often justified as being in the animal's best interest. Highly invasive clinical veterinary procedures with high morbidity and low success rates may not be in the animal's best interest. A working party was set up by the European College of Veterinary Anaesthesia and Analgesia to discuss the ethics of clinical veterinary practice and improve the approach to ethically challenging clinical cases. Relevant literature was reviewed. The 'best interest principle' was translated into norms immanent to the clinic by means of the 'open question argument'. Clinical interventions with potential to cause harm need ethical justification, and suggest a comparable structure of ethical reflection to that used in the context of in vivo research should be applied to the clinical setting. To structure the ethical debate, pertinent questions for ethical decision-making were identified. These were incorporated into a prototype ethical tool developed to facilitate clinical ethical decision-making. The ethical question 'Where should the line on treatment be drawn' should be replaced by 'How should the line be drawn?' © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Qualitative Evaluation Methods in Ethics Education: A Systematic Review and Analysis of Best Practices.

PubMed

Watts, Logan L; Todd, E Michelle; Mulhearn, Tyler J; Medeiros, Kelsey E; Mumford, Michael D; Connelly, Shane

2017-01-01

Although qualitative research offers some unique advantages over quantitative research, qualitative methods are rarely employed in the evaluation of ethics education programs and are often criticized for a lack of rigor. This systematic review investigated the use of qualitative methods in studies of ethics education. Following a review of the literature in which 24 studies were identified, each study was coded based on 16 best practices characteristics in qualitative research. General thematic analysis and grounded theory were found to be the dominant approaches used. Researchers are effectively executing a number of best practices, such as using direct data sources, structured data collection instruments, non-leading questioning, and expert raters. However, other best practices were rarely present in the courses reviewed, such as collecting data using multiple sources, methods, raters, and timepoints, evaluating reliability, and employing triangulation analyses to assess convergence. Recommendations are presented for improving future qualitative research studies in ethics education.

Facilitating the development of moral insight in practice: teaching ethics and teaching virtue.

PubMed

Begley, Ann M

2006-10-01

Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.

Does uncontrolled cardiac death for organ donation raise ethical questions? An opinion survey.

PubMed

Goudet, V; Albouy-Llaty, M; Migeot, V; Pain, B; Dayhot-Fizelier, C; Pinsard, M; Gil, R; Beloucif, S; Robert, R

2013-11-01

Organ donation after uncontrolled cardiac death raises complex ethical issues. We conducted a survey in a large hospital staff population, including caregivers and administrators, to determine their ethical viewpoints regarding organ donation after uncontrolled cardiac death. Multicenter observational survey using a questionnaire, including information on the practical modalities of the procedure. Respondents were asked to answer 15 detailed ethical questions corresponding to different ethical issues raised in the literature. Ethical concerns was defined when respondents expressed ethical concerns in their answers to at least three of nine specifically selected ethical questions. One thousand one hundred ninety-six questionnaires were received, and 1057 could be analysed. According to our definition, 573 respondents out of 1057 (54%) had ethical concerns with regard to donation after cardiac death and 484 (46 %) had no ethical concerns. Physicians (55%) and particularly junior intensivists (65%) tended to have more ethical issues than nurses (52%) and hospital managers (37%). Junior intensivists had more ethical issues than senior intensivists (59%), emergency room physicians (46%) and transplant specialists (43%). Only 46% of hospital-based caregivers and managers appear to accept easily the legitimacy of organ donation after cardiac death. A significant number of respondents especially intensivists, expressed concerns over the dilemma between the interests of the individual and those of society. These results underline the need to better inform both healthcare professionals and the general population to help to the development of such procedure. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The virtues in their place: virtue ethics in medicine.

PubMed

Jansen, L A

2000-01-01

We are currently in the midst of a revival of interest in the virtues. A number of contemporary moral philosophers have defended a virtue-based approach to ethics. But does this renewal of interest in the virtues have much to contribute to medical ethics and medical practice? This paper critically discusses this question. It considers and rejects a number of important arguments that purport to establish the significance of the virtues for medical practice. Against these arguments, the paper seeks to show that while the virtues have a genuine role to play in medical ethics, it is a limited role, one that is subordinate to the role that other moral concepts such as rules and principles play.

Ethics in Psychotherapy and Counseling: A Practical Guide. Second Edition.

ERIC Educational Resources Information Center

Pope, Kenneth S.; Vasquez, Melba J. T.

Although they may be reflected in professional guidelines, formal standards, or law, ethics are not static codes. They are an active process by which the individual therapist or counselor struggles with the sometimes bewildering, always unique constellation of questions, responsibilities, contexts, and competing demands of helping another person.…

Ethics and Representation in Qualitative Studies of Literacy.

ERIC Educational Resources Information Center

Mortensen, Peter, Ed.; Kirsch, Gesa E., Ed.

Reflecting on the practice of qualitative literacy research, this book presents 14 essays that address the most pressing questions faced by qualitative researchers today: how to represent others and themselves in research narratives; how to address ethical dilemmas in research-participant relations; and how to deal with various rhetorical,…

Good Conversations: An Enhanced Model to Teach Business Ethics

ERIC Educational Resources Information Center

Thomson, Grace S.

2011-01-01

Business practices are a constant matter of discussion by ethical theorists concerned with the conflicts between profitability and justice (Cherry, Lee, & Chien, 2003). Business decisions are complex and hence likely to be compromised by low-quality or questionable strategies (Carpenter & Sanders, 2008). The line between misbehavior and…

Virtue and the scientist: using virtue ethics to examine science's ethical and moral challenges.

PubMed

Chen, Jiin-Yu

2015-02-01

As science has grown in size and scope, it has also presented a number of ethical and moral challenges. Approaching these challenges from an ethical framework can provide guidance when engaging with them. In this article, I place science within a virtue ethics framework, as discussed by Aristotle. By framing science within virtue ethics, I discuss what virtue ethics entails for the practicing scientist. Virtue ethics holds that each person should work towards her conception of flourishing where the virtues enable her to realize that conception. The virtues must become part of the scientist's character, undergirding her intentions and motivations, as well as the resulting decisions and actions. The virtue of phronêsis, or practical wisdom, is critical for cultivating virtue, enabling the moral agent to discern the appropriate actions for a particular situation. In exercising phronêsis, the scientist considers the situation from multiple perspectives for an in-depth and nuanced understanding of the situation, discerns the relevant factors, and settles upon an appropriate decision. I examine goods internal to a practice, which are constitutive of science practiced well and discuss the role of phronêsis when grappling with science's ethical and moral features and how the scientist might exercise it. Although phronêsis is important for producing scientific knowledge, it is equally critical for working through the moral and ethical questions science poses.

Sensitive and controversial ethical issues subject of groundbreaking Toronto exhibit.

PubMed Central

Kezwer, G; Kramer, D

1996-01-01

Medical research and practice have always posed many ethical dilemmas for scientists and physicians, but technologic advances mean that the questions are becoming even more difficult. That is why an exhibit, A Question of Truth, that is being prepared at Toronto's Ontario Science Centre is so timely. It examines the biases and political climates in which science operates, as well as the relative subjectivity of truth, knowledge and reality. Images p1484-a p1485-a p1486-a PMID:8943940

Workarounds Are Routinely Used by Nurses-But Are They Ethical?

PubMed

Berlinger, Nancy

2017-10-01

: Nurses regularly circumvent work systems they perceive to be flawed to provide more efficient or better care. If kept secret, however, such workarounds become ethically questionable, even when the nurse is trying to do the right thing. In this article, the author discusses how nurses can be creative problem solvers without resorting to practices that may be ethical in intent yet potentially harmful in their consequences.

Radiology and Ethics Education.

PubMed

Camargo, Aline; Liu, Li; Yousem, David M

2017-09-01

The purpose of this study is to assess medical ethics knowledge among trainees and practicing radiologists through an online survey that included questions about the American College of Radiology Code of Ethics and the American Medical Association Code of Medical Ethics. Most survey respondents reported that they had never read the American Medical Association Code of Medical Ethics or the American College of Radiology Code of Ethics (77.2% and 67.4% of respondents, respectively). With regard to ethics education during medical school and residency, 57.3% and 70.0% of respondents, respectively, found such education to be insufficient. Medical ethics training should be highlighted during residency, at specialty society meetings, and in journals and online resources for radiologists.

Perceptions and attitudes of community pharmacists toward professional ethics and ethical dilemmas in the workplace.

PubMed

Vuković Rodríguez, Jadranka; Juričić, Živka

2018-05-01

Formal training in pharmacy ethics is relatively new in Croatia, and the professional code of ethics is more than 20 years old. Very little is known about how practicing pharmacists implement ethical considerations and relevant professional guidelines in their work. This study aimed to provide the first description of the perceptions and attitudes of Croatian community pharmacists toward ethics in pharmacy practice, how often they face certain ethical dilemmas and how they resolve them. A cross-sectional survey of 252 community pharmacists, including community pharmacists and pre-licensing trainees, was conducted in Zagreb, Croatia. This group accounts for 18% of licensed pharmacists in Croatia. The survey questions included four sections: general sociodemographic information, multiple-choice questions, pre-defined ethical scenarios, and ethical scenarios filled in by respondents. More than half of pharmacists (62.7%) face ethical dilemmas in everyday work. Nearly all (94.4%) are familiar with the current professional code of ethics in Croatia, but only 47.6% think that the code reflects the changes that the pharmacy profession faces today. Most pharmacists (83.3%) solve ethical dilemmas on their own, while nearly the same proportion (75.4%) think that they are not adequately trained to deal with ethical dilemmas. The pre-defined ethical scenarios experienced by the largest proportion of pharmacists are being asked to dispense a drug to someone other than the patient (93.3%), an unnecessary over-the-counter medicine (84.3%), a generic medicine clinically equivalent to the prescribed one (79.4%), or hormonal contraception over the counter (70.4%). The results demonstrate a need to improve formal pharmacy ethics education and training in how to assess ethical issues and make appropriate decisions, which implies the need for stronger collaboration between pharmacists and their professional association. Our results also highlight an urgent need to revise and update the Croatian code of ethics for pharmacists. Copyright © 2017 Elsevier Inc. All rights reserved.

‘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.

Foucault at the bedside: a critical analysis of empowering a healthy lifestyle.

PubMed

Devisch, Ignaas; Vanheule, Stijn

2015-06-01

Since quite a few years, philosophy is heading towards the bedside of the patient: the practice of philosophy has stepped out of its ivory tower, it seems, to deal with empirical or practical questions. Apart from the advantages, we should keep in mind the importance of a critical analysis of medical or clinical practice as such. If ethics partakes the clinical stage, it runs the risk only to discuss the how question and to forget the more fundamental what or why questions: what are we doing exactly and why is it good for? Starting from the principle of the empowerment of the patient, we will demonstrate how the discourse on empowerment in health care seems to forget a profound reflection upon this principle as such. By rehearsing some basics from the governmentality theory of Michel Foucault and the actualization of it by Nicolas Rose, we will argue how philosophical investigation in medical-ethical evolutions such as empowerment of the patient is still needed to understand what is really going on in today's clinical practice. © 2015 John Wiley & Sons, Ltd.

A Comparative Study on Scientific Misconduct between Korean and Japanese Science Gifted Students

ERIC Educational Resources Information Center

Lee, Jiwon; Kim, Jung Bog; Isozaki, Tetsuo

2017-01-01

The scientific integrity, perceptions of scientific misconduct, and students' needs in the research ethics education of Korean and Japanese gifted students were analyzed to address three questions. First, how well do students practice research ethics in their research? Second, how do students perceive scientists' misconduct? Third, do students…

Surveillance Cameras in Schools: An Ethical Analysis

ERIC Educational Resources Information Center

Warnick, Bryan R.

2007-01-01

In this essay, Bryan R. Warnick responds to the increasing use of surveillance cameras in public schools by examining the ethical questions raised by their use. He explores the extent of a student's right to privacy in schools, stipulates how video surveillance is similar to and different from commonly accepted in-person surveillance practices,…

Empirical research in medical ethics: how conceptual accounts on normative-empirical collaboration may improve research practice.

PubMed

Salloch, Sabine; Schildmann, Jan; Vollmann, Jochen

2012-04-13

The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis.

Empirical research in medical ethics: How conceptual accounts on normative-empirical collaboration may improve research practice

PubMed Central

2012-01-01

Background The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. Discussion A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. Summary High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis. PMID:22500496

Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

PubMed Central

Wilkinson, G

1986-01-01

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings.

PubMed

Ewashen, Carol; Lane, Annette

2007-09-01

Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between 'counselor', and 'caring educator'? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions.

Teaching business ethics to professional engineers.

PubMed

Sauser, William I

2004-04-01

Without question "business ethics" is one of the hot topics of the day. Over the past months we have seen business after business charged with improper practices that violate commonly-accepted ethical norms. This has led to a loss of confidence in corporate management, and has had severe economic consequences. From many quarters business educators have heard the call to put more emphasis on ethical practices in their business courses and curricula. Engineering educators are also heeding this call, since the practice of engineering usually involves working for (or leading) a business and/or engaging in business transactions. In the summer of 2002, Auburn University's Engineering Professional Development program made the decision to produce--based on the author's Executive MBA course in Business Ethics--a distance-delivered continuing education program for professional engineers and surveyors. Participants across the USA now may use the course to satisfy continuing education requirements with respect to professional licensing and certification. This paper outlines the purpose and content of the course and describes its production, distribution, application, and evaluation.

Scientific misconduct and science ethics: a case study based approach.

PubMed

Consoli, Luca

2006-07-01

The Schön misconduct case has been widely publicized in the media and has sparked intense discussions within and outside the scientific community about general issues of science ethics. This paper analyses the Report of the official Committee charged with the investigation in order to show that what at first seems to be a quite uncontroversial case, turns out to be an accumulation of many interesting and non-trivial questions (of both ethical and philosophical interest). In particular, the paper intends to show that daily scientific practices are structurally permeated by chronic problems; this has serious consequences for how practicing scientists assess their work in general, and scientific misconduct in particular. A philosophical approach is proposed that sees scientific method and scientific ethics as inextricably interwoven. Furthermore, the paper intends to show that the definition of co-authorship that the members of the Committee use, although perhaps clear in theory, proves highly problematic in practice and raises more questions that it answers. A final plea is made for a more self-reflecting attitude of scientists as far as the moral and methodological profile of science is concerned as a key element for improving not only their scientific achievements, but also their assessment of problematic cases.

Nursing students' experiences of ethical issues in clinical practice: A New Zealand study.

PubMed

Sinclair, J; Papps, E; Marshall, B

2016-03-01

Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately. Copyright © 2016 Elsevier Ltd. All rights reserved.

Ethical advertising in dentistry.

PubMed

Graskemper, Joseph P

2009-01-01

Advertising in dentistry has steadily increased since the 1970s to become a leading choice of many dentists to promote their practices. The manner in which advertising progresses within the profession affects all dentists and how patients perceive dentistry as a profession. This paper presents ethical concepts that should be followed when dentists are pursuing practice promotion through advertising. It also raises questions that, hopefully, will increase attention and discussion on dental advertising. The paper concludes that ethical advertising is easily achieved by promoting patient education while not placing the dentist's self-interests ahead of the patient's. With this approach, dentistry may continue to be one of the most trusted professions.

Six questions about translational due diligence.

PubMed

Selinger, Evan

2010-04-28

To maintain stable respect and support, translational research must be guided by appropriate ethical, social, legal, and political concerns and carry out culturally competent practices. Considering six key questions concerning due diligence will enable the translational research community to examine critically how it approaches these endeavors.

Ethical issues in autologous stem cell transplantation (ASCT) in advanced breast cancer: a systematic literature review.

PubMed

Droste, Sigrid; Herrmann-Frank, Annegret; Scheibler, Fueloep; Krones, Tanja

2011-04-15

An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature.

Ethical issues in autologous stem cell transplantation (ASCT) in advanced breast cancer: A systematic literature review

PubMed Central

2011-01-01

Background An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. Methods We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. Results Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. Conclusions The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature. PMID:21496244

Medical internet ethics: a field in evolution.

PubMed

Dyer, K A; Thompson, C D

2001-01-01

As in any new field, the merger of medicine, e-commerce and the Internet raises many questions pertaining to ethical conduct. Key issues include defining the essence of the patient-provider relationship, establishing guidelines and training for practicing online medicine and therapy, setting standards for ethical online research, determining guidelines for providing quality healthcare information and requiring ethical conduct for medical and health websites. Physicians who follow their professional code of ethics are obligated not to exploit the relationship they have with patients, nor allow anyone else working with them to do so. Physicians and therapists are obligated to serve those who place trust in them for treatment, whether in face-to-face or online Internet encounters with patients or clients. This ethical responsibility to patients and clients is often in direct conflict with the business model of generating profits. Healthcare professionals involved in Medical Internet Ethics need to define the scope of competent medical and healthcare on the Internet. The emerging ethical issues facing medicine on the Internet, the current state of medical ethics on the Internet and questions for future directions of study in this evolving field are reviewed in this paper.

What is good medical ethics? A very personal response to a difficult question.

PubMed

Farsides, Bobbie

2015-01-01

A personal reflection upon a career in medical ethics leads to four conclusions on what makes for 'good medical ethics'. Good medical ethics is practical in approach, philosophically well grounded, cross disciplinary, and while it might not be a necessary feature, the experience of the author suggests that it is the work of 'good people'. 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.

Undergraduate healthcare ethics education, moral resilience, and the role of ethical theories.

PubMed

Monteverde, Settimio

2014-06-01

This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation. After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated. In addition to the regular online module evaluation, specific questions referring to the teaching of ethical theories were added using simple (yes/no) and Likert rating answer formats. At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor's program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey. The survey was voluntary and anonymous. Students were free to write their name and additional comments. Students consider ethical theories-as taught within the proposed framework-as practically applicable, useful, and transferable into practice. Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem. The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to "frame" and "name" the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. © The Author(s) 2013.

Neuroethics and fMRI: Mapping a Fledgling Relationship

PubMed Central

Garnett, Alex; Whiteley, Louise; Piwowar, Heather; Rasmussen, Edie; Illes, Judy

2011-01-01

Human functional magnetic resonance imaging (fMRI) informs the understanding of the neural basis of mental function and is a key domain of ethical enquiry. It raises questions about the practice and implications of research, and reflexively informs ethics through the empirical investigation of moral judgments. It is at the centre of debate surrounding the importance of neuroscience findings for concepts such as personhood and free will, and the extent of their practical consequences. Here, we map the landscape of fMRI and neuroethics, using citation analysis to uncover salient topics. We find that this landscape is sparsely populated: despite previous calls for debate, there are few articles that discuss both fMRI and ethical, legal, or social implications (ELSI), and even fewer direct citations between the two literatures. Recognizing that practical barriers exist to integrating ELSI discussion into the research literature, we argue nonetheless that the ethical challenges of fMRI, and controversy over its conceptual and practical implications, make this essential. PMID:21526115

Case Study in Ethics of Research: The Bucharest Early Intervention Project

PubMed Central

Zeanah, Charles H.; Fox, Nathan A.; Nelson, Charles A.

2014-01-01

The Bucharest Early Intervention Project is the first ever randomized controlled trial of foster care as an alternative to institutional care for young abandoned children. This paper examines ethical issues in the conceptualization and implementation of the study, which involved American investigators conducting research in another country, as well as vulnerable participants. We organize discussion of ethical questions about the study around several key issues. These include the nature and location of the vulnerable study population, the social value of conducting the study, risks and benefits of participating in the study to participants, and the post-trial obligations of the investigators. In discussing how these questions were addressed as the study was designed and after it was initiated, we describe our attempts to wed sound scientific practices with meaningful ethical protections for participants. PMID:22373763

Dialogical nursing ethics: the quality of freedom restrictions.

PubMed

Abma, Tineke A; Widdershoven, Guy A M; Frederiks, Brenda J M; van Hooren, Rob H; van Wijmen, Frans; Curfs, Paul L M G

2008-11-01

This article deals with the question of how ethicists respond to practical moral problems emerging in health care practices. Do they remain distanced, taking on the role of an expert, or do they become engaged with nurses and other participants in practice and jointly develop contextualized insights about good care? A basic assumption of dialogical ethics entails that the definition of good care and what it means to be a good nurse is a collaborative product of ongoing dialogues among various stakeholders engaged in the practice. This article discusses the value of a dialogical approach to ethics by drawing on the work of various nursing scholars. We present a case example concerning the quality of freedom restrictions for intellectually disabled people. Issues for discussion include the role and required competences of the ethicist and dealing with asymmetrical relationships between stakeholders.

[Controversies over the surgical placebo: legal issues and the ethical debate].

PubMed

Hervé, C; Moutel, G; Meningaud, J P; Wolf, M; Lopes, M

2000-06-17

The debate on controlled surgery trials has had some rather "sensational" repercussions, enlivening the placebo issue. In France, there is a consensus on the ethical conditions necessary for proper protection of individual persons. This consensus has taken on a legal form with the promulgation of the Huriet law. For this reason, all studies and research protocols in medicine and surgery are examined by ethics committees (CCPPRB) who assess the inclusion conditions within the framework of biomedical research and in compliance with the concept that individual participants must be give proper protection. These committees are faced with increasingly complex situations, particularly concerning the pertinence of information give to the participant and the modalities of consent. In France, standard measures were established after a parliamentary debate issuing from a wider public debate. The issue has become a social transaction between biomedical research professionals and the society in general. The international debate over the surgery placebo is an interesting illustration of how mediation institutions, working along the principles of ethical committees, play a key role in social awareness of the ethical issues involved before an innovating practice is initiated. But how legitimate are sensational pieces published in the media, which as is clearly demonstrated with the debate over the surgical placebo, are almost always individual points of view? Shouldn't the debate take into account the contributions of ethical committees which integrate representatives of the social community as well as the importance of a legal framework for individual protection as proposed by the French law? Shouldn't personal points of view be counterbalanced by regularly expressed ethical committee opinions formed after appropriate ethics-oriented discussion going beyond the simple question of "should we do it", a question often dismissed by extreme theoretical arguments that leave unanswered the practical question of "how should we do it"?

The Teaching of the Code of Ethics and Standard Practices for Texas Educator Preparation Programs

ERIC Educational Resources Information Center

Davenport, Marvin; Thompson, J. Ray; Templeton, Nathan R.

2015-01-01

The purpose of this descriptive quantitative research study was to answer three basic informational questions: (1) To what extent ethics training, as stipulated in Texas Administrative Code Chapter 247, was included in the EPP curriculum; (2) To what extent Texas public universities with approved EPP programs provided faculty opportunities for…

Paying Students to Learn: An Ethical Analysis of Cash for Grades Programmes

ERIC Educational Resources Information Center

Warnick, Bryan R.

2017-01-01

A growing number of schools have begun experimenting with giving students cash rewards to improve academic performance. This practice has come to be known as "cash-for-grades." In this article, I examine some of the philosophical and ethical questions involved with cash-for-grades programmes, rather than focusing on whether such…

The impact of medical tourism and the code of medical ethics on advertisement in Nigeria

PubMed Central

Makinde, Olusesan Ayodeji; Brown, Brandon; Olaleye, Olalekan

2014-01-01

Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done. PMID:25722776

The impact of medical tourism and the code of medical ethics on advertisement in Nigeria.

PubMed

Makinde, Olusesan Ayodeji; Brown, Brandon; Olaleye, Olalekan

2014-01-01

Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done.

[Do-it-yourself biology and medicine: history, practices, issues].

PubMed

Meyer, Morgan

2018-05-01

Do-it-yourself (DIY) biology and medicine are based on various practices and logics: amateur and DIY practices, the ethics of hacking and open source, the drive to domesticate molecular biology and genetics, the ideal of participation and citizen science. The article shows that this democratization is a process that is at once spatial (construction of new spaces), technical (creative workarounds equipment), social (establishment of accessible networks/laboratories) and political. It is therefore through their practices, gestures and questions - tinkering, experimenting, working around, amaterializing, ethicizing, comparing, valuating, etc. - that we need to grasp DIY sciences. © 2018 médecine/sciences – Inserm.

Prepared for practice? Law teaching and assessment in UK medical schools.

PubMed

Preston-Shoot, Michael; McKimm, Judy

2010-11-01

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical schools are responding to the preparation of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training.

Are phase 1 trials therapeutic? Risk, ethics, and division of labor.

PubMed

Anderson, James A; Kimmelman, Jonathan

2014-03-01

Despite their crucial role in the translation of pre-clinical research into new clinical applications, phase 1 trials involving patients continue to prompt ethical debate. At the heart of the controversy is the question of whether risks of administering experimental drugs are therapeutically justified. We suggest that prior attempts to address this question have been muddled, in part because it cannot be answered adequately without first attending to the way labor is divided in managing risk in clinical trials. In what follows, we approach the question of therapeutic justification for phase 1 trials from the viewpoint of five different stakeholders: the drug regulatory authority, the IRB, the clinical investigator, the referring physician, and the patient. Our analysis shows that the question of therapeutic justification actually raises multiple questions corresponding to the roles and responsibilities of the different stakeholders involved. By attending to these contextual differences, we provide more coherent guidance for the ethical negotiation of risk in phase 1 trials involving patients. We close by discussing the implications of our argument for various perennial controversies in phase 1 trial practice. © 2012 John Wiley & Sons Ltd.

Brief report.

PubMed

Colnerud, Gunnel

2013-10-01

Most accounts of the ethical problems facing researchers across a broad spectrum of research fields come from ethicists, ethics committees, and specialists committed to the study of ethics in human research. In contrast, this study reports on the ethical questions that researchers, themselves, report facing in their everyday practice. Fifty-five Swedish researchers contributed 109 examples of ethical dilemmas, conflicts, and problems in research. They were all researchers at the postdoctoral level in the fields of medicine, the humanities, education, and the social sciences, who devoted at least 50 percent of their working hours to research. They reported issues they face before, during, and after gathering data. Their range of issues is broader than generally discussed and points to the importance of researchers' ethical sensitivity.

Reporting transparency: making the ethical mandate explicit.

PubMed

Nicholls, Stuart G; Langan, Sinéad M; Benchimol, Eric I; Moher, David

2016-03-16

Improving the transparency and quality of reporting in biomedical research is considered ethically important; yet, this is often based on practical reasons such as the facilitation of peer review. Surprisingly, there has been little explicit discussion regarding the ethical obligations that underpin reporting guidelines. In this commentary, we suggest a number of ethical drivers for the improved reporting of research. These ethical drivers relate to researcher integrity as well as to the benefits derived from improved reporting such as the fair use of resources, minimizing risk of harms, and maximizing benefits. Despite their undoubted benefit to reporting completeness, questions remain regarding the extent to which reporting guidelines can influence processes beyond publication, including researcher integrity or the uptake of scientific research findings into policy or practice. Thus, we consider investigation on the effects of reporting guidelines an important step in providing evidence of their benefits.

[Medical research-ethics applied to social sciences: relevance, limits, issues and necessary adjustments].

PubMed

Desclaux, A

2008-04-01

Social sciences are concretely concerned by the ethics of medical research when they deal with topics related to health, since they are subjected to clearance procedures specific to this field. This raises at least three questions: - Are principles and practices of medical research ethics and social science research compatible? - Are "research subjects" protected by medical research ethics when they participate in social science research projects? - What can social sciences provide to on-going debates and reflexion in this field? The analysis of the comments coming from ethics committees about social science research projects, and of the experience of implementation of these projects, shows that the application of international ethics standards by institutional review boards or ethics committees raises many problems in particular for researches in ethnology anthropology and sociology. These problems may produce an impoverishment of research, pervert its meaning, even hinder any research. They are not only related to different norms, but also to epistemological divergences. Moreover, in the case of studies in social sciences, the immediate and differed risks, the costs, as well as the benefits for subjects, are very different from those related to medical research. These considerations are presently a matter of debates in several countries such as Canada, Brasil, and USA. From another hand, ethics committees seem to have developed without resorting in any manner to the reflexion carried out within social sciences and more particularly in anthropology Still, the stakes of the ethical debates in anthropology show that many important and relevant issues have been discussed. Considering this debate would provide openings for the reflexion in ethics of health research. Ethnographic studies of medical research ethics principles and practices in various sociocultural contexts may also contribute to the advancement of medical ethics. A "mutual adjustment" between ethics of medical research and social sciences is presently necessary: it raises new questions open for debate.

Ethical issues in engineering models: an operations researcher's reflections.

PubMed

Kleijnen, J

2011-09-01

This article starts with an overview of the author's personal involvement--as an Operations Research consultant--in several engineering case-studies that may raise ethical questions; e.g., case-studies on nuclear waste, water management, sustainable ecology, military tactics, and animal welfare. All these case studies employ computer simulation models. In general, models are meant to solve practical problems, which may have ethical implications for the various stakeholders; namely, the modelers, the clients, and the public at large. The article further presents an overview of codes of ethics in a variety of disciples. It discusses the role of mathematical models, focusing on the validation of these models' assumptions. Documentation of these model assumptions needs special attention. Some ethical norms and values may be quantified through the model's multiple performance measures, which might be optimized. The uncertainty about the validity of the model leads to risk or uncertainty analysis and to a search for robust models. Ethical questions may be pressing in military models, including war games. However, computer games and the related experimental economics may also provide a special tool to study ethical issues. Finally, the article briefly discusses whistleblowing. Its many references to publications and websites enable further study of ethical issues in modeling.

[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.

Ethical conflicts with hospitals: the perspective of nurses and physicians.

PubMed

Gaudine, Alice; LeFort, Sandra M; Lamb, Marianne; Thorne, Linda

2011-11-01

Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question 'What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?' We interviewed 34 registered nurses, 10 nurse managers, and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians.

Moral philosophy and nursing curricula: indoctrination of the new breed.

PubMed

Cartwright, T; Davson-Galle, P; Holden, R J

1992-05-01

A sizable proportion of nursing curricula subtly indoctrinate students with a particular normative ethic. Seldom is there adequate philosophical justification for the ethic, and students are rarely invited to subject that ethic to a rigorous philosophical analysis. Nursing curricula are replete with philosophical positions treated as moral imperatives to which all, students and faculty, owe their allegiance. This unsatisfactory situation warrants urgent attention. One problem is that of failing to justify the school's moral philosophy; another is the question of philosophically indoctrinating students to adhere to an ethic that advocates the individual's freedom and responsibility, a practice inconsistent with the predominant proposition advanced by the ethic.

Neuroscience, ethics and legal responsibility: the problem of the insanity defense. Commentary on "The ethics of neuroscience and the neuroscience of ethics: a phenomenological-existential approach".

PubMed

Smith, Steven R

2012-09-01

The insanity defense presents many difficult questions for the legal system. It attracts attention beyond its practical significance (it is seldom used successfully) because it goes to the heart of the concept of legal responsibility. "Not guilty by reason of insanity" generally requires that as a result of mental illness the defendant was unable to distinguish right from wrong at the time of the crime. The many difficult and complex questions presented by the insanity defense have led some in the legal community to hope that neuroscience might help resolve some of these problems, but that hope is not likely to be realized.

Cultural conundrums: the ethics of epidemiology and the problems of population in implementing pre-exposure prophylaxis.

PubMed

Fiereck, Kirk

2015-04-01

The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of 'who' are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiologic category in the specific national context of South Africa. © 2013 John Wiley & Sons Ltd.

Cultural Conundrums: The Ethics of Epidemiology and the Problems of Population in Implementing Pre-Exposure Prophylaxis

PubMed Central

2013-01-01

The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of epidemiological science and knowledge production practices. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiological surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of “who” are inextricably linked to knowledge about sex, gender and sexuality. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the medical humanities and biomedicine. This paper examines how cultural conundrums within the fields of bio- and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiological category in the specific national context of South Africa. PMID:24373050

In the business of dying: questioning the commercialization of hospice.

PubMed

Perry, Joshua E; Stone, Robert C

2011-01-01

This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward "market-driven medicine" at the end of life. For example, the article examines issues raised by an influx of for-profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that end-of-life patient care is inferior among for-profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non-profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., "no margin, no mission"). Given the limitations of existing empirical data and contrasting ideological commitments of for-profit versus non-profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family--a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end-of-life alternative. © 2011 American Society of Law, Medicine & Ethics, Inc.

Moving It Along: A study of healthcare professionals' experience with ethics consultations.

PubMed

Crigger, Nancy; Fox, Maria; Rosell, Tarris; Rojjanasrirat, Wilaiporn

2017-05-01

Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them. The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals. The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States. The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.

Should relatives witness resuscitation? Ethical issues and practical considerations

PubMed Central

Rosenczweig, C

1998-01-01

In winning second prize in the Logie Medical Ethics Essay Contest in 1997, Carolyn Rosenczweig raised questions about the role patients' family members should be allowed to play during resuscitative efforts by medical staff. She concluded that even though their presence might complicate resuscitation attempts, "blanket policies that exclude all relatives from being present seem a knee-jerk reaction." PMID:9526478

Dilemmas with Dilemmas...Exploring the Suitability of Dilemma Stories as a Way of Addressing Ethical Issues in Science Education.

ERIC Educational Resources Information Center

Settelmaier, Elisabeth

Traditionally, many science educators have taught science without addressing ethical questions. However, the inclusion of moral discourse in science teaching may help educators to bring to the fore problematic issues in relation to science, and it may offer an opportunity for students to practice their future engagement in the public discourse…

Are all "research fields" equal? Rethinking practice for the use of data from crowdsourcing market places.

PubMed

Gleibs, Ilka H

2017-08-01

New technologies like large-scale social media sites (e.g., Facebook and Twitter) and crowdsourcing services (e.g., Amazon Mechanical Turk, Crowdflower, Clickworker) are impacting social science research and providing many new and interesting avenues for research. The use of these new technologies for research has not been without challenges, and a recently published psychological study on Facebook has led to a widespread discussion of the ethics of conducting large-scale experiments online. Surprisingly little has been said about the ethics of conducting research using commercial crowdsourcing marketplaces. In this article, I focus on the question of which ethical questions are raised by data collection with crowdsourcing tools. I briefly draw on the implications of Internet research more generally, and then focus on the specific challenges that research with crowdsourcing tools faces. I identify fair pay and the related issue of respect for autonomy, as well as problems with the power dynamic between researcher and participant, which has implications for withdrawal without prejudice, as the major ethical challenges of crowdsourced data. Furthermore, I wish to draw attention to how we can develop a "best practice" for researchers using crowdsourcing tools.

A gentle ethical defence of homeopathy.

PubMed

Levy, David; Gadd, Ben; Kerridge, Ian; Komesaroff, Paul A

2015-06-01

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is "unethical." They have also diminished patients' perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics-one that fails to account either for the moral worth of care and of relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation-a type of moral calculus-quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients.

How Should We Respond to Non-Dominant Healing Practices, the Example of Homeopathy.

PubMed

Gray, Ben

2017-03-01

The debate around the ethics of homeopathy in recent issues of the journal has been approached as a binary question; is homeopathy ethical or not? This paper suggests that this is an unhelpful question and instead discusses a framework to establish the extent to which the dominant (medical) culture should tolerate non-dominant health practices such as homeopathy. This requires a sophisticated understanding of the placebo effect, a critical evaluation of what evidence is available, a consideration of the harm that the non-dominant practice might cause, and a consideration of how this might be affected by the culture of the patient. This is presented as a matter of cultural competence. At a clinical level clinicians need to respect the values and beliefs of their patients and communicate with all the practitioners involved in a patient's care. At a societal level there are a number of factors to be considered when a community decides which practices to tolerate and to what extent.

Environmental ethics and professional practice: A case study of an environmental challenge for century 2000

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

Malone, C.

1995-12-01

Objective resolution of environmental issues involves questions of facts and values, and, for environmental issues to be resolved ethically, a proper synthesis of environmental facts with questions of ethics must occur. In this case study, the proposal by the U.S. Department of Energy (DOE) to use the Yucca Mountain site in southwest Nevada as a deep geologic repository for the permanent disposal of the nation`s high-level nuclear waste is examined in part in the context of the {open_quotes}Code of Ethics and Standards of Practice for Environmental Professionals{close_quotes} adopted by the National Association of Environmental Professionals (NAEP). Current plans are thatmore » a repository at the Yucca Mountain site would begin functioning in 2010 and would be sealed after about 150 years. The requirement that a geologic repository must isolate nuclear waste from the environment for at least 10,000 years poses unique challenges to environmental professionals. This case study also analyzes the challenges in terms of the implications of a new federal Executive Order on Ecosystem Management and corresponding internal orders within all federal agencies to conform to the Executive Order. The imposition of the principles and practices of ecosystem-based resource management on federal agencies provides an opportunity to also address, in the context of the DOE Yucca Mountain Project, (1) the ecosystem approach to environmental management, (2) concepts of holistic resource management planning, and (3) the concepts of sustainability and biodiversity. Within this framework there are important implications for environmental ethics and professional practice that must remain at the forefront of concerns of the NAEP over the next two decades.« less

The investigation of life-threatening child abuse and Munchausen syndrome by proxy.

PubMed Central

Evans, D

1995-01-01

The use of covert video surveillance in the investigation of suspected life-threatening child abuse and Munchausen syndrome by proxy raises important ethical questions. That the recently reported provision of this facility in North Staffordshire was not presented to a Local Research Ethics Committee (LREC) for approval as a research exercise raises important questions about the ethical review of research and practice. The case made for avoiding such review is first set out and then examined. The three main premisses which form the basis of the view that LREC approval is not required are identified and tested in turn. The conclusion is that there is an undeniable element of research involved in the procedure and that the welfare of all those subjected to the surveillance would be best protected by the submission of the protocol to an independent committee for ethical assessment. PMID:7776355

[Illness, culture and religion--issues of intercultural medical ethics and nursing ethics].

PubMed

Körtner, Ulrich H J

2007-01-01

Should modern medicine be allowed to do what it is capable of? And what role are religious norms and attitudes to play in both the medical course of life and the bioethical discourse of modern societies? Questions like these are subject of current intercultural medical and nursing ethics. Religious attitudes not only influence the cultural and political surroundings of medical research but also exert a practical influence on the health and illness attitudes of the individual. Coming before moral judgement should be the endeavour to understand one's counterpart, namely the patient, and his/her socio-cultural background. The question to be answered is how therapy and nursing can best be applied within the given socio-cultural framework without those responsible denying their own medical premises or their own concepts of nursing. Intercultural medical and nursing ethics provide an important contribution to the current debate on integration.

Ethics support for GPs: what should it look like?

PubMed

Clark-Grill, Monika

2016-03-01

INTRODUCTION Ethics support services for hospital clinicians have become increasingly common globally but not as yet in New Zealand. However, an initiative to change this is gathering momentum. Its slogan 'Clinical ethics is everyone's business' indicates that the aim is to encompass all of health care, not just the hospital sector. General Practitioners (GPs) deal with ethical issues on a daily basis. These issues are often quite different from ethical issues in hospitals. To make future ethics support relevant for primary care, local GPs were interviewed to find out how they might envisage ethics support services that could be useful to them. METHODS A focus group interview with six GPs and semi-structured individual interviews with three GPs were conducted. Questions included how they made decisions on ethical issues at present, what they perceived as obstacles to ethical reflection and decision-making, and what support might be helpful. FINDINGS Three areas of ethics support were considered potentially useful: Formal ethics education during GP training, access to an ethicist for assistance with analysing an ethical issue, and professional guidance with structured ethics conversations in peer groups. CONCLUSION The complex nature of general practice requires GPs to be well educated and supported for handling ethical issues. The findings from this study could serve as input to the development of ethics support services. KEYWORDS General practice; primary care; ethics; support; education.

Ethics Teaching in Higher Education for Principled Reasoning: A Gateway for Reconciling Scientific Practice with Ethical Deliberation.

PubMed

Aközer, Mehmet; Aközer, Emel

2017-06-01

This paper proposes laying the groundwork for principled moral reasoning as a seminal goal of ethics interventions in higher education, and on this basis, makes a case for educating future specialists and professionals with a foundation in philosophical ethics. Identification of such a seminal goal is warranted by (1) the progressive dissociation of scientific practice and ethical deliberation since the onset of a problematic relationship between science and ethics around the mid-19th century, and (2) the extensive mistrust of integrating ethics in science and engineering curricula beyond its "applied," "practical," or "professional" implications. Although calls by international scientific and educational bodies to strengthen ethics teaching in scientific education over the past quarter century have brought about a notion of combining competence in a certain field with competence in ethics, this is neither entrenched in the academic community, nor fleshed out as regards its core or instruments to realize it. The legitimate goals of ethics teaching in higher education, almost settled since the 1980s, can be subsumed under the proposed seminal goal, and the latter also would safeguard content and methods of ethics interventions against the intrusion of indoctrinative approaches. In this paper, derivation of the proposed seminal goal rests on an interpretation of the Kohlbergian cognitive-developmental conception of moral adulthood consisting in autonomous principled moral reasoning. This interpretation involves, based on Kant's conception of the virtuous person, integrating questions about the "good life" into the domain of principled reasoning.

Medication monitoring and drug testing ethics project.

PubMed

Payne, Richard; Moe, Jeffrey L; Sevier, Catherine Harvey; Sevier, David; Waitzkin, Michael

2015-01-01

In 2012, Duke University initiated a research project, funded by an unrestricted research grant from Millennium Laboratories, a drug testing company. The project focused on assessing the frequency and nature of questionable, unethical, and illegal business practices in the clinical drug testing industry and assessing the potential for establishing a business code of ethics. Laboratory leaders, clinicians, industry attorneys, ethicists, and consultants participated in the survey, were interviewed, and attended two face-to-face meetings to discuss a way forward. The study demonstrated broad acknowledgment of variations in the legal and regulatory environment, resulting in inconsistent enforcement of industry practices. Study participants expressed agreement that overtly illegal practices sometimes exist, particularly when laboratory representatives and clinicians discuss reimbursement, extent of testing, and potential business incentives with medical practitioners. Most respondents reported directly observing probable violations involving marketing materials, contracts, or, in the case of some individuals, directly soliciting people with offers of clinical supplies and other "freebies." While many study respondents were skeptical that voluntary standards alone would eliminate questionable business practices, most viewed ethics codes and credentialing as an important first step that could potentially mitigate uneven enforcement, while improving quality of care and facilitating preferred payment options for credentialed parties. Many were willing to participate in future discussions and industry-wide initiatives to improve the environment.

Ethical Legal and Social Issues of Biobanking: Past, Present, and Future.

PubMed

Bledsoe, Marianna J

2017-04-01

The past 15 years has seen considerable changes in the research environment. These changes include the development of new sophisticated genetic and genomic technologies, a proliferation of databases containing large amount of genotypic and phenotypic data, and wide-spread data sharing among many institutions, nationally and internationally. These changes have raised new questions regarding how best to protect the participants of biobanking research. In response to these questions, best practices for addressing the legal, ethical, and social issues of biobanking have been developed. In addition, new ethical guidelines related to biobanking have been established, as well as new regulations regarding privacy and human subject protections. Finally, changes in the science and the research environment have raised complex ethical issues related to biobanking, such as questions about the most appropriate consent models to use for biobanking research, commercial use and ownership issues, and whether and how to return individual research results to biobank participants. This article reviews some of the developments over the past 15 years related to the ELSI of biobanking with a look toward the future.

Sex, pain and cranberries - ideas from the 2006 Registrar Research Workshop.

PubMed

Montgomery, Brett D; McMeniman, Erin; Cameron, Sara Kate; Duncan, Tristram; Prosser, Stuart; Moore, Ray

2007-01-01

The Registrar Research Workshop has been a feature of Australian general practice training since 1994. Twenty five general practice registrars attend the annual 3 day event, which aims to develop registrars' understanding of the research process. Presenters and facilitators are drawn from the academic general practitioner and primary health care research community. Presentations alternate with small group sessions, where groups of five registrars are guided through the process of developing a research question, identifying appropriate research methods, and addressing ethical and funding concerns, before preparing a presentation about their research proposal for their peers. Research questions are developed from unanswered questions that have arisen in registrars' clinical practice.

Embedding Scientific Integrity and Ethics into the Scientific Process and Research Data Lifecycle

NASA Astrophysics Data System (ADS)

Gundersen, L. C.

2016-12-01

Predicting climate change, developing resources sustainably, and mitigating natural hazard risk are complex interdisciplinary challenges in the geosciences that require the integration of data and knowledge from disparate disciplines and scales. This kind of interdisciplinary science can only thrive if scientific communities work together and adhere to common standards of scientific integrity, ethics, data management, curation, and sharing. Science and data without integrity and ethics can erode the very fabric of the scientific enterprise and potentially harm society and the planet. Inaccurate risk analyses of natural hazards can lead to poor choices in construction, insurance, and emergency response. Incorrect assessment of mineral resources can bankrupt a company, destroy a local economy, and contaminate an ecosystem. This paper presents key ethics and integrity questions paired with the major components of the research data life cycle. The questions can be used by the researcher during the scientific process to help ensure the integrity and ethics of their research and adherence to sound data management practice. Questions include considerations for open, collaborative science, which is fundamentally changing the responsibility of scientists regarding data sharing and reproducibility. The publication of primary data, methods, models, software, and workflows must become a norm of science. There are also questions that prompt the scientist to think about the benefit of their work to society; ensuring equity, respect, and fairness in working with others; and always striving for honesty, excellence, and transparency.

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

Realizing good care within a context of cross-cultural diversity: an ethical guideline for healthcare organizations in Flanders, Belgium.

PubMed

Denier, Yvonne; Gastmans, Chris

2013-09-01

In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks. Copyright © 2013. Published by Elsevier Ltd.

[Acute care nurses’ ethical reasoning: a thematic analysis].

PubMed

Barandun Schäfer, Ursi; Ulrich, Anja; Meyer-Zehnder, Barbara; Frei, Irena Anna

2015-12-01

In the day-to-day course of nursing, ethical issues are being openly articulated to a growing extent. However, nurses only rarely systematically address these issues. This subject was explored in interviews with professionals who have a particular focus on ethics. Gain input for further developing the skills of nursing staff in ethical reasoning. In two focus groups and four individual interviews, we questioned 14 professionals, including nine nurses, who have a special interest in ethics. Nurses find it ethically problematic when the wishes of patients are not respected or something is forced on them, creating the impression that the care being given is exacerbating rather than alleviating the patient’s suffering. These problematic aspects are often overlooked because the consequences of the action in question are not immediately apparent. Ethical issues in nursing are often addressed in informal, non-systematic discussions among nursing staff. Nurses actively and confidently engage in discussions on treatment goals, and the teamwork with doctors is usually experienced as being based on mutual respect and partnership. The inherent hierarchical role differences between nursing and medical staff nevertheless manifest in ethical issues. Through the practical application of ethical reasoning in day-to-day nursing, structured discussions of the ethical aspects of cases and dedicated further education, nurses should learn to better recognise ethical issues in nursing and effectively analyse them and find solutions.

Ethics and the pediatric surgeon.

PubMed

Fallat, Mary E; Caniano, Donna A; Fecteau, Annie H

2007-01-01

Care of infants and children with life-impairing or life-threatening congenital and acquired disorders often raises ethical concerns for pediatric surgeons. The purpose of this survey was to determine the level of interest in clinical ethics and how respondents would manage ethical dilemmas within several clinical case scenarios. A 12-item validated questionnaire developed by the Ethics and Advocacy Committee was provided for the American Pediatric Surgical Association (APSA; www.eapsa.org) members on the organizational website. General categories of questions included informed consent, patient privacy, and what constitutes research. The survey was completed by 235 of the 825 APSA members; a response rate of 28.4%. The majority (62%) were in academic practice, 22% had additional education or an advanced degree in ethics, and 11% were members of a hospital ethics committee. There was a clear majority response for seven questions. Topics generating the most controversy included the impact of consent by minors, decision making in the neurologically devastated child, what constitutes research in pediatric surgery, the use of interpreters for consent, and patient privacy. Respondents chose a well-referenced manuscript as the preferred modality for ethics education of the APSA members. Pediatric surgeons have a general interest in clinical ethics as it relates to the care of their patients. An important mission of the Ethics and Advocacy Committee can be to provide education that gives guidance and knowledge to the members of APSA on timely topics in surgical ethics.

The ethics and practice of neonatal resuscitation at the limits of viability: an international perspective.

PubMed

Fanaroff, Jonathan M; Hascoët, Jean-Michel; Hansen, Thor Willy Ruud; Levene, Malcolm; Norman, Mikael; Papageorgiou, Apostolos; Shinwell, Eric; van de Bor, Margot; Stevenson, David K

2014-07-01

Premature infants at the limits of viability raise difficult ethical, legal, social and economic questions. Neonatologists attending an international Collegium were surveyed about delivery room behaviour, and the approach taken by selected countries practicing 'modern' medicine was explored. There were strong preferences for comfort care at 22 weeks and full resuscitation at 24 weeks. Resuscitation was a grey area at 23 weeks. Cultural, social and legal factors also had a considerable impact on decision-making. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Researchers and the Rural Poor: Asking Questions in the Third World.

ERIC Educational Resources Information Center

Adams, William M.; Megaw, Charles C.

1997-01-01

Discusses the theory and practice of rural socioeconomic surveys in developing nations. Highlights the close links between choice of research topic, field area and research methods, and the ethics of field research. Offers a personal commentary on some practical problems concerning field research. (MJP)

Common law morality.

PubMed

Arras, John D

1990-01-01

Arras reviews A.R. Jonsen and S. Toulmin's The Abuse of Casuistry: A History of Moral Reasoning (University of California Press; 1988). Jonsen and Toulmin, both of whom worked with the federal National Commission for the Protection of Human Subjects, critique the role of ethical theory in practical deliberation and attack the belief that moral theories are "universal, mutually exclusive sources of...ethical truth." They argue that "all genuine ethics is already concrete and particular," and champion casuistical reasoning with its emphasis on particularity and practical judgment. Arras find The Abuse of Casuistry to be "a fascinating and thought-provoking study of moral methodology that will enrich our understanding of moral reasoning and quicken the ongoing debate over the appropriate role of ethical theory in bioethical analysis." He questions, however, the authors' faith in casuistry as the means to achieve social consensus on biomedical controversies.

Ethical Dilemmas in Disaster Medicine

PubMed Central

Ozge Karadag, C; Kerim Hakan, A

2012-01-01

Background Disasters may lead to ethical challenges that are different from usual medical practices. In addition, disaster situations are related with public health ethics more than medical ethics, and accordingly may require stronger effort to achieve a balance between individual and collective rights. This paper aims to review some ethical dilemmas that arise in disasters and mainly focuses on health services. Disasters vary considerably with respect to their time, place and extent; therefore, ethical questions may not always have `one-size-fits-all` answers. On the other hand, embedding ethical values and principles in every aspect of health-care is of vital importance. Reviewing legal and organizational regulations, developing health-care related guidelines, and disaster recovery plans, establishing on-call ethics committees as well as adequate in-service training of health-care workers for ethical competence are among the most critical steps. It is only by making efforts before disasters, that ethical challenges can be minimized in disaster responses. PMID:23285411

[RESPECT FOR AUTONOMY AND CONFIDENTIALITY, BETWEEN "ETHICAL NORMS' AND "LOCAL MORALITY". AN ANTHROPOLOGICAL ANALYSIS OF ETHICS OF CARE IN ST LUCIA].

PubMed

Meudec, Marie

2015-10-01

This article considers the difficulty of applying ethical norms as part of an anthropological research on moralities and ethics of healing practices in St. Lucia (Caribbean). This reflection is based on the moral evaluations related to obeah, locally conceived as a set of magical, religious and witchcraft practices that helps to manage disease and misfortune. Through the analysis of local conceptions surrounding the ethical notions of autonomy and confidentiality, I call attention to potential nuisance caused by the application of principles of beneficence and respect for the individual. Indeed, local idioms that are moral discretion and self-sufficiency, which can respectively refer to the concepts of autonomy and confidentiality, are, paradoxically, both valued and likely to be associated with dubious morality. I will demonstrate that the fact of applying these principles in all ethnographic relationship may harm interlocutors by increasing, in the case of St. Lucia, the risk of witchcraft accusations and derogatory moral attributions. The anthropological field experience presented here questions the principles of beneficence and respect for the individual as defined in the field of research ethics; it also imposes the need to think about their adaptation to suit local representations. This leads to recommend a pragmatic and emerging ethics of anthropological research/practice.

Virtue-Epistemology and the Chagos Unknown: Questioning the Indictment of Knowledge Transmission

ERIC Educational Resources Information Center

Papastephanou, Marianna

2015-01-01

Though concerned with knowledge, this article begins with unknown political events that are ignored by the culture and educational practices of the societies in whose name the events took place. The questions that these events raise indicate a relation of epistemology with ethics and education that complicates some theoretical and managerial…

Educational technologies and the teaching of ethics in science and engineering.

PubMed

Loui, Michael C

2005-07-01

To support the teaching of ethics in science and engineering, educational technologies offer a variety of functions: communication between students and instructors, production of documents, distribution of documents, archiving of class sessions, and access to remote resources. Instructors may choose to use these functions of the technologies at different levels of intensity, to support a variety of pedagogies, consistent with accepted good practices. Good pedagogical practices are illustrated in this paper with four examples of uses of educational technologies in the teaching of ethics in science and engineering. Educational technologies impose costs for the purchase of hardware, licensing of software, hiring of support personnel, and training of instructors. Whether the benefits justify these costs is an unsettled question. While many researchers are studying the possible benefits of educational technologies, all instructors should assess the effectiveness of their practices.

Do physicians have an ethical obligation to care for patients with AIDS?

PubMed Central

Angoff, N. R.

1991-01-01

This paper responds to the question: Do physicians have an ethical obligation to care for patients with acquired immunodeficiency syndrome (AIDS)? First, the social and political milieu in which this question arises is sampled. Here physicians as well as other members of the community are found declaring an unwillingness to be exposed to people with AIDS. Next, laws, regulations, ethical codes and principles, and the history of the practice of medicine are examined, and the literature as it pertains to these areas is reviewed. The obligation to care for patients with AIDS, however, cannot be located in an orientation to morality defined in rules and codes and an appeal to legalistic fairness. By turning to the orientation to morality that emerges naturally from connection and is defined in caring, the physicians' ethical obligation to care for patients with AIDS is found. Through an exploration of the writings of modern medical ethicists, it is clear that the purpose of the practice of medicine is healing, which can only be accomplished in relationship to the patient. It is in relationship to patients that the physician has the opportunity for self-realization. In fact, the physician is physician in relationship to patients and only to the extent that he or she acts virtuously by being morally responsible for and to those patients. Not to do so diminishes the physician's ethical ideal, a vision of the physician as good physician, which has consequences for the physician's capacity to care and for the practice of medicine. PMID:1788990

The Ethics of Western Rhetoric as a Basis for Teaching Foreign Students.

ERIC Educational Resources Information Center

Schliessmann, Michael R.

An increase in foreign student enrollment and subsequent questioning of traditional concepts of western rhetorical practice, particularly freedom of speech, resulted in an evaluation of current teaching practices in South Dakota State University's basic speech communication course. In a summer session course, 36 international students responded to…

The Ethics of Corporatization: Competing Visions for University Leadership

ERIC Educational Resources Information Center

Johnson, Benjamin Ashby

2010-01-01

Corporate business practices among leaders of higher education have increasingly come under fire during the last two decades. Questions of university leadership, however, particularly corporate practices, go back at least to the early twentieth century. This paper contrasts the views of Thorstein Veblen and Charles W. Eliot, two prominent early…

"Open" Philosophy or Down the Rabbit Hole?

ERIC Educational Resources Information Center

Bowman, Wayne

2017-01-01

In this essay, I challenge the open-closed dualism at the heart of Allsup's project and question the very possibility of an "open" philosophy. I propose an account of music, musical instruction, and philosophy as ethically guided practices, discussing a number of practical and philosophical consequences that follow from such a view.

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.

Complementary and alternative medicine: the challenges of ethical justification. A philosophical analysis and evaluation of ethical reasons for the offer, use and promotion of complementary and alternative medicine.

PubMed

Mertz, Marcel

2007-09-01

With the prevalence of complementary and alternative medicine (CAM) increasing in western societies, questions of the ethical justification of these alternative health care approaches and practices have to be addressed. In order to evaluate philosophical reasoning on this subject, it is of paramount importance to identify and analyse possible arguments for the ethical justification of CAM considering contemporary biomedical ethics as well as more fundamental philosophical aspects. Moreover, it is vital to provide adequate analytical instruments for this task, such as separating 'CAM as belief system' and 'CAM as practice'. Findings show that beneficence and non-maleficence are central issues for an ethical justification of CAM as practice, while freedom of thought and religion are central to CAM as belief system. Many justification strategies have limitations and qualifications that have to be taken into account. Singularly descriptive premises in an argument often prove to be more problematic than universal ethical principles. Thus, non-ethical issues related to a general philosophical underpinning--e.g. epistemology, semantics, and ontology--are highly relevant for determining a justification strategy, especially when strong metaphysical assumptions are involved. Even if some values are shared with traditional biomedicine, axiological differences have to be considered as well. Further research should be done about specific CAM positions. These could be combined with applied qualitative social research methods.

'Troubling' moments in health promotion: unpacking the ethics of empowerment.

PubMed

Spencer, Grace

2015-12-01

Concepts of empowerment feature strongly in global health discourses. Empowerment is frequently advocated as a positive approach to addressing individual and community-level health needs. Despite its popularity, relatively little has been said about the unintended consequences of empowerment, which may give rise to some troubling ethical issues or, indeed, result in outcomes that may not be considered health promoting. Drawing on current uses of empowerment within health promotion, along with insights from an ethnographic study on young people's health, this paper raises some critical questions about the ethics of empowerment. By doing so, the paper troubles the idea that empowerment is a 'good thing' without some careful attention to the varying ways in which the ethics of empowerment may unfold in practice. Findings revealed young people's different perspectives on health and priorities for health promotion. The present analysis highlights how these alternative framings prompt a number of ethical tensions for understanding and operationalising empowerment. In conclusion, the findings underscore the importance of promoting ethical reflexivity in health promotion and, crucially, attending to the unintended and potentially ethically problematic consequences of empowerment. So what? This paper raises some critical questions about the ethics of empowerment and calls for a more thorough engagement with the unintended consequences of empowerment within health promotion.

Resolving ethical dilemmas in suicide prevention: the case of telephone helpline rescue policies.

PubMed

Mishara, Brian L; Weisstub, David N

2010-04-01

The ethical basis of suicide prevention is illustrated by contrasting helpline emergency rescue policies of the Samaritans and the AAS and the U.S. National Suicide Prevention Lifeline network. We contrast moralist, relativist, and libertarian ethical premises and question whether suicide can be rational. Samaritans respect a caller's right to decide to die by suicide; U.S. helplines oblige emergency intervention during an attempt even against the caller's will. We analyze the effect of emergency rescue when there is high suicide risk but an attempt has not been initiated. We examine links between values and actions, needs for empirical evidence to guide practice, and propose vigorous dialogue about values in the gray zone of moral practice.

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.

Diagnosing dementia: Ethnography, interactional ethics and everyday moral reasoning.

PubMed

Hillman, Alexandra

2017-02-01

This article highlights the contribution of ethnography and qualitative sociology to the ethical challenges that frame the diagnosis of dementia. To illustrate this contribution, the paper draws on an ethnographic study of UK memory clinics carried out between 2012 and 2014. The ethnographic data, set alongside other studies and sociological theory, contest the promotion of a traditional view of autonomy; the limiting of the point of ethical interest to a distinct moment of diagnosis disclosure; and the failure to recognise risk and uncertainty in the building of clinical 'facts' and their communication. In addressing these specific concerns, this article contributes to the wider debate over the relationship between sociology and bioethics (medical ethics). At the heart of these debates lies more fundamental questions: how can we best understand and shape moral decision-making and ethics that guide behaviour in medical practice, and what should be the guiding ideas, concepts and methods to inform ethics in the clinic? Using the case of dementia diagnosis, this article illustrates the benefits of an ethnographic approach, not just for understanding this ethical problem but also for exploring if and how a more empirically informed ethics can help shape healthcare practices for the better.

[Is a strategy of bio-socio-ethic necessary?].

PubMed

Alonso Trujillo, Federico; López Medel, Raquel; Asensio Fernández, Inmaculada; Pinzón Pulido, Sandra; González Montero, M Carmen

2016-01-01

The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors. 75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Diagnosing dementia: Ethnography, interactional ethics and everyday moral reasoning

PubMed Central

Hillman, Alexandra

2016-01-01

This article highlights the contribution of ethnography and qualitative sociology to the ethical challenges that frame the diagnosis of dementia. To illustrate this contribution, the paper draws on an ethnographic study of UK memory clinics carried out between 2012 and 2014. The ethnographic data, set alongside other studies and sociological theory, contest the promotion of a traditional view of autonomy; the limiting of the point of ethical interest to a distinct moment of diagnosis disclosure; and the failure to recognise risk and uncertainty in the building of clinical ‘facts’ and their communication. In addressing these specific concerns, this article contributes to the wider debate over the relationship between sociology and bioethics (medical ethics). At the heart of these debates lies more fundamental questions: how can we best understand and shape moral decision-making and ethics that guide behaviour in medical practice, and what should be the guiding ideas, concepts and methods to inform ethics in the clinic? Using the case of dementia diagnosis, this article illustrates the benefits of an ethnographic approach, not just for understanding this ethical problem but also for exploring if and how a more empirically informed ethics can help shape healthcare practices for the better. PMID:28255279

What makes a problem an ethical problem? An empirical perspective on the nature of ethical problems in general practice

PubMed Central

Braunack-Mayer, A. J.

2001-01-01

Whilst there has been considerable debate about the fit between moral theory and moral reasoning in everyday life, the way in which moral problems are defined has rarely been questioned. This paper presents a qualitative analysis of interviews conducted with 15 general practitioners (GPs) in South Australia to argue that the way in which the bioethics literature defines an ethical dilemma captures only some of the range of lay views about the nature of ethical problems. The bioethics literature has defined ethical dilemmas in terms of conflict and choice between values, beliefs and options for action. While some of the views of some of the GPs in this study about the nature of their ethical dilemmas certainly accorded with this definition, other explanations of the ethical nature of their problems revolved around the publicity associated with the issues they were discussing, concern about their relationships with patients, and anxiety about threats to their integrity and reputation. The variety of views about what makes a problem a moral problem indicates that the moral domain is perhaps wider and richer than mainstream bioethics would generally allow. Key Words: Empirical ethics • general practice • qualitative research PMID:11314166

What Ethics for Bioart?

PubMed

Vaage, Nora S

Living artworks created with biotechnology raise a range of ethical questions, some of which are unprecedented, others well known from other contexts. These questions are often discussed within the framework of bioethics, the ethics of the life sciences. The basic concern of institutionalised bioethics is to develop and implement ethical guidelines for ethically responsible handling of living material in technological and scientific contexts. Notably, discussions of ethical issues in bioart do not refer to existing discourses on art and morality from the field of aesthetics. The latter framework is primarily concerned with how the moral value of an artwork affects its artistic value. The author argues that a successful integration of these two frameworks will make possible an ethics of bioart that is adequate to its subject matter and relevant for practice. Such an integrated approach can give increased depth to understandings of ethical issues in bioart, inspire new ways of thinking about ethics in relation to art in general and give novel impulses to bioethics and technology assessment. Artworks by the Tissue Culture and Art Project and their reception serve as the empirical starting point for connecting perspectives in art with those of bioethics, developing an ethics for bioart. The author suggests that consideration of the effect of these artworks is vital in validating ethically problematical applications of biotechnology for art. It is argued that the affective, visceral qualities of living artworks may spur the audience to adjust, revise or develop their personal ethical framework.

Ethical Challenges of Medicine and Health on the Internet: A Review

PubMed Central

2001-01-01

Knowledge and capabilities, particularly of a new technology or in a new area of study, frequently develop faster than the guidelines and principles needed for practitioners to practice ethically in the new arena; this is particularly true in medicine. The blending of medicine and healthcare with e-commerce and the Internet raises many questions involving what sort of ethical conduct should be expected by practitioners and developers of the medical Internet. Some of the early pioneers in medical and healthcare Web sites pushed the ethical boundaries with questionable, even unethical, practices. Many involved with the medical Internet are now working to reestablish patient and consumer trust by establishing guidelines to determine how the fundamentals of the medical code of ethical conduct can best be adapted for the medical/healthcare Internet. Ultimately, all those involved in the creation, maintenance, and marketing of medical and healthcare Web sites should be required to adhere to a strict code of ethical conduct, one that has been fairly determined by an impartial international organization with reasonable power to regulate the code. This code could also serve as a desirable, recognizable label-of-distinction for ethical Web sites within the medical and healthcare Internet community. One challenge for those involved with the medical and healthcare Internet will be to determine what constitutes "Medical Internet Ethics" or "Healthcare Internet Ethics," since the definition of medical ethics can vary from country to country. Therefore, the emerging field of Medical/ Healthcare Internet Ethics will require careful thought and insights from an international collection of ethicists in many contributing areas. This paper is a review of the current status of the evolving field of Medical/Healthcare Internet Ethics, including proposed definitions and identification of many diverse areas that may ultimately contribute to this multidisciplinary field. The current role that medicine and health play in the growing area of Internet communication and commerce and many of the ethical challenges raised by the Internet for the medical community are explored and some possible ways to address these ethical challenges are postulated. PMID:11720965

Ethical challenges of medicine and health on the Internet: a review.

PubMed

Dyer, K A

2001-01-01

Knowledge and capabilities, particularly of a new technology or in a new area of study, frequently develop faster than the guidelines and principles needed for practitioners to practice ethically in the new arena; this is particularly true in medicine. The blending of medicine and healthcare with e-commerce and the Internet raises many questions involving what sort of ethical conduct should be expected by practitioners and developers of the medical Internet. Some of the early pioneers in medical and healthcare Web sites pushed the ethical boundaries with questionable, even unethical, practices. Many involved with the medical Internet are now working to reestablish patient and consumer trust by establishing guidelines to determine how the fundamentals of the medical code of ethical conduct can best be adapted for the medical/healthcare Internet. Ultimately, all those involved in the creation, maintenance, and marketing of medical and healthcare Web sites should be required to adhere to a strict code of ethical conduct, one that has been fairly determined by an impartial international organization with reasonable power to regulate the code. This code could also serve as a desirable, recognizable label-of-distinction for ethical Web sites within the medical and healthcare Internet community. One challenge for those involved with the medical and healthcare Internet will be to determine what constitutes "Medical Internet Ethics" or "Healthcare Internet Ethics," since the definition of medical ethics can vary from country to country. Therefore, the emerging field of Medical/ Healthcare Internet Ethics will require careful thought and insights from an international collection of ethicists in many contributing areas. This paper is a review of the current status of the evolving field of Medical/Healthcare Internet Ethics, including proposed definitions and identification of many diverse areas that may ultimately contribute to this multidisciplinary field. The current role that medicine and health play in the growing area of Internet communication and commerce and many of the ethical challenges raised by the Internet for the medical community are explored and some possible ways to address these ethical challenges are postulated.

Ethical issues faced by field primatologists: asking the relevant questions.

PubMed

Fedigan, Linda Marie

2010-09-01

Field primatologists face unusual ethical issues. We study animals rather than people and receive research approval from animal care rather than ethics committees. However, animal care evaluation forms are developed from concerns about laboratory animal research and are based on the "Three R's" for humane treatment of captive experimental subjects (replacement, reduction and refinement), which are only debatably relevant to field research. Scientists who study wild, free-ranging primates in host countries experience many ethical dilemmas seldom dealt with in animal care forms. This paper reviews the ethical issues many field primatologists say they face and how these might be better addressed by animal care forms. The ethical issues arising for field researchers are divided into three categories: "Presence, Protocols and People" and for each the most frequent issues are described. The most commonly mentioned ethical concern arising from our presence in the field is the possibility of disease transmission. Although most primate field studies employ only observational protocols, the practice of habituating our study animals to close human presence is an ethical concern for many since it can lessen the animals' fear of all humans, thereby facilitating undesirable behaviors (e.g., crop-raiding) and rendering them vulnerable to harm. Field primatologists who work in host countries must observe national laws and local traditions. As conservationists, primatologists must often negotiate between the resource needs and cultural practices of local people and the interests of the nonhuman primates. Many say they face more ethical dilemmas arising from human interactions than from research on the animals per se. This review concludes with suggestions for relevant questions to ask on animal care forms, and actions that field primatologists can take to better inform animal care committees about the common ethical issues we experience as well as how to develop guidelines for addressing them. (c) 2010 Wiley-Liss, Inc.

Physicians' and nurses' expectations and objections toward a clinical ethics committee.

PubMed

Jansky, Maximiliane; Marx, Gabriella; Nauck, Friedemann; Alt-Epping, Bernd

2013-11-01

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one's own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

A Lay Ethics Quest for Technological Futures: About Tradition, Narrative and Decision-Making.

PubMed

van der Burg, Simone

2016-01-01

Making better choices about future technologies that are being researched or developed is an important motivator behind lay ethics interventions. However, in practice, they do not always succeed to serve that goal. Especially authors who have noted that lay ethicists sometimes take recourse to well-known themes which stem from old, even 'archetypical' stories, have been criticized for making too little room for agency and decision-making in their approach. This paper aims to contribute to a reflection on how lay ethics can acquire more practical relevance. It will use resources in narrative ethics to suggest that in order to be relevant for action, facilitators of lay ethics interventions need to invite participants to engage in a narrative quest. As part of a quest, lay ethicists should be asked to (1) reflect on a specific question or choice, (2) use diverse (imaginative) input which is informative about the heterogeneity of viewpoints that are defended in society and (3) argue for their standpoints.

"Measuring up" to ethical standards in service delivery to college students on the Autism Spectrum: A practical application of Powell's model for ethical practices in clinical phonetics and linguistics.

PubMed

Weiss, Amy L; Rohland, Pamela

2014-01-01

This paper examined an interdisciplinary college-based support programme, the Communication Coaching Program (CCP), designed for students diagnosed on the autism spectrum in light of six ethical constructs described by Powell. Collecting data to monitor the successes and ongoing needs of individual participants in the programme is of vital importance, of course, but only addresses a portion of the efficacy question. In addition, the authors, who co-direct the programme and represent different professional expertise and perspectives, recognize the importance of determining whether their evolving intervention model has also been successful in meeting the ethical standards of their respective professions. Careful review of the 4 years of the CCP's operation in terms of ethical constructs has yielded evidence that the CCP, although based on sound principles of theory and scholarship, should be further individualized to meet the particular needs of participants diagnosed with deficits in social communication and executive functioning skills.

Neuroscientists' everyday experiences of ethics: the interplay of regulatory, professional, personal and tangible ethical spheres.

PubMed

Brosnan, Caragh; Cribb, Alan; Wainwright, Steven P; Williams, Clare

2013-11-01

The ethical issues neuroscience raises are subject to increasing attention, exemplified in the emergence of the discipline neuroethics. While the moral implications of neurotechnological developments are often discussed, less is known about how ethics intersects with everyday work in neuroscience and how scientists themselves perceive the ethics of their research. Drawing on observation and interviews with members of one UK group conducting neuroscience research at both the laboratory bench and in the clinic, this article examines what ethics meant to these researchers and delineates four specific types of ethics that shaped their day-to-day work: regulatory, professional, personal and tangible. While the first three categories are similar to those identified elsewhere in sociological work on scientific and clinical ethics, the notion of 'tangible ethics' emerged by attending to everyday practice, in which these scientists' discursive distinctions between right and wrong were sometimes challenged. The findings shed light on how ethical positions produce and are, in turn, produced by scientific practice. Informing sociological understandings of neuroscience, they also throw the category of neuroscience and its ethical specificity into question, given that members of this group did not experience their work as raising issues that were distinctly neuro-ethical. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Set-Theoretic Analysis of Ethical Systems for Off-Planet Future Engagement with Living Organisms

NASA Astrophysics Data System (ADS)

Helman, Daniel S.

2016-10-01

Living organisms are a conundrum. Their origin and provenance are open questions. An operational definition for their detection has been settled upon for practical reasons, i.e. in order to plan mission goals. The spirit of such undertakings is typically noble, and yet the question arises clearly related to how humanity will engage with other living organisms. Prudence demands a pre-contact appraisal of ethical requirements towards other living organisms. To answer this question, an anology with the number line in mathematics (integers versus the set of real numbers) will be presented to explore the structure of finite versus open-ended hierarchies. In this, the architecture of set theory will be used as a basis to describe the validity of systems hierarchies in general. Note that how numbers populate sets follow distinct rules when the elements of the sets or the sets themselves are unbounded. Principles of axiomatic versus observed conclusions will be emphasized. Results from mathematics will be used to inform analysis and dilemmas in ethical systems.

Genetics, biometrics and the informatization of the body.

PubMed

van der Ploeg, Irma

2007-01-01

"Genetics" is a term covering a wide set of theories, practices, and technologies, only some of which overlap with the practices and technologies of biometrics. In this paper some current technological developments relating to biometric applications of genetics will be highlighted. Next, the author will elaborate the notion of the informatization of the body, by means of a brief philosophical detour on the dualisms of language and reality, words and things. In the subsequent sections she will then draw out some of the questions relevant to the purposes of Biometrics Identification Technology Ethics (BITE), and discuss the ethical problems associated with the informatization of the body. There are, however some problems and limitations to the currently dominant ethical discourse to deal with all things ethical in relation to information technology in general, and biometrics or genetics in particular. The final section will discuss some of these meta-problems.

[Ethical aspects of biological sample banks].

PubMed

Cambon-Thomsen, A; Rial-Sebbag, E

2003-02-01

Numerous activities in the domain of epidemiology require the constitution or the use of biological sample banks. Such biobanks raise ethical issues. A number of recommendations are applicable to this field, in France and elsewhere. Major principles applicable to biobanks include the respect of person's autonomy, the respect of human body, the respect of confidentiality. These principles are translated into practices through the following procedures: relevant information to the persons regarding their sample management prior to informed consent, opinion of an independent ethics committee, actual implementation of conditions for protecting samples and data. However, although those principles may appear quite simple and obvious, in the context of a largely international practice of research and given the large variety of biobanks, it is not always obvious for researchers to find their way. The attitudes vary between countries, there are numerous texts for various types of biobanks, the same texts raise different interpretations in different institutions, there are new ethical opinions expressed, and mainly the novelty of questions raised by the uses of samples that are possible today, especially in genetics, and were not foreseeable at the time of sampling make the field difficult in practice. This article reviews the types of biobanks, the relevant ethical issues. It also underlines the still unclear or ambiguous situations using some examples of practical situations.

[Ethics and kidney transplants with living donors].

PubMed

Mamzer Bruneel, Marie-France

2016-12-01

The ethical debate surrounding transplant practices questions our societies. International recommendations set out numerous precautions which must be taken to ensure that donors act with their free will. While in most countries, including France, organ donation is a voluntary and non-commercial act, a black market exists in the world resulting in the trafficking of organs and tragic transplant tourism. Copyright © 2016. Publié par Elsevier Masson SAS.

Ethical and regulatory issues of pragmatic cluster randomized trials in contemporary health systems

PubMed Central

Anderson, Monique L; Califf, Robert M; Sugarman, Jeremy

2015-01-01

Cluster randomized trials (CRTs) randomly assign groups of individuals to examine research questions or test interventions and measure their effects on individuals. Recent emphasis on quality improvement, comparative effectiveness, and learning health systems has prompted expanded use of pragmatic CRTs in routine healthcare settings, which in turn poses practical and ethical challenges that current oversight frameworks may not adequately address. The 2012 Ottawa Statement provides a basis for considering many issues related to pragmatic CRTs but challenges remain, including some arising from the current U.S. research and healthcare regulations. In order to examine the ethical, regulatory, and practical questions facing pragmatic CRTs in healthcare settings, the National Institutes of Health (NIH) Health Care Systems Research Collaboratory convened a workshop in Bethesda, Maryland in July of 2013. Attendees included experts in clinical trials, patient advocacy, research ethics, and research regulations from academia, industry, the NIH, and other federal agencies. Workshop participants identified substantial barriers to implementing these types of CRTs, including issues related to research design, gatekeepers and governance in health systems, consent, institutional review boards, data monitoring, privacy, and special populations. We describe these barriers and suggest means for understanding and overcoming them to facilitate pragmatic CRTs in healthcare settings. PMID:25733677

Another look at the legal and ethical consequences of pharmacological memory dampening: the case of sexual assault.

PubMed

Chandler, Jennifer A; Mogyoros, Alexandra; Rubio, Tristana Martin; Racine, Eric

2013-01-01

Research on the use of propranolol as a pharmacological memory dampening treatment for post-traumatic stress disorder is continuing and justifies a second look at the legal and ethical issues raised in the past. We summarize the general ethical and legal issues raised in the literature so far, and we select two for in-depth reconsideration. We address the concern that a traumatized witness may be less effective in a prosecution emerging from the traumatic event after memory dampening treatment. We analyze this issue in relation to sexual assault, where the suggestion that corroborating evidence may remedy any memory defects is less likely to be helpful. We also consider the clinical ethical question about a physician's obligation to discuss potential legal consequences of memory dampening treatment. We conclude that this latter question reflects a general problem related to novel medical treatments where the broader socio-legal consequences may be poorly understood, and suggest that issues of this sort could usefully be addressed through the promulgation of practice guidelines. © 2013 American Society of Law, Medicine & Ethics, Inc.

Ethical problems in clinical psychopharmacology.

PubMed

Müller-Oerlinghausen, B

1978-10-01

The present article originates from some intriguing problems which the author, working as a clinical pharmacologist and psychiatrist, was faced with during clinical investigations. Practical difficulties appearing at first glance as of a rather methodological nature often reveal themselves as ethical questions. Investigation of psychotropic drugs in normal volunteers as well as in psychiatric patients is taken as a model to exemplify certain fundamental ethical aspects of medical research. It is emphasized that the "solution" of ethical problems cannot be achieved by referring to a given code of norms which themselves depend on certain historical circumstances, but rather by recognizing and reasoning the conflicts which result from various moral maxims. Clinical psychopharmacology should not only be conscious of its methodological shortcomings and future goals but also accept the justification of discussions about the ethical and legal questions involved in its dealings and take an active part in these debates. With regard to the relationship between patient and investigator, "solidarity" [23] instead of ongoing paternalism or legal formalism, appears to be a realistic goal. This is also true in the area of psychopharmacological research.

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.

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.

Scaling ethics up and down: moral craft in clinical genetics and in global health research

PubMed Central

Parker, Michael

2015-01-01

This paper engages with the question of what it is to ‘do good medical ethics’ in two ways. It begins with an exploration of what it might mean to say that health professionals practise good medical ethics as part of practising good ethical medicine. Using the example of the Genethics Club, a well-established national ethics forum for genetics professionals in the UK, the paper develops an account of moral craftsmanship grounded in the concepts of shared moral commitments and practices, moral work, ethics and living morality. In the light of this discussion, the paper goes on to consider what it might mean for a specialist in medical ethics, a bioethicist, to do good medical ethics. Finally, a research agenda focusing on the challenges of thinking about good medical ethics in a global context and a proposal for an innovative approach to bioethics methodology is outlined. PMID:25516955

Equality as a central concept of nursing ethics: a systematic literature review.

PubMed

Kangasniemi, Mari

2010-12-01

Equality is a central concept in the Western way of thinking and in health care. In ethics research within nursing science, equality is a key concept but the meaning of its contents is more or less presumptive. The purpose of this study was to define the concept of equality as a value of nursing ethics research. Data were collected through systematic literature review and analysed using deductive and inductive content analysis. Equality has been studied as a concept and in relation to ethical theories. In nursing ethics, research on equality on theoretical and functional level is presented. These levels consist of dimensions, i.e. themes, that equality is related to. The dimensions of the theoretical level are the equality of being, i.e. universal human value, and distributive equality, i.e. equal opportunities, circumstances and results. The dimensions of functional equality included themes such as critique of distributive equality, context, difference, power and care. Critique is aimed at incompatibility of theoretical level with practice. Context raises questions of each nursing situation in relation to equality. Variation within context is closely related to differences involving parties to nursing, and it is a starting point to questions of equality. Power is understood as comprising knowledge, skills and authority that create differences and questions of equality between nurses and patients and nurses and other professionals or students. Nursing as care always includes relationship between two or more persons and needs to be inspected from the point of view of equality. The concept of equality has been complex to achieve in practice. The dimensions of the levels of equality defined in this study provide an opportunity to reach a better understanding of equality in nursing ethics. There is still a great demand for more research on the concept of equality. © 2010 The Author. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

Visions of What Inclusive Education Can Be--With Emphasis on Kindergartens

ERIC Educational Resources Information Center

Andresen, Ragnhild

2013-01-01

The research questions of the article are: What takes place in the professional cooperative work of including children with special needs in kindergartens and in counteracting exclusive process? How are views on children and ethics expressed through practice and in reflections on practice among the staff in kindergarten? What constitutes…

Rejecting the Null: Research and Social Justice Means Asking Different Questions

ERIC Educational Resources Information Center

Chapman, Stephanie; Schwartz, Jonathan P.

2012-01-01

The focus of this article is on the specific ethical issues related to social justice research and the practical implications of engaging in social justice research, including the potential impact of research results on practice, policy, and advocacy at the local and national level. Specific recommendations are offered, including identifying…

Virtue in Medical Practice: An Exploratory Study.

PubMed

Kotzee, Ben; Ignatowicz, Agnieszka; Thomas, Hywel

2017-03-01

Virtue ethics has long provided fruitful resources for the study of issues in medical ethics. In particular, study of the moral virtues of the good doctor-like kindness, fairness and good judgement-have provided insights into the nature of medical professionalism and the ethical demands on the medical practitioner as a moral person. Today, a substantial literature exists exploring the virtues in medical practice and many commentators advocate an emphasis on the inculcation of the virtues of good medical practice in medical education and throughout the medical career. However, until very recently, no empirical studies have attempted to investigate which virtues, in particular, medical doctors and medical students tend to have or not to have, nor how these virtues influence how they think about or practise medicine. The question of what virtuous medical practice is, is vast and, as we have written elsewhere, the question of how to study doctors' moral character is fraught with difficulty. In this paper, we report the results of a first-of-a-kind study that attempted to explore these issues at three medical schools (and associated practice regions) in the United Kingdom. We identify which character traits are important in the good doctor in the opinion of medical students and doctors and identify which virtues they say of themselves they possess and do not possess. Moreover, we identify how thinking about the virtues contributes to doctors' and medical students' thinking about common moral dilemmas in medicine. In ending, we remark on the implications for medical education.

Ethical issues in health workforce development.

PubMed Central

Cash, Richard

2005-01-01

Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed. PMID:15868019

Ethical Issues in Public Health Practice in Michigan

PubMed Central

Gollust, Sarah E.; Goold, Susan D.; Jacobson, Peter D.

2009-01-01

Objectives. We sought to ascertain the types of ethical challenges public health practitioners face in practice and to identify approaches used to resolve such challenges. Methods. We conducted 45 semistructured interviews with public health practitioners across a range of occupations (e.g., health officers, medical directors, sanitarians, nurses) at 13 health departments in Michigan. Results. Through qualitative analysis, we identified 5 broad categories of ethical issues common across occupations and locations: (1) determining appropriate use of public health authority, (2) making decisions related to resource allocation, (3) negotiating political interference in public health practice, (4) ensuring standards of quality of care, and (5) questioning the role or scope of public health. Participants cited a variety of values guiding their decision-making that did not coalesce around core values often associated with public health, such as social justice or utilitarianism. Public health practitioners relied on consultations with colleagues to resolve challenges, infrequently using frameworks for decision-making. Conclusions. Public health practitioners showed a nuanced understanding of ethical issues and navigated ethical challenges with minimal formal assistance. Decision-making guides that are empirically informed and tailored for practitioners might have some value. PMID:19059850

Gender in medical ethics: re-examining the conceptual basis of empirical research.

PubMed

Conradi, Elisabeth; Biller-Andorno, Nikola; Boos, Margarete; Sommer, Christina; Wiesemann, Claudia

2003-01-01

Conducting empirical research on gender in medical ethics is a challenge from a theoretical as well as a practical point of view. It still has to be clarified how gender aspects can be integrated without sustaining gender stereotypes. The developmental psychologist Carol Gilligan was among the first to question ethics from a gendered point of view. The notion of care introduced by her challenged conventional developmental psychology as well as moral philosophy. Gilligan was criticised, however, because her concept of 'two different voices' may reinforce gender stereotypes. Moreover, although Gilligan stressed relatedness, this is not reflected in her own empirical approach, which still focuses on individual moral reflection. Concepts from social psychology can help overcome both problems. Social categories like gender shape moral identity and moral decisions. If morality is understood as being lived through actions of persons in social relationships, gender becomes a helpful category of moral analysis. Our findings will provide a conceptual basis for the question how empirical research in medical ethics can successfully embrace a gendered perspective.

Ethical issues across different fields of forensic science.

PubMed

Yadav, Praveen Kumar

2017-01-01

Many commentators have acknowledged the fact that the usual courtroom maxim to "tell the truth, the whole truth, and nothing but the truth" is not so easy to apply in practicality. In any given situation, what does the whole truth include? In case, the whole truth includes all the possible alternatives for a given situation, what should a forensic expert witness do when an important question is not asked by the prosecutor? Does the obligation to tell the whole truth mean that all possible, all probable, all reasonably probable, all highly probable, or only the most probable alternatives must be given in response to a question? In this paper, an attempt has been made to review the various ethical issues in different fields of forensic science, forensic psychology, and forensic DNA databases. Some of the ethical issues are common to all fields whereas some are field specific. These ethical issues are mandatory for ensuring high levels of reliability and credibility of forensic scientists.

The for-profit sector in humanitarian response: integrating ethical considerations in public policy decision making.

PubMed

Huckel Schneider, Carmen; Negin, Joel

2016-01-01

The engagement of the for-profit private sector in health, social and humanitarian services has become a topic of keen interest. It is particularly contentious in those instances where for-profit organizations have become recipients of public funds, and where they become key decision-makers in terms of how, and to whom, services are provided. We put forward a framework for identifying and organizing the ethical questions to be considered when contracting government services to the for-profit sector, specifically in those areas that have traditionally remained in the public or not-for-profit spheres. The framework is designed to inform both academic debate and practical decision-making regarding the acceptability, feasibility and legitimacy of for-profit organizations carrying out humanitarian work. First, we outline the importance of posing ethical questions in government contracting for-profit vs. not-for-profit organizations. We then outline five key areas to be considered before then examining the extent to which ethics concerns are warranted and how they may be safeguarded.

`I Don't Even Have Time to be Their Friend!' Ethical Dilemmas in Ph.D. Supervision in the Hard Sciences

NASA Astrophysics Data System (ADS)

Löfström, Erika; Pyhältö, Kirsi

2015-11-01

This study focused on exploring students' and supervisors' perceptions of ethical problems in doctoral supervision in the natural sciences. Fifteen supervisors and doctoral students in one research community in the natural sciences were interviewed about their practices and experiences in the doctoral process and supervision. We explored to what extent doctoral students and supervisors experienced similar or different ethical challenges in the supervisory relationship and analyzed how the experiences of ethical dilemmas in supervision could be understood in light of the structure and practices of natural science research groups. The data were analyzed by theory-driven content analysis. Five ethical principles, namely non-maleficence, beneficence, autonomy, fidelity and justice, were used as a framework for identifying ethical issues. The results show that one major question that appears to underpin many of the emerging ethical issues is that the supervisors and students have different expectations of the supervisory role. The second important observation is that doctoral students primarily described their own experiences, whereas the supervisors described their activities as embedded in a system and elaborated on the causes and consequences at a system level.

Moral instability: the upsides for nursing practice.

PubMed

McCarthy, Joan

2010-04-01

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale - a 'Good Samaritan' story - which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times.

Variability in research ethics review of cluster randomized trials: a scenario-based survey in three countries

PubMed Central

2014-01-01

Background Cluster randomized trials (CRTs) present unique ethical challenges. In the absence of a uniform standard for their ethical design and conduct, problems such as variability in procedures and requirements by different research ethics committees will persist. We aimed to assess the need for ethics guidelines for CRTs among research ethics chairs internationally, investigate variability in procedures for research ethics review of CRTs within and among countries, and elicit research ethics chairs’ perspectives on specific ethical issues in CRTs, including the identification of research subjects. The proper identification of research subjects is a necessary requirement in the research ethics review process, to help ensure, on the one hand, that subjects are protected from harm and exploitation, and on the other, that reviews of CRTs are completed efficiently. Methods A web-based survey with closed- and open-ended questions was administered to research ethics chairs in Canada, the United States, and the United Kingdom. The survey presented three scenarios of CRTs involving cluster-level, professional-level, and individual-level interventions. For each scenario, a series of questions was posed with respect to the type of review required (full, expedited, or no review) and the identification of research subjects at cluster and individual levels. Results A total of 189 (35%) of 542 chairs responded. Overall, 144 (84%, 95% CI 79 to 90%) agreed or strongly agreed that there is a need for ethics guidelines for CRTs and 158 (92%, 95% CI 88 to 96%) agreed or strongly agreed that research ethics committees could be better informed about distinct ethical issues surrounding CRTs. There was considerable variability among research ethics chairs with respect to the type of review required, as well as the identification of research subjects. The cluster-cluster and professional-cluster scenarios produced the most disagreement. Conclusions Research ethics committees identified a clear need for ethics guidelines for CRTs and education about distinct ethical issues in CRTs. There is disagreement among committees, even within the same countries, with respect to key questions in the ethics review of CRTs. This disagreement reflects variability of opinion and practices pointing toward possible gaps in knowledge, and supports the need for explicit guidelines for the ethical conduct and review of CRTs. PMID:24495542

Incorporating global components into ethics education.

PubMed

Wang, George; Thompson, Russell G

2013-03-01

Ethics is central to science and engineering. Young engineers need to be grounded in how corporate social responsibility principles can be applied to engineering organizations to better serve the broader community. This is crucial in times of climate change and ecological challenges where the vulnerable can be impacted by engineering activities. Taking a global perspective in ethics education will help ensure that scientists and engineers can make a more substantial contribution to development throughout the world. This paper presents the importance of incorporating the global and cross culture components in the ethic education. The authors bring up a question to educators on ethics education in science and engineering in the globalized world, and its importance, necessity, and impendency. The paper presents several methods for discussion that can be used to identify the differences in ethics standards and practices in different countries; enhance the student's knowledge of ethics in a global arena.

Internet research and ethics: transformative issues in nursing education research.

PubMed

Mahon, Pamela Young

2014-01-01

As practice in the educational and clinical settings seeks to be evidence based, faculty are increasingly required to conduct research and publish the results to advance the science of our profession. The purpose of this article is to discuss transformative research ethics because Internet use is an increasing component of current research studies. How nurse educators can engage in research-utilizing methodologies inclusive of technology while adhering to ethical standards developed before the advance of the Internet is reviewed. Recommendations are cited to address the new questions that arise at institutional review board meetings resulting from potential ethical implications of using students or research participants in cyber space. © 2014.

What Ethical Issues Really Arise in Practice at an Academic Medical Center? A Quantitative and Qualitative Analysis of Clinical Ethics Consultations from 2008 to 2013.

PubMed

Wasson, Katherine; Anderson, Emily; Hagstrom, Erika; McCarthy, Michael; Parsi, Kayhan; Kuczewski, Mark

2016-09-01

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male (55.8 %), white (57.1 %), between 50 and 69 years old (38.5 %), of non-Hispanic origin (85.9 %), and of Roman Catholic faith (43.6 %). Nearly half (47.4 %) were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making (93.6 %), goals of care/treatment (80.8 %), and end-of-life (73.1 %). More specifically, capacity (57.1 %), patient's wishes/autonomy (54.5 %), and surrogate decision maker (51.3 %) were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment (12.8 %), patient wishes/autonomy (12.2 %), and capacity (11.5 %). Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field.

Ethical challenges in designing and conducting medicine quality surveys.

PubMed

Tabernero, Patricia; Parker, Michael; Ravinetto, Raffaella; Phanouvong, Souly; Yeung, Shunmay; Kitutu, Freddy E; Cheah, Phaik Yeong; Mayxay, Mayfong; Guerin, Philippe J; Newton, Paul N

2016-06-01

In this paper we discuss the main ethical challenges related to the conduct of medicine quality surveys and make suggestions on how to address them. Most evidence-based information regarding medicine quality derives from surveys. However, existing research ethical guidelines do not provide specific guidance for medicine quality surveys. Hence, those conducting surveys are often left wondering how to judge what counts as best practice. A list of the main ethical challenges in the design and conduct of surveys is presented. It is vital that the design and conduct of medicine quality surveys uphold moral and ethical obligations and analyse the ethical implications and consequences of such work. These aspects include the impact on the local availability of and access to medicines; the confidentiality and privacy of the surveyors and the surveyed; questions as to whether outlet staff personnel should be told they are part of a survey; the need of ethical and regulatory approvals; and how the findings should be disseminated. Medicine quality surveys should ideally be conducted in partnership with the relevant national Medicine Regulatory Authorities. An international, but contextually sensitive, model of good ethical practice for such surveys is needed. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Need for an Ethical Framework for Testing for Systemic Diseases in Dental Clinics

PubMed Central

Silveira, Marushka Leanne; Chattopadhyay, Amit

2012-01-01

Testing for systemic diseases in dental clinics is a potentially attractive avenue for oral health professionals and may be viewed as an opportunity to increase professional reach, expand practice, and improve financial returns. However, several ethical questions arise that must be addressed before such activities are adopted. (1) What should be the level of training dentists must acquire to deal with challenges associated with testing? (2) How well are dental practices aware of and compliant with the Health Insurance Portability and Accountability Act and procedures related to informed consent? (3) What is the evidence regarding acceptability and effectiveness of testing? (4) What should be the acceptable standard of practice for conduct of invasive and noninvasive tests? (5) What is the boundary delineating “testing” and “reporting” vis-à-vis counseling? (6) What is the value of testing without counseling? (7) What assurances need to be in place to ensure voluntariness of testing? (8) How would data from testing be used in “research,” especially with the growth of practice based research networks? and (9) Does the American Dental Association Code of Ethics need to incorporate guidance for practicing dentists? We discuss how ethical principles can be used to develop a framework of guidelines for potential testing for systemic diseases in dental clinics.. PMID:24600534

Is mandatory research ethics reviewing ethical?

PubMed

Dyck, Murray; Allen, Gary

2013-08-01

Review boards responsible for vetting the ethical conduct of research have been criticised for their costliness, unreliability and inappropriate standards when evaluating some non-medical research, but the basic value of mandatory ethical review has not been questioned. When the standards that review boards use to evaluate research proposals are applied to review board practices, it is clear that review boards do not respect researchers or each other, lack merit and integrity, are not just and are not beneficent. The few benefits of mandatory ethical review come at a much greater, but mainly hidden, social cost. It is time that responsibility for the ethical conduct of research is clearly transferred to researchers, except possibly in that small proportion of cases where prospective research participants may be so intrinsically vulnerable that their well-being may need to be overseen.

The transformation of (bio)ethics expertise in a world of ethical pluralism.

PubMed

Kovács, József

2010-12-01

Today, bioethics experts have an increasing role in public life. However, the question arises: what does bioethics expertise really mean? Can there be such a thing in our globalised world characterised by ethical pluralism? I will argue that bioethics as a discipline represents the transformation of ethics expertise from a hard to a soft form of it. Bioethics was born as a reaction to the growing awareness of ethical pluralism, and it denied the hard form of normative-prescriptive ethics expertise (the ability to determine what is the right course of action for others), particularly in its medical ethics form. In contrast, the traditional medical ethics model, and pre-modern societies in general, believed in hard normative ethics expertise. From this followed the characteristic paternalism of traditional medical practice: if physicians were experts in moral matters as well, if they knew what the right course of action to choose was, then they had a right to benevolently force this course of action on their patients. The remnants of this doctrine, although rarely stated explicitly, still can often be seen in clinical practice. The whole bioethics movement can be seen as a radical denial of the doctrine of physician's hard expertise in moral matters. Bioethics, however, represents a type of soft ethics expertise (mainly value sensitivity). Hence follows the seeming paradox of bioethics expertise: bioethics is both a denial of ethics expertise (in its hard form) as well as a type of (soft) ethics expertise.

An audit of health products advertised for sale on chiropractic Web sites in Canada and consideration of these practices in the context of Canadian chiropractic codes of ethics and conduct.

PubMed

Page, Stacey A; Grod, Jaroslaw P

2009-01-01

This study describes the extent to which chiropractors with Web sites practicing in Canada advertise health products for sale and considers this practice in the context of chiropractic codes of ethics and conduct. Chiropractic Web sites in Canada were identified using a public online business directory (Canada 411). The Web sites were searched, and an inventory of the health products for sale was taken. The influences of type of practice and province of practice on the sale of health product were assessed. Textual comments about health product marketing were summarized. National and provincial codes of ethics were reviewed, and the content on health product advertising was summarized. Two hundred eighty-seven Web sites were reviewed. Just more than half of the Web sites contained information on health products for sale (n = 158, 54%). Orthotics were advertised most often (n = 136 practices, 47%), followed by vitamins/nutritional supplements (n = 53, 18%), pillows and supports (n = 40, 14%), and exercise/rehabilitation products (n = 20, 7%). Chiropractors in solo or group chiropractic practices were less likely to advertise health products than those in multidisciplinary practice (P < .001), whereas chiropractors in BC were less likely to advertise nutritional supplements (P < .01). Provincial codes of ethics and conduct varied in their guidelines regarding health product sales. Variations in codes of ethics and in the proportions of practitioners advertising health products for sales across the country suggest that opinions may be divided on the acceptability of health product sales. Such practices raise questions and considerations for the chiropractic profession.

Impacts of Socratic questioning on moral reasoning of nursing students.

PubMed

Torabizadeh, Camellia; Homayuni, Leyla; Moattari, Marzieh

2018-03-01

Nurses are often faced with complex situations that made them to make ethical decisions; and to make such decisions, they need to possess the power of moral reasoning. Studies in Iran show that the majority of nursing students lack proper ethical development. Socratic teaching is a student-centered method which is strongly opposed to the lecturing method. This study was conducted to evaluate the impacts of Socratic questioning on the moral reasoning of the nursing students. In a quasi-experimental study, Crisham's Nursing Dilemma Test was used to evaluate the results of three groups before, immediately after, and 2 months after intervention. The data were analyzed using the SPSS statistical software (v 15). Participants and research context: Through random allocation, 103 nursing students were divided into three groups. In experiment group 1 (37 students), intervention consisted of Socratic questioning-based sessions on ethics and how to deal with moral dilemmas; experiment group 2 (33 students) attended a 4-h workshop; and the control group (33 students) was not subject to any interventions. Signed informed consent forms: This research was approved by the Ethics Committee of the University. All the participants signed written informed consents. There were significant differences between experiment group 1 and experiment group 2's pre-test and post-test scores on moral reasoning (p ≤ 0.001, p ≤ 0.001), nursing principled thinking (p ≤ 0.001, p ≤ 0.001), and practical considerations (p ≤ 0.001, p ≤ 0.031). Both the teaching approaches improved the subjects' moral reasoning; however, Socratic questioning proved more effective than lecturing. Compared to other similar studies in Iran and other countries, the students had inadequate moral reasoning competence. This study confirms the need for the development of an efficient course on ethics in the nursing curriculum. Also, it appears that Socratic questioning is an effective method to teach nursing ethics and develop nursing students' competence of moral reasoning.

Through the Looking Glass: Examining the Practice of Science Classroom Dissection with a Multi-Faceted Lens

ERIC Educational Resources Information Center

Witte, Melissa Marie

2014-01-01

Dissection of lab specimens is a common procedure in science classrooms, yet there are many unasked and unexamined questions relating to this practice. In addition to ethical considerations, there are personal and environmental health impacts of using conventional dissection, which has historically included animals and animal organs embalmed in…

Establishing HIV treatment as prevention in the HIV Prevention Trials Network 052 randomized trial: an ethical odyssey.

PubMed

Cohen, Myron S; McCauley, Marybeth; Sugarman, Jeremy

2012-06-01

Obtaining the definitive data necessary to determine the safety and efficacy of using antiretroviral treatment (ART) to reduce the sexual transmission of HIV in heterosexual couples encountered an array of ethical challenges that threatened to compromise HIV Prevention Trials Network (HPTN) 052, the multinational clinical trial addressing this issue that has profound public health implications. To describe and analyze the major ethical challenges faced in HPTN 052. The ethical issues and modifications of HPTN 052 in response to these issues were cataloged by the principal investigator, the lead coordinator, and the ethicist working on the trial. The major ethical issues that were unique to the trial were then described and analyzed in light of the published literature as well as guidances and policies. The ethical challenges that must be addressed in many clinical trials, such as those related to obtaining informed consent and making provisions for ancillary care, are not described. When HPTN 052 was being designed, ethical questions emerged related to the relevance of the research question itself given data from observational research and a range of beliefs about the appropriate means of preventing and treating HIV infection and AIDS. Furthermore, ethical challenges were faced regarding site selection since there was a scientific need to conduct the research in settings where HIV incidence was high, but alternatives to study participation should be available. As in most HIV-prevention research, ethical questions surrounded the determination of the appropriate prevention package for all of those enrolled. During the course of the trial, guidance documents and policies emerged that were of direct relevance to the research questions, calling for a balancing of concerns for the research subjects and trial integrity. When the study results were made public, there was a need to ensure access to the treatment shown to be effective that in some cases differed from the guidelines used at the sites where the research was being conducted. In addition, questions were raised about whether there was an obligation to notify subjects about 'unlinked' transmissions of HIV, that is, infections acquired from someone other than the designated sexual partner enrolled in the study. The ethical issues described are limited to those discerned by the authors and not those of other stakeholders who may have identified additional issues or had a different perspective in analyzing them. Understanding the ethical challenges faced in HPTN 052 promises to inform the design and conduct of future complex, long-term clinical trials aimed at addressing critical scientific and public health questions, where data and practice patterns emerge over the course of the trial.

The active engagement model of applied ethics as a structure for ethical reflection in the context of course-based service learning.

PubMed

Nesbit, Kathryn C; Jensen, Gail M; Delany, Clare

2018-01-01

The purpose of this case report is to explore the active engagement model as a tool to illuminate the ethical reflections of student physical therapists in the context of service learning in a developing country. The study participants were a convenience sample of six students. The study design is a case report using a phenomenological perspective. Data were collected from students' narrative writing and semi-structured interviews. The steps of the active engagement model provided the structural framework for student responses. The analysis process included open coding, selective coding, and member checking. Results showed the emergence of two main themes: 1) gathering rich detail and 2) developing independent moral identity. Students' descriptions of their relationships were detailed and included explanations about the complexities of the sociocultural context. Independent and deliberate agency was evident by the students' preparedness to be collaborative, to raise ethical questions, to identify ethically important aspects of their practice and to describe their professional roles. The students noted that the use of the model increased their engagement in the ethical decision-making process and their recognition of ethical questions. This case report illustrates attributes of the active engagement model which have implications for teaching ethical reflection: scaffolding for ethical reflection, use of narrative for reflection, reflection in action, and illumination of relevant themes. Each of these attributes leads to the development of meaningful ethical reflection. The attributes of this model shown by this case report have potential applications to teaching ethical reflection.

Conceptual, Methodological, and Ethical Problems in Communicating Uncertainty in Clinical Evidence

PubMed Central

Han, Paul K. J.

2014-01-01

The communication of uncertainty in clinical evidence is an important endeavor that poses difficult conceptual, methodological, and ethical problems. Conceptual problems include logical paradoxes in the meaning of probability and “ambiguity”— second-order uncertainty arising from the lack of reliability, credibility, or adequacy of probability information. Methodological problems include questions about optimal methods for representing fundamental uncertainties and for communicating these uncertainties in clinical practice. Ethical problems include questions about whether communicating uncertainty enhances or diminishes patient autonomy and produces net benefits or harms. This article reviews the limited but growing literature on these problems and efforts to address them and identifies key areas of focus for future research. It is argued that the critical need moving forward is for greater conceptual clarity and consistent representational methods that make the meaning of various uncertainties understandable, and for clinical interventions to support patients in coping with uncertainty in decision making. PMID:23132891

Ethical reflection and psychotherapy.

PubMed

Vyskocilová, Jana; Prasko, Jan

2013-01-01

Theories of ethics and ethical reflection may be applied to both theory and practice in psychotherapy. There is a natural affinity between ethics and psychotherapy. Psychotherapy practice is concerned with human problems, dilemmas and emotions related to both one's own and other people's values. Ethics is also concerned with dilemmas in human thinking and with how these dilemmas reflect other individuals' values. Philosophical reflection itself is not a sufficient basis for the ethics of psychotherapy but it may aid in exploring attitudes related to psychotherapy, psychiatry and health care. PubMed, Web of Science and Scopus databases were searched for articles containing the keywords "psychotherapy", "ethics", "therapeutic relationship" and "supervision". The search was conducted by repeating the terms in various combinations without language or time restrictions. Also included were data from monographs cited in reviews. The resulting text is a review with conclusions concerning ethical aspects of psychotherapy. The ability to behave altruistically, sense for justice and reciprocity and mutual help are likely to be genetically determined as dispositions to be later developed by upbringing or to be formed or deformed by upbringing. Early experiences lead to formation of ethical attitudes which are internalized and then applied to both one's own and other people's behavior. Altruistic behavior has a strong impact on an individual's health and its acceptance may positively influence the pathophysiological mechanisms underlying numerous diseases. Ethical theory and reflection, however, may be applied to both theory and practice of psychotherapy in a conscious, targeted and thoughtful manner. In everyday practice, psychotherapists and organizations must necessarily deal with conscious conflicts between therapeutic possibilities, clients' wishes, their own as well as clients' ideas and the real world. Understanding one's own motives in therapy is one of the aims of a psychotherapist's personal therapy and a frequent goal of supervision interventions. It is a psychotherapist's ethical obligation to do no harm, maintain clear therapeutic borders, not abuse patients, undertake supervision and learn good self-reflection. Knowledge of ethical questions and related issues as well as continuous ethical self-reflection are essential components of high-quality psychotherapeutic management. This requires both good psychotherapy training and systematic supervision.

Using Health Impact Assessment as an Interdisciplinary Teaching Tool.

PubMed

Chinchilla, Melissa; Arcaya, Mariana C

2017-07-08

Health Impact Assessment (HIA) courses are teaching public health and urban planning students how to assess the likely health effects of proposed policies, plans, and projects. We suggest that public health and urban planning have complimentary frameworks for training practitioners to address the living conditions that affect health. Planning perspectives emphasize practical skills for impacting community change, while public health stresses professional purpose and ethics. Frameworks from both disciplines can enhance the HIA learning experience by helping students tackle questions related to community impact, engagement, social justice, and ethics. We also propose that HIA community engagement processes can be enriched through an empathetic practice that focuses on greater personal introspection.

Screening the use of informed consent forms prior to procedures involving operative dentistry: ethical aspects

PubMed Central

Graziele Rodrigues, Livia; De Souza, João Batista; De Torres, Erica Miranda; Ferreira Silva, Rhonan

2017-01-01

Background. The present study aimed to screen the knowledge and attitudes of dentists toward the use of informed consent forms prior to procedures involving operative dentistry. Methods. A research tool containing questions (questionnaire) regarding the use of informed consent forms was developed. The questionnaire consisted of seven questions structured to screen the current practice in operative dentistry towards the use of informed consent forms. Results. The questionnaires were distributed among 731 dentists, of which 179 returned them with answers. Sixty-seven dentists reported not using informed consent forms. The main reasons for not using informed consent forms were: having a complete dental record signed by the patient (67.2%) and having a good relation with patients (43.6%). The dentists who reported using informed consent forms revealed that they obtained them from other dentists and made their own modifications (35.9%). Few dentists revealed contacting lawyers (1.7%) and experts in legal dentistry (0.9%) for the development of their informed consent forms. Conclusion. A high number of dentists working in the field of operative dentistry behave according to the ethical standards in the clinical practice, becoming unprotected against ethical and legal actions. PMID:28413600

The changing landscape of care: does ethics education have a new role to play in health practice?

PubMed

Wintrup, Julie

2015-05-08

In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students' experiences and their stories. This paper asks whether ethics education has a new role to play, in a context of major organisational change, a global and national austerity agenda and the ramifications of disturbing reports of failures in care. It asks: how would it be different if equal amounts of attention were given to the conditions in which health decisions are made, if the ethics of organisational and policy decisions were examined, and if guiding collaborations with patients and others who use services informed ethics education and its processes? This is in three parts. In part one an example from an inspection report is used to question the ways in which clinical events are decontextualised and constructed for different purposes. Ramifications of a decision are reflected upon and a case made for different kinds of allegiances to be developed. In part two I go on to broaden the scope of ethics education and make a case for beginning with the messy realities of practice rather than with overarching moral theories. The importance of power in ethical practice is introduced, and in part three the need for greater political and personal awareness is proposed as a condition of moral agency. This paper proposes that ethics education has a new contribution to make, in supporting and promoting ethical practice - as it is defined in and by the everyday actions and decisions of practitioners and people who need health services. Ethics education that promotes moral agency, rather than problem solving approaches, would explore not only clinical problems, but also the difficult and contested arenas in which they occur. It would seek multiple perspectives and would begin with places and people, and their priorities. It would support students to locate their practice in imperfect global contexts, and to understand how individual and collective forms of power can influence healthcare quality.

Rethinking critical reflection on care: late modern uncertainty and the implications for care ethics.

PubMed

Vosman, Frans; Niemeijer, Alistair

2017-12-01

Care ethics as initiated by Gilligan, Held, Tronto and others (in the nineteen eighties and nineties) has from its onset been critical towards ethical concepts established in modernity, like 'autonomy', alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Late modern organizations, like the general hospital, codetermined by various (control-, information-, safety-, accountability-) systems are characterized by complexity and the need for complexity reduction, both permeating care practices. By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power. In the final section a proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices.

Ethical reflections on pharmacogenetics and DNA banking in a cohort of HIV-infected patients

PubMed Central

de Montgolfier, Sandrine; Moutel, Grégoire; Duchange, Nathalie; Theodorou, Ioannis; Hervé, Christian; Leport, Catherine

2002-01-01

The aim of this study was to analyze ethical questions concerning the storage of human biological samples to be used in genetic analyses and pharmacogenetic research based on a French experience of DNA banking in a cohort of HIV-infected patients receiving protease inhibitor treatment (APROCO). We describe the ethical issues raised during the establishment of a DNA bank, including questions dealing with autonomy, benefit to the patient, information sharing and confidentiality as well as guarantees concerning the storage and use of DNA. We describe the practical applications of themes illustrated theoretically in the literature. Most of the points raised are not specific to HIV, but some of them may be more accurate due to the characteristics of the HIV population. The questions raised are not exhaustive and we conclude with specific points that remain to be defined. Our results are summarized in the memorandum and consent form presented in the appendices. This work should allow other researchers and members of evaluation committees to enrich their considerations and should stimulate discussion on this subject. PMID:12464796

Quagmires for clinical psychology and executive coaching? Ethical considerations and practice challenges.

PubMed

Gebhardt, Judith Ann

2016-04-01

As the coaching field burgeons, both the mental health and coaching professionals, and their respective professions, face a myriad of potential quagmires, especially if the unique challenges encountered are ignored. After a short introduction and presentation on ethics and morals related to executive coaching and clinical therapy, a discussion follows on the lengthy and intimate relationship between executive coaching and psychology. Next are definitions and comparisons and 6 areas that are potential quagmires. This includes roles, skill sets/core competencies, education/training, licensing/credentialing-certification, governing bodies and confidentiality, and fees/reimbursement. Each section includes a discussion and several questions to highlight potentially problematic areas, practice challenges, and/or ethical issues, followed with brief responses. This paper concludes with the inquiry, "Where do we go from here?" (c) 2016 APA, all rights reserved).

Truth in Advertising: Disclosure of Participant Payment in Research Recruitment Materials.

PubMed

Gelinas, Luke; Lynch, Holly Fernandez; Largent, Emily A; Shachar, Carmel; Cohen, I Glenn; Bierer, Barbara E

2018-05-01

The practice of paying research participants has received significant attention in the bioethics literature, but the focus has been almost exclusively on consideration of factors relevant to determining acceptable payment amounts. Surprisingly little attention has been paid to what happens once the payment amount is set. What are the ethical parameters around how offers of payment may be advertised to prospective participants? This article seeks to answer this question, focusing on the ethical and practical issues associated with disclosing information about payment, and payment amounts in particular, in recruitment materials. We argue that it is permissible-and indeed typically ethically desirable-for recruitment materials to disclose the amount that participants will be paid. Further, we seek to clarify the regulatory guidance on "emphasizing" payment in a way that can facilitate design and review of recruitment materials.

Ethical foundations of environmental radiological protection.

PubMed

Oughton, D H

2016-06-01

Assessing the potential ecological impact of ionising radiation raises a number of ethical questions. These include fundamental questions such as what exactly constitutes harming the environment, and how the environment should be valued, as well as links to political protection principles such as sustainability and biodiversity. Starting from developments within ecological risk assessment, this paper summarises some of the ethical issues concerning the protection of the environment from radiation. Chapter 2 gives a brief overview of different philosophical and cultural world views on valuing the environment in a context of radiation risk. Chapter 3 addresses some recent challenges to proposed environmental protection frameworks, including practical applications following the Chernobyl and Fukushima accidents, and some scientific developments such as the ecosystem approach. Finally, Chapter 4 offers some recommendations on how ethical evaluation can help produce a more robust and transparent approach to the protection of the environment. In conclusion, there is a need for a holistic evaluation of the environmental impacts of ionising radiation that not only considers the direct consequences on the health of humans and non-human species, but also the more complex social, ethical, and economic consequences of both human and non-human exposures. © The International Society for Prosthetics and Orthotics.

Complementary or competing climates? Examining the interactive effect of service and ethical climates on company-level financial performance.

PubMed

Myer, Adam T; Thoroughgood, Christian N; Mohammed, Susan

2016-08-01

By bending rules to please their customers, companies with high service climates may be less ethical but ultimately more profitable. In this article, we pose the question of whether being ethical comes at a cost to profits in customer-oriented firms. Despite the organizational reality that multiple climates coexist at a given time, research has largely ignored these types of questions, and the simultaneous analysis of multiple climate dimensions has received little empirical attention to date. Given their scientific and practical importance, this study tested complementary and conflicting perspectives regarding interactions between service (outcome-focused) and ethical (process-focused) climates on company-level financial performance. Drawing on a sample of 16,862 medical sales representatives spread across 77 subsidiary companies of a large multinational corporation in the health care product industry, we found support for a complementary view. More precisely, results revealed that profitability was enhanced, not diminished, in service-oriented firms that also stressed the importance of ethics. Results suggest studying the interactive effects of multiple climates is a more fruitful approach than examining main effects alone. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Evaluation of a cartoon-based knowledge dissemination intervention on scientific and ethical challenges raised by nutrigenomics/nutrigenetics research.

PubMed

Lafrenière, Darquise; Hurlimann, Thierry; Menuz, Vincent; Godard, Béatrice

2014-10-01

The push for knowledge translation on the part of health research funding agencies is significant in Canada, and many strategies have been adopted to promote the conversion of knowledge into action. In recent years, an increasing number of health researchers have been studying arts-based interventions to transform knowledge into action. This article reports on the results of an online questionnaire aimed at evaluating the effectiveness of a knowledge dissemination intervention (KDI) conveying findings from a study on the scientific and ethical challenges raised by nutrigenomics-nutrigenetics (NGx) research. The KDI was based on the use of four Web pages combining original, interactive cartoon-like illustrations accompanied by text to disseminate findings to Canadian Research Ethics Boards members, as well as to NGx researchers and researchers in ethics worldwide. Between May and October 2012, the links to the Web pages were sent in a personal email to target audience members, one thematic Web page at a time. On each thematic Web page, members of the target audience were invited to answer nine evaluation questions assessing the effectiveness of the KDI on four criteria, (i) acquisition of knowledge; (ii) change in initial understanding; (iii) generation of questions from the findings; and (iv) intent to change own practice. Response rate was low; results indicate that: (i) content of the four Web pages did not bring new knowledge to a majority of the respondents, (ii) initial understanding of the findings did not change for a majority of NGx researchers and a minority of ethics respondents, (iii) although the KDI did raise questions for respondents, it did not move them to change their practice. While target end-users may not feel that they actually learned from the KDI, it seems that the findings conveyed encouraged reflection and raised useful and valuable questions for them. Moreover, the evaluation of the KDI proved to be useful to gain knowledge about our target audiences' views since respondents' comments allowed us to improve our understanding of the disseminated knowledge as well as to modify (and hopefully improve) the content of the Web pages used for dissemination. Copyright © 2014 Elsevier Ltd. All rights reserved.

Perceiving the moral dimension of practice: insights from Murdoch, Vetlesen, and Aristotle.

PubMed

Scott, P Anne

2006-07-01

This paper situates the moral domain of practice within the context of a particular description of nursing practice - one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice. Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual's moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen.

After bioethics and towards virtue?

PubMed Central

Toon, P D

1993-01-01

The place of philosophical medical ethics in medical education and clinical practice has recently been questioned. Although partially valid, the criticisms do not warrant abandoning the enterprise. Instead a reappraised model, based on Aristotelean concepts of intellectual and moral virtue is suggested. PMID:8459433

Why not integrate ethics in HTA: identification and assessment of the reasons.

PubMed

Hofmann, Bjørn

2014-01-01

From the conception of HTA in the 1970s it has been argued that addressing ethical issues is an element of HTA, and many methods for integrating ethics in HTA have become available. However, despite almost 40 years with repeated intentions, only few HTA reports include ethical analysis. Why is this so? How come, ethics is a constituent part of HTA, there are many methods available, but ethics is rarely part of practical HTA work? This is the key question of this article and several reasons why ethics is not a part of HTA are identified. A) Ethicists are professional strangers in HTA. B) A common agreed methodology for integrating ethics is lacking. Ethics methodology appears to be C) deficient, D) insufficient, or E) unsuitable. F) Integrating ethics in HTA is neither efficient nor needed for successful HTA. G) Most moral issues are general, and are not specific to a given technology. H) All relevant ethical issues can be handled within other frameworks, e.g., within economics. I) Ethics can undermine or burst the foundation of HTA. Hence, there are many reasons why ethics is not an integrated part of HTA so many years after identifying ethics as constitutive to HTA. These reasons may all explain why it is so, but on closer scrutiny, they do not work as compelling arguments for not addressing ethical issues in HTA. Hence, the identified reasons may work well as explanations, but not as justifications. In order to move on from a situation of failure we can: Exclude ethics from definitions of HTA, and as a consequence, establish a separate kind of evaluation (Health Technology Evaluation - HTE). Take the existing definition seriously and actually integrate ethics in the performance of HTA practice. Amend, expand or change HTA so that ethics is more genuinely incorporated. Which of these options to choose is open for discussion, but we need to move away from a situation where we have a definition of HTA which does not correspond with HTA practice.

Why not integrate ethics in HTA: identification and assessment of the reasons

PubMed Central

Hofmann, Bjørn

2014-01-01

From the conception of HTA in the 1970s it has been argued that addressing ethical issues is an element of HTA, and many methods for integrating ethics in HTA have become available. However, despite almost 40 years with repeated intentions, only few HTA reports include ethical analysis. Why is this so? How come, ethics is a constituent part of HTA, there are many methods available, but ethics is rarely part of practical HTA work? This is the key question of this article and several reasons why ethics is not a part of HTA are identified. A) Ethicists are professional strangers in HTA. B) A common agreed methodology for integrating ethics is lacking. Ethics methodology appears to be C) deficient, D) insufficient, or E) unsuitable. F) Integrating ethics in HTA is neither efficient nor needed for successful HTA. G) Most moral issues are general, and are not specific to a given technology. H) All relevant ethical issues can be handled within other frameworks, e.g., within economics. I) Ethics can undermine or burst the foundation of HTA. Hence, there are many reasons why ethics is not an integrated part of HTA so many years after identifying ethics as constitutive to HTA. These reasons may all explain why it is so, but on closer scrutiny, they do not work as compelling arguments for not addressing ethical issues in HTA. Hence, the identified reasons may work well as explanations, but not as justifications. In order to move on from a situation of failure we can: Exclude ethics from definitions of HTA, and as a consequence, establish a separate kind of evaluation (Health Technology Evaluation – HTE). Take the existing definition seriously and actually integrate ethics in the performance of HTA practice. Amend, expand or change HTA so that ethics is more genuinely incorporated. Which of these options to choose is open for discussion, but we need to move away from a situation where we have a definition of HTA which does not correspond with HTA practice. PMID:25493101

Is there anything unique in the ethics of synthetic biology?

PubMed

Heyd, David

2012-01-01

Synthetic biology does not create any ethical dilemmas that have not already been raised in the development of practices such as genetic screening, genetic engineering, and other interventions in the evolutionary processes. The issue is, nevertheless, ethically serious. Two different angles are examined: the philosophical legitimacy of human intervention in the shaping of human nature, and the more pragmatic (though by no means less important) question of the risks involved in such a novel line of research. As for the first, the claim made here is that in principle there is no constraint in human intervention in the world, since ultimately the source of any value lies in human interests, welfare, and values. This is an approach that is opposite to Habermas's. As for the practical problem of risk, research in synthetic biology calls for particular caution, since in at least the first stages of a new research or program, there is no social regulation, and society is wholly dependent on the scientist's ethical integrity.

Ethical philanthropy in academic psychiatry.

PubMed

Roberts, Laura Weiss

2006-05-01

From an ethical perspective, psychiatrists cannot accept gifts of significant monetary value from their patients. This guideline raises important questions regarding institutional practices related to gift-giving in academic psychiatry. The first aim of this article is to explain the ethical tensions and shared ethical commitments of the professions of psychiatry and philanthropy. The second aim is to outline a series of steps that may be undertaken to assure ethical philanthropic practices within an institution, including the establishment of a committed advisory workgroup and the creation of ground rules and safeguards for gift-giving. Each situation should be evaluated for "ethical risk," and specific measures to safeguard donors should be considered. The author outlines methods to manage, minimize, or eliminate conflict of interest issues, including identification and disclosure of conflicting interests, role separation, goal clarification, confidentiality protections, proper timing, and ongoing oversight. Three case illustrations are provided and discussed. The process of institutional engagement, dialogue, and shared problem-solving is especially important. A shared, constructive ethic will be attained only if leaders and diverse stakeholders communicate the value of the new approach through their words, expectations, and actions. Through these efforts, greater attention will be given to the concerns of people with mental illness, and academic institutions may be better able to fulfill their responsibilities to this important but neglected population now and in the future.

Taking stock of the ethical foundations of international health research: pragmatic lessons from the IU-Moi Academic Research Ethics Partnership.

PubMed

Meslin, Eric M; Were, Edwin; Ayuku, David

2013-09-01

It is a sine qua non that research and health care provided in international settings raise profound ethical questions when different cultural and political values are implicated. Yet ironically, as international health research expands and as research on ethical issues in international health research broadens and deepens, we appear to have moved away from discussing the moral foundations of these activities. For international health research to thrive and lead to the kind of benefits it is capable of, it is helpful to occasionally revisit the foundational premises that justify the enterprise as a whole. We draw on the experience of the Indiana University-Moi University Academic Research Ethics Partnership, an innovative bioethics training program co-located in Indianapolis and Eldoret, Kenya to highlight the changing nature of ethical issues in international health research and the ongoing practical challenges.

Correction.

PubMed

2015-06-01

Gillon R. Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. J Med Ethics 2015;41:111–6. The author misrepresented Beauchamp and Childress when he wrote: ‘My own view (unlike Beauchamp and Childress who explicitly state that they make no such claim ( p. 421)1, is that all moral agents whether or not they are doctors or otherwise involved in healthcare have these prima facie moral obligations; but in the context of answering the question ‘what is it to do good medical ethics ?’ my claim is limited to the ethical obligations of doctors’. The author intended and should have written the following: ‘My own view, unlike Beauchamp and Childress who explicitly state that they make no such claim (p.421)1 is that these four prima facie principles can provide a basic moral framework not only for medical ethics but for ethics in general’.

Why "Who Is the Client?" Is the Wrong Ethical Question

ERIC Educational Resources Information Center

Fisher, Mary Alice

2014-01-01

The familiar question "Who is the client?" elicits a singular answer. This may be appropriate as a clinical question, and it is sometimes necessary as a legal question or reimbursement question, but on ethical questions, the National Association of School Psychologists Ethics Code requires school psychologists to "think plural"…

Community treatment orders: ethical practice in an era of magical thinking.

PubMed

Everett, B

2001-01-01

With the passage of legislation in June 2000, coercive measures in the form of community treatment orders (CTOs) have become part of the community mental health landscape in Ontario. Given that community practitioners place a high value upon their ability to create voluntary and egalitarian partnerships with clients, the question of whether ethical practice is possible under conditions of legislated coercion is relevant. Based upon a review of the pro and con arguments that preceded CTO legislation, followed by an examination of available research on effectiveness, this paper suggests that forms of magical thinking have been at work on both sides of the CTO debate. A broader definition of coercion is proposed--one that envelopes both overt and covert forms. Finally, the author offers an approach to ethical practice which is based on the use of transformative power rather than coercive power, and which includes a 3-step strategy (using liberation tactics, proactive contracting, and procedural justice).

Marketing and medicine: a questionable mix.

PubMed

Moran, Michael E; Baum, Neil H

2012-01-01

Historically, medicine has been an evolving art and science. It never remains the same. Only in the past few decades has it been acceptable for doctors to market and promote their practices. This article will review the history of medical marketing and provide ethical examples of marketing that might be available to any physician, in any practice, and in any geographic location.

From painful busyness to emotional immunization: Nurses' experiences of ethical challenges.

PubMed

Storaker, Anne; Nåden, Dagfinn; Sæteren, Berit

2017-08-01

The professional values presented in ethical guidelines of the Norwegian Nurses Organisation and International Council of Nurses describe nurses' professional ethics and the obligations that pertain to good nursing practice. The foundation of all nursing shall be respect for life and the inherent dignity of the individual. Research proposes that nurses lack insight in ethical competence and that ethical issues are rarely discussed on the wards. Furthermore, research has for some time confirmed that nurses experience moral distress in their daily work and that this has become a major problem for the nursing profession. The purpose of this article is to obtain a deeper understanding of the ethical challenges that nurses face in daily practice. The chosen research questions are "What ethical challenges do nurses experience in their daily practice?" We conducted a qualitative interview study using a hermeneutical approach to analyzing data describing nurses' experiences. Ethical considerations: The Norwegian Social Science Data services approved the study. Furthermore, the head of the hospital gave permission to conduct the investigation. The requirement of anonymity and proper data storage in accordance with the World Medical Association Declaration of Helsinki was met. The context for the study comprised three different clinical wards at a university hospital in Norway. Nine qualified nurses were interviewed. The results were obtained through a systematic development beginning with the discovery of busyness as a painful phenomenon that can lead to conflicts in terms of ethical values. Furthermore, the consequences compromising professional principles in nursing care emerged and ended in moral blindness and emotional immunization of the healthcare providers. Emotional immunization occurred as a new dimension involving moral blindness and immunity in relation to being emotionally touched.

Socioscience and ethics in science classrooms: Teacher perspectives and strategies

NASA Astrophysics Data System (ADS)

Sadler, Troy D.; Amirshokoohi, Aidin; Kazempour, Mahsa; Allspaw, Kathleen M.

2006-04-01

This study explored teacher perspectives on the use of socioscientific issues (SSI) and on dealing with ethics in the context of science instruction. Twenty-two middle and high school science teachers from three US states participated in semi-structured interviews, and researchers employed inductive analyses to explore emergent patterns relative to the following two questions. (1) How do science teachers conceptualize the place of ethics in science and science education? (2) How do science teachers handle topics with ethical implications and expression of their own values in their classrooms? Profiles were developed to capture the views and reported practices, relative to the place of ethics in science and science classrooms, of participants. Profile A comprising teachers who embraced the notion of infusing science curricula with SSI and cited examples of using controversial topics in their classes. Profile B participants supported SSI curricula in theory but reported significant constraints which prohibited them from actualizing these goals. Profile C described teachers who were non-committal with respect to focusing instruction on SSI and ethics. Profile D was based on the position that science and science education should be value-free. Profile E transcended the question of ethics in science education; these teachers felt very strongly that all education should contribute to their students' ethical development. Participants also expressed a wide range of perspectives regarding the expression of their own values in the classroom. Implications of this research for science education are discussed.

Expected Ethical Competencies of Public Health Professionals and Graduate Curricula in Accredited Schools of Public Health in North America

PubMed Central

Wright, Brandy; Semaan, Salaam

2013-01-01

Objectives. We assessed expected ethics competencies of public health professionals in codes and competencies, reviewed ethics instruction at schools of public health, and recommended ways to bridge the gap between them. Methods. We reviewed the code of ethics and 3 sets of competencies, separating ethics-related competencies into 3 domains: professional, research, and public health. We reviewed ethics course requirements in 2010–2011 on the Internet sites of 46 graduate schools of public health and categorized courses as required, not required, or undetermined. Results. Half of schools (n = 23) required an ethics course for graduation (master’s or doctoral level), 21 did not, and 2 had no information. Sixteen of 23 required courses were 3-credit courses. Course content varied from 1 ethics topic to many topics addressing multiple ethics domains. Conclusions. Consistent ethics education and competency evaluation can be accomplished through a combination of a required course addressing the 3 domains, integration of ethics topics in other courses, and “booster” trainings. Enhancing ethics competence of public health professionals is important to address the ethical questions that arise in public health research, surveillance, practice, and policy. PMID:22994177

Concluding with a Synthesis.

ERIC Educational Resources Information Center

Johansen, Jane Thompson

2003-01-01

Presents an assignment, conducted by the business communications instructor as "raconteur," that elicits discussions about ethics, decision making, channeling, legal questions, and the practical applications of business communications. Describes how the class completes a major report on a career and participates in three interviews so that they…

Ethics and images of suffering bodies in humanitarian medicine.

PubMed

Calain, Philippe

2013-12-01

Media representations of suffering bodies from medical humanitarian organisations raise ethical questions, which deserve critical attention for at least three reasons. Firstly, there is a normative vacuum at the intersection of medical ethics, humanitarian ethics and the ethics of photojournalism. Secondly, the perpetuation of stereotypes of illness, famine or disasters, and their political derivations are a source of moral criticism, to which humanitarian medicine is not immune. Thirdly, accidental encounters between members of the health professions and members of the press in the humanitarian arena can result in misunderstandings and moral tension. From an ethics perspective the problem can be specified and better understood through two successive stages of reasoning. Firstly, by applying criteria of medical ethics to the concrete example of an advertising poster from a medical humanitarian organisation, I observe that media representations of suffering bodies would generally not meet ethical standards commonly applied in medical practice. Secondly, I try to identify what overriding humanitarian imperatives could outweigh such reservations. The possibility of action and the expression of moral outrage are two relevant humanitarian values which can further be spelt out through a semantic analysis of 'témoignage' (testimony). While the exact balance between the opposing sets of considerations (medical ethics and humanitarian perspectives) is difficult to appraise, awareness of all values at stake is an important initial standpoint for ethical deliberations of media representations of suffering bodies. Future pragmatic approaches to the issue should include: exploring ethical values endorsed by photojournalism, questioning current social norms about the display of suffering, collecting empirical data from past or potential victims of disasters in diverse cultural settings, and developing new canons with more creative or less problematic representations of suffering bodies than the currently accepted stereotypes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ethical concerns and dilemmas of Finnish and Dutch health professionals.

PubMed

Hopia, Hanna; Lottes, Ilsa; Kanne, Mariël

2016-09-01

Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them. To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master's level. Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data. Participants' online discussions were analyzed using inductive content analysis. The sample consisted of 49 students at master's level enrolled in professional ethics courses at universities in Finland and the Netherlands. Permission for conducting the study was granted from both universities of applied sciences. All students provided their informed consent for the use of their assignments as research data. Participants described 51 problematic work situations. Among these, 16 were found to be ethical dilemmas, and the remaining were work issues with an ethical concern and did not meet criteria of a dilemma. The most common problems resulted from concerns about quality care, safety of healthcare professionals, patients' rights, and working with too few staff and inadequate resources. The results indicated that participants were concerned about providing quality of care and raised numerous questions about how to provide it in challenging situations. The results show that it was difficult for students to differentiate ethical dilemmas from other ethical work concerns. Online discussions among healthcare providers give them an opportunity to relate ethical principles to real ethical dilemmas and problems in their work as well as to critically analyze ethical issues. We found that discussions with descriptions of ethical dilemmas and concerns by health professionals provide important information and recommendations not only for education and practice but also for health policy. © The Author(s) 2015.

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.

The limited relevance of analytical ethics to the problems of bioethics.

PubMed

Holmes, R L

1990-04-01

Philosophical ethics comprises metaethics, normative ethics and applied ethics. These have characteristically received analytic treatment by twentieth-century Anglo-American philosophy. But there has been disagreement over their interrelationship to one another and the relationship of analytical ethics to substantive morality--the making of moral judgments. I contend that the expertise philosophers have in either theoretical or applied ethics does not equip them to make sounder moral judgments on the problems of bioethics than nonphilosophers. One cannot "apply" theories like Kantianism or consequentialism to get solutions to practical moral problems unless one knows which theory is correct, and that is a metaethical question over which there is no consensus. On the other hand, to presume to be able to reach solutions through neutral analysis of problems is unavoidably to beg controversial theoretical issues in the process. Thus, while analytical ethics can play an important clarificatory role in bioethics, it can neither provide, nor substitute for, moral wisdom.

Building workforce capacity for ethical reflection in health promotion: a practitioner's experience.

PubMed

Axford, Annabel; Carter, Drew

2015-12-01

Health promotion does not have a code of ethics, although attempts have been made to assist practitioners in their understanding and application of ethical concepts. This article describes and analyses one such attempt, sustained from 2006 to 2014 in rural South Australia. The attempt comprised capacity-building activities that were informed by principles of organisational change management, especially the principle of creating champions. The article also presents a framework (largely comprising ethical questions) that may help practitioners as a prompt and guide to ethical reflection. The framework was developed to be as accessible as possible in light of the diverse educational backgrounds found in rural settings. Finally, the article highlights some philosophical dimensions to the framework and defends its role, proposing that ethical reflection is integral to good practice and never simply the province of theorists. The article does all this with a view to stimulating discussion on how to increase the frequency and quality of ethical reflection undertaken by health promotion practitioners.

How Should We Treat the Vulnerable?: Qualitative Study of Authoritative Ethics Documents.

PubMed

Zagorac, Ivana

2016-01-01

The aim of this study is to explore what actual guidance is provided by authoritative ethics documents regarding the recognition and protection of the vulnerable. The documents included in this analysis are the Belmont Report, the Declaration of Helsinki, The Council for International Organizations of Medical Sciences (CIOMS) Guidelines, and the UNESCO Universal Declaration on Bioethics and Human Rights, including its supplementary report on vulnerability. A qualitative analysis of these documents was conducted in light of three questions: what is vulnerability, who are the vulnerable, and how should the vulnerable be protected? The results show significant differences among the documents regarding the first two questions. None of the documents provides any guidance on the third question (how to protect the vulnerable). These results suggest a great discrepancy between the acknowledged importance of the concept of vulnerability and a general understanding of the scope, content, and practical implications of vulnerability.

Scaling ethics up and down: moral craft in clinical genetics and in global health research.

PubMed

Parker, Michael

2015-01-01

This paper engages with the question of what it is to 'do good medical ethics' in two ways. It begins with an exploration of what it might mean to say that health professionals practise good medical ethics as part of practising good ethical medicine. Using the example of the Genethics Club, a well-established national ethics forum for genetics professionals in the UK, the paper develops an account of moral craftsmanship grounded in the concepts of shared moral commitments and practices, moral work, ethics and living morality. In the light of this discussion, the paper goes on to consider what it might mean for a specialist in medical ethics, a bioethicist, to do good medical ethics. Finally, a research agenda focusing on the challenges of thinking about good medical ethics in a global context and a proposal for an innovative approach to bioethics methodology is outlined. 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.

Counseling and Values in a Time Perspective

ERIC Educational Resources Information Center

Smith, Darrell; Peterson, James A.

1977-01-01

Smith and Peterson answer the question, "What are the common values and ethics that influence our practice?" Their searching analysis extends for beyond professional beliefs and extends into the influence of issues such as the space race, sexism, race relations, Viet Nam, and Watergate. (Author)

Cross-cultural perspectives of scientific misconduct.

PubMed

Momen, Hooman; Gollogly, Laragh

2007-09-01

The increasing globalization of scientific research lends urgency to the need for international agreement on the concepts of scientific misconduct. Universal spiritual and moral principles on which ethical standards are generally based indicate that it is possible to reach international agreement on the ethical principles underlying good scientific practice. Concordance on an operational definition of scientific misconduct that would allow independent observers to agree which behaviour constitutes misconduct is more problematic. Defining scientific misconduct to be universally recognized and universally sanctioned means addressing the broader question of ensuring that research is not only well-designed - and addresses a real need for better evidence - but that it is ethically conducted in different cultures. An instrument is needed to ensure that uneven ethical standards do not create unnecessary obstacles to research, particularly in developing countries.

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.

Codes of medical ethics: traditional foundations and contemporary practice.

PubMed

Sohl, P; Bassford, H A

1986-01-01

The Hippocratic Coprus recognized the interaction of 'business' and patient-health moral considerations, and urged that the former be subordinated to the latter. During the 1800s with the growth of complexity in both scientific knowledge and the organization of health services, the medical ethical codes addressed themselves to elaborate rules of conduct to be followed by the members of the newly emerging national medical associations. After World War II the World Medical Association was established as an international forum where national medical associations could debate the ethical problems presented by modern medicine. The International Code of Medical ethics and the Declaration of Geneva were written as 20th century restatements of the medical profession's commitment to the sovereignty of the patient-care norm. Many ethical statements have been issued by the World Medical Association in the past 35 years; they show the variety and difficulties of contemporary medical practice. The newest revisions were approved by the General Assembly of the World Medical Association in Venice, Italy October 1983. Their content is examined and concern is voiced about the danger of falling into cultural relativism when questions about the methods of financing medical services are the subject of an ethical declaration which is arrived at by consensus in the W.M.A.

Elective ventilation for organ donation: law, policy and public ethics.

PubMed

Coggon, John

2013-03-01

This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: 'basic elective ventilation'; 'epistemically complex elective ventilation'; 'practically complex elective ventilation'; and 'epistemically and practically complex elective ventilation'. I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation.

Detecting, preventing, and responding to "fraudsters" in internet research: ethics and tradeoffs.

PubMed

Teitcher, Jennifer E F; Bockting, Walter O; Bauermeister, José A; Hoefer, Chris J; Miner, Michael H; Klitzman, Robert L

2015-01-01

Internet-based health research is increasing, and often offers financial incentives but fraudulent behavior by participants can result. Specifically, eligible or ineligible individuals may enter the study multiple times and receive undeserved financial compensation. We review past experiences and approaches to this problem and propose several new strategies. Researchers can detect and prevent Internet research fraud in four broad ways: (1) through the questionnaire/instrument (e.g., including certain questions in survey; and software for administering survey); (2) through participants' non-questionnaire data and seeking external validation (e.g., checking data for same email addresses, usernames, passwords, and/or fake addresses or phone numbers; (3) through computer information, (e.g., IP addresses and cookies), and 4) through study design (e.g., avoid lump sum compensation and interviewing participants). These approaches each have pros and cons, and raise ethical, legal, and logistical questions, given that ethical tensions can emerge between preserving the integrity of research vs. protecting the privacy and confidentiality of study respondents. While past discussions concerning the ethics of online research have tended to focus on the participants' ability to trust the researchers, needs now arise to examine researchers' abilities to trust the participants. This analysis has several critical implications for future practice, policy, and research. © 2015 American Society of Law, Medicine & Ethics, Inc.

Exploring the relevance of social justice within a relational nursing ethic.

PubMed

Woods, Martin

2012-01-01

In the last few decades, a growing number of commentators have questioned the appropriateness of the 'justice view' of ethics as a suitable approach in health care ethics, and most certainly in nursing. Essentially, in their ethical deliberations, it is argued that nurses do not readily adopt the high degree of impartiality and objectivity that is associated with a justice view; instead their moral practices are more accurately reflected through the use of alternative approaches such as relational or care-based ethics. Yet, it has also been argued that this viewpoint does not necessarily 'do justice' to the broader moral responsibilities of nurses towards humanity in general, i.e. to the wider socio-cultural and socio-political issues in society, and to the concept of social justice in particular. This criticism has triggered a much closer examination of relational and care-based ethics in nursing at levels beyond individual responsiveness within relationships and brought into the spotlight the need for a more ethically refined nursing response to an increasingly complex set of socio-cultural inequalities. This article explores a relational ethic within nursing practices with contemporary ideas regarding social justice. In particular, it is argued that the synergy between the two actually produces an ethic that is capable of not only challenging the continuing predominance of justice-based ethics within health care, but of replacing it. Subsequently, in the discussion that follows, it is suggested that a combined social justice and relational care-based approach, as a social ethic, should guide the moral deliberations and actions of nurses. It is maintained that such an approach is not only possible, but crucial if nurses are to realize their full potential as ethical agents for individual and social good. © 2011 Blackwell Publishing Ltd.

Assessing and addressing moral distress and ethical climate Part II: neonatal and pediatric perspectives.

PubMed

Sauerland, Jeanie; Marotta, Kathleen; Peinemann, Mary Anne; Berndt, Andrea; Robichaux, Catherine

2015-01-01

Moral distress remains a pervasive and, at times, contested concept in nursing and other health care disciplines. Ethical climate, the conditions and practices in which ethical situations are identified, discussed, and decided, has been shown to exacerbate or ameliorate perceptions of moral distress. The purpose of this mixed-methods study was to explore perceptions of moral distress, moral residue, and ethical climate among registered nurses working in an academic medical center. Two versions of the Moral Distress Scale in addition to the Hospital Ethical Climate Survey were used, and participants were invited to respond to 2 open-ended questions. Part I reported the findings among nurses working in adult acute and critical care units. Part II presents the results from nurses working in pediatric/neonatal units. Significant differences in findings between the 2 groups are discussed. Subsequent interventions developed are also presented.

Ethical issues regarding related and nonrelated living organ donors.

PubMed

Testa, Giuliano

2014-07-01

The ethics of the clinical practice of transplanting human organs for end-stage organ disease is a fascinating topic. Who is the "owner" of the transplantable organs of a deceased, brain-dead patient? Who should have a right to receive these organs? Who set the boundaries between a living donor's autonomy and a "paternalistic" doctor? What constitutes a proper consent? These questions are only some of the ethical issues that have been discussed in the last 60 years. All of these ethical issues are intensified by the fact that supply of human organs does not match demand, and that, as a consequence, living-donor organ transplantation is widely utilized. The aim of this article is not to be exhaustive but to present the general ethical principles of beneficence, nonmaleficence, and justice as applied to organ transplantation. Moreover, the topic of reimbursement for organ donation is also discussed.

Examination of ethical dilemmas experienced by adult intensive care unit nurses in physical restraint practices.

PubMed

Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Dizer, Berna; Gümüş, Fatma; Koyuncu, Rukiye

2014-01-01

Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.

Patient Power: Complex Issues Need Complex Answers.

ERIC Educational Resources Information Center

Wiener, Carolyn; And Others

1980-01-01

Discusses ethical and practical questions that arise in physician/patient interactions as a result of the rising prevalence of chronic illness, the growth of medical technology, and the increased differentiation of medical specialization. Issues considered include patients' rights, medical malpractice, informed consent, and the patient self-help…

Right Filter for the Wrong Addresses: Regulating Net Access.

ERIC Educational Resources Information Center

Simpson, Carol

1996-01-01

Guides librarians in evaluating "filtering" software which schools may purchase for restricting access to potentially inappropriate Internet sites. This article discusses the workings of filtering programs and practical and ethical questions such as: how sites are restricted, who decides, and whether transactions are monitored.…

Transplant Tourism to China: The Impact on Domestic Patient Care Decisions

PubMed Central

Biggins, Scott W.; Bambha, Kiran; Terrault, Norah; Inadomi, John; Roberts, John P.; Bass, Nathan

2009-01-01

Organ procurement in China has been criticized because of its reliance on executed prisoners as donors. We aimed to assess the influence of perceptions about organ procurement practices in China on domestic patient care decisions. Methods An anonymous Internet administered case-based questionnaire was used to survey an sample of healthcare professionals with affiliations to hepatology and transplantation professional societies. Results Of 674 completed surveys, the vast majority (93%) of the respondents were physicians, surgeons or allied transplant professionals actively caring for liver transplant patients and 81% practiced in the United States (US). A strong majority believed procurement practices were ethically sound in the US and Europe (87% and 73%) but fare fewer believed that procurement practices were ethically sound in China (4%, p<0.001). In case-based questions, lack of confidence in the ethical standards of organ procurement in China predicted patient-care decisions. The majority would provide post-transplantation care for patients who underwent liver transplantation at another domestic center, in a foreign country and in China (90%,78%,63%, respectively, p<0.001) yet respondents who suspected unethical procurement practices in China were more reluctant to do so (p<0.001). Conclusions Transplant professionals expressed concern about organ procurement practices in China which influenced their patient care decision-making. PMID:19191815

Transplant tourism to China: the impact on domestic patient-care decisions.

PubMed

Biggins, Scott W; Bambha, Kiran; Terrault, Norah; Inadomi, John; Roberts, John P; Bass, Nathan

2009-01-01

Organ procurement in China has been criticized because of its reliance on executed prisoners as donors. We aimed to assess the influence of perceptions about organ procurement practices in China on domestic patient-care decisions. An anonymous internet administered case-based questionnaire was used to survey a sample of healthcare professionals with affiliations to hepatology and transplantation professional societies. Of 674 completed surveys, the vast majority (93%) of the respondents were physicians, surgeons or allied transplant professionals actively caring for liver transplant patients and 81% practiced in the US. A strong majority believed procurement practices were ethically sound in the US and Europe (87% and 73%) but fare fewer believed that procurement practices were ethically sound in China (4%, p < 0.001). In case-based questions, lack of confidence in the ethical standards of organ procurement in China predicted patient-care decisions. The majority would provide post-transplantation care for patients who underwent liver transplantation at another domestic center, in a foreign country and in China (90%, 78%, and 63%, respectively, p < 0.001) yet respondents who suspected unethical procurement practices in China were more reluctant to do so (p < 0.001). Transplant professionals expressed concern about organ procurement practices in China which influenced their patient-care decision-making.

Ethical Considerations and Planetary Protection for Future Space Exploration - Starting with the Basics

NASA Astrophysics Data System (ADS)

Race, Margaret

2012-07-01

As COSPAR scientists deliberate what types of frameworks and policy approaches may be applicable to future activities by various sectors in space exploration, it also needs to consider the challenging question of what ethical values and foundations should be used in dealing with life, objects and activities in outer space. A 2010 COSPAR Workshop Report on Ethical Considerations for Planetary Protection in Space Exploration recommended that it is appropriate to maintain the existing PP policy aimed at scientific concerns even as we begin to explore various practical approaches to future contamination avoidance policies. It is also appropriate to examine in parallel the ethical considerations applicable to potential indigenous extraterrestrial life, non-living extraterrestrial features and environments, and planned uses and activities involving diverse life from Earth. Since numerous sectors have begun to propose activities raising varied ethical concerns (e.g., protection and management on the moon, strip mining, space synthetic biology, space code of conduct, and commercial space transport), it is timely to initiate serious international discussions about the appropriate ethical foundations and questions applicable to future space exploration. Plans are underway for convening interdisciplinary work groups to explore and deliberate on the values (e.g., intrinsic and instrumental) and ethical foundations that are appropriate for use in deliberations involving potential indigenous extraterrestrial life and the different classes of target objects and environments in our solar system. More than ever, information on bioethics, environmental ethics and geoethics will provide helpful guidance and foundational approaches of relevance to future policy deliberations that seek to go beyond science protection per se.

Research across the disciplines: a road map for quality criteria in empirical ethics research.

PubMed

Mertz, Marcel; Inthorn, Julia; Renz, Günter; Rothenberger, Lillian Geza; Salloch, Sabine; Schildmann, Jan; Wöhlke, Sabine; Schicktanz, Silke

2014-03-01

Research in the field of Empirical Ethics (EE) uses a broad variety of empirical methodologies, such as surveys, interviews and observation, developed in disciplines such as sociology, anthropology, and psychology. Whereas these empirical disciplines see themselves as purely descriptive, EE also aims at normative reflection. Currently there is literature about the quality of empirical research in ethics, but little or no reflection on specific methodological aspects that must be considered when conducting interdisciplinary empirical ethics. Furthermore, poor methodology in an EE study results in misleading ethical analyses, evaluations or recommendations. This not only deprives the study of scientific and social value, but also risks ethical misjudgement. While empirical and normative-ethical research projects have quality criteria in their own right, we focus on the specific quality criteria for EE research. We develop a tentative list of quality criteria--a "road map"--tailored to interdisciplinary research in EE, to guide assessments of research quality. These quality criteria fall into the categories of primary research question, theoretical framework and methods, relevance, interdisciplinary research practice and research ethics and scientific ethos. EE research is an important and innovative development in bioethics. However, a lack of standards has led to concerns about and even rejection of EE by various scholars. Our suggested orientation list of criteria, presented in the form of reflective questions, cannot be considered definitive, but serves as a tool to provoke systematic reflection during the planning and composition of an EE research study. These criteria need to be tested in different EE research settings and further refined.

Research across the disciplines: a road map for quality criteria in empirical ethics research

PubMed Central

2014-01-01

Background Research in the field of Empirical Ethics (EE) uses a broad variety of empirical methodologies, such as surveys, interviews and observation, developed in disciplines such as sociology, anthropology, and psychology. Whereas these empirical disciplines see themselves as purely descriptive, EE also aims at normative reflection. Currently there is literature about the quality of empirical research in ethics, but little or no reflection on specific methodological aspects that must be considered when conducting interdisciplinary empirical ethics. Furthermore, poor methodology in an EE study results in misleading ethical analyses, evaluations or recommendations. This not only deprives the study of scientific and social value, but also risks ethical misjudgement. Discussion While empirical and normative-ethical research projects have quality criteria in their own right, we focus on the specific quality criteria for EE research. We develop a tentative list of quality criteria – a “road map” – tailored to interdisciplinary research in EE, to guide assessments of research quality. These quality criteria fall into the categories of primary research question, theoretical framework and methods, relevance, interdisciplinary research practice and research ethics and scientific ethos. Summary EE research is an important and innovative development in bioethics. However, a lack of standards has led to concerns about and even rejection of EE by various scholars. Our suggested orientation list of criteria, presented in the form of reflective questions, cannot be considered definitive, but serves as a tool to provoke systematic reflection during the planning and composition of an EE research study. These criteria need to be tested in different EE research settings and further refined. PMID:24580847

[Ethical behavioral standards of medical students on examinations and studies].

PubMed

Tolkin, Lior; Glick, Shimon

2007-06-01

In recent years the medical literature has reflected an increasing interest in the medical ethics of physicians and medical students. Studies have shown that cheating in medical school is frequent enough to cause concern, that there is a positive correlation between students' ethical attitude and their ethical behavior and between cheating in school and cheating in patient care. This study aims to examine student attitudes towards cheating, their self-reported behavior, analyze cultural and sub-cultural differences, and to reach practical conclusions that might be incorporated into the teaching of ethics in medical schools. Anonymous questionnaires were distributed to 193 first and second year students of the Israeli and American programs at Ben-Gurion University. The questionnaire consisted of fifty three multiple choice questions. The students were asked to state their opinion on various cheating practices at medical school and dishonesty in patient care, to estimate how they would resolve various ethical dilemmas and to provide some demographic information. The results were analyzed using SPSS. T-tests, Chi-Square tests, one-way analysis of variance, and Pearson and Spearman's coefficients, all used as appropriate. Completed questionnaires were returned by 141 students (73%). The majority of the students regard cheating in an exam (93%) or on a final paper (85%) to be morally unacceptable behavior. Copying during an exam is regarded as more morally unacceptable than copying a homework exercise. The majority of the students consider faking a patient's laboratory results to be morally unacceptable behavior (98%). American students regard copying a homework exercise, reconstructing exam questions for the benefit of next year students and giving answers to a fellow student during an exam to be more morally unacceptable in comparison to the Israeli students. Married students consider cheating to be more morally unacceptable than unmarried students. A positive correlation was found between religiosity and the position that cheating is a morally negative practice. There is a positive correlation between cheating in high school and the position that cheating is morally acceptable. In addition, the more often a student cheated in high school the more that student claims that he or she would cheat if they were sure that they would not be caught. Amongst Israeli students, there was a correlation between the view that the faculty did not treat them well, and the position that cheating is morally acceptable, No correlation was found between cheating and gender, age, birth country of parents, army service, or type of high school. Students' attitude toward cheating is significantly determined by the cultural and sub-cultural characteristics of each student's background. Ethical discussions in which an ethical code would be formed, moral dilemmas analyzed and cultural differences addressed, may help improve the ethical behavior of students in medical school, and thus improve their ethical practice in patient care.

Tricks and Clicks: How Low-Cost Carriers Ply Their Trade Through Self-Service Websites

NASA Astrophysics Data System (ADS)

Barry, Chris; Torres, Ann M.

Ethics on the Internet has been a widely debated topic in recent years covering issues that range from privacy to security to fraud. Little, however, has been written on more subtle ethical questions, such as the exploitation of web technologies to inhibit or avoid customer service. Increasingly some firms are using websites to create distance between them and their customer base in specific areas of their operations, while simultaneously developing excellence in sales transaction committal via self-service. This chapter takes a magnifying glass with an ethical lens to one sector - the low-cost, web-based, self-service airline industry, specifically in Ireland. It is noted that the teaching of information systems development (ISD) and, for the most part its practice, assumes ethicality. Similarly, marketing courses focus on satisfying customer needs more effectively and efficiently within the confines of an acceptable ethos. This chapter observes that while these business disciplines are central to the success of self-service websites, there is a disconnect between the normative view and the actuality of practice.

Ethical concerns: comparison of values from two cultures.

PubMed

Wros, Peggy L; Doutrich, Dawn; Izumi, Shigeko

2004-06-01

The present study was a secondary analysis of data from two phenomenological studies of nurses in the USA and Japan. The study incorporated hermeneutics and feminist methodologies to answer the following questions. Are there common values and ethical concerns and values within the nursing cultures of Japan and the USA? What are some commonalities and differences between Japanese nurses' ethical concerns and those of American nurses? Findings indicated that nurses from the USA and Japan share common values and ethical concerns as professional nurses, including competence, respect for the patient as a person, responsibility, relationship and connection, importance of the family, caring, good death, comfort, truth-telling, understanding the patient/situation, and anticipatory care. Although ethical concerns are similar, related background meanings and actions often look different between cultures; truth-telling is described as an example. Nurses in each country also hold unique values not found in the nursing practice of the other country. Understanding these commonalities and differences is critical for the development of global nursing ethics.

Beyond demarcation: Care ethics as an interdisciplinary field of inquiry.

PubMed

Leget, Carlo; van Nistelrooij, Inge; Visse, Merel

2017-01-01

For many years the body of literature known as 'care ethics' or 'ethics of care' has been discussed as regards its status and nature. There is much confusion and little structured discussion. The paper of Klaver et al. (2014) was written as a discussion article to which we respond. We aim to contribute to the ongoing discussion about the status and nature of care ethics. Responding to 'Demarcation of the ethics of care as a discipline' by Klaver et al. (2014) and 'Three versions of an ethics of care' by Edwards (2009), we identified shared concerns and formulated criticisms of both texts in order to develop an alternative view. Participants and research context: This paper has been written from the academic context of a master in care ethics an policy. Ethical considerations: We have tried to be fair and respectful to the authors discussed. Both Klaver et al. (2014) and Edwards (2009) raise important concerns about the question if care ethics can be considered an academic discipline, and to what extend it can be seen as a moral theory. Despite shared concerns, their arguments fail to convince us in all respects. We propose to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection. Departing from the notion of caring as a practice of contributing to a life-sustaining web, we argue that care ethics can only profit from a loosely organized academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices. This asks for ways of searching for a common focus and interest that is inherently democratic and dialogical and thus beyond demarcation.

Respondents as Interlocutors: Translating Deliberative Democratic Principles to Qualitative Interviewing Ethics

ERIC Educational Resources Information Center

Curato, Nicole

2012-01-01

The epistemic interview is a conversational practice, which aims to generate knowledge by subjecting respondents' beliefs to dialectical tests of reasons. Developed by Svend Brinkmann, this model draws inspiration from Socratic dialogues where the interviewer asks confronting questions to press respondents to articulate the normative bases of…

The Ethics of Academic Practice in a Postmodern Era.

ERIC Educational Resources Information Center

Brown, Richard Harvey; And Others

1995-01-01

Questions how academia can continue to engage in knowledge production without producing and legitimating dominant discourses. Maintains that academia must accept that individuals live in a time of multiple perspectives, an absence of embracing consensus, and the deconstruction of any absolute or foundational principles of truth. (MJP)

Cliché, Gossip, and Anecdote as Supervision Training

ERIC Educational Resources Information Center

Grealy, Liam

2016-01-01

This article expands on a co-authored project with Timothy Laurie on the practices and ethics of higher degree research (HDR) supervision (or advising): "What does good HDR supervision look like?" in contemporary universities. It connects that project with scholarship on the relevance of "common sense" to questions of…

Ethical Questions Regarding Joint Authorship: Business and Nonbusiness Faculty Perceptions on Noncontributing Authorship.

ERIC Educational Resources Information Center

Hamilton, J. Brooke, III; And Others

1997-01-01

Survey responses from 36 of 61 business faculty and 53 of 139 nonbusiness faculty found that both groups considered it unethical to give noncontributors authorship credit. However, business faculty reported the practice to be more prevalent and considered their colleagues more likely to do it. (SK)

School Finance as a Moral Dilemma

ERIC Educational Resources Information Center

Pijanowski, John C.

2017-01-01

Alternative approaches to raising funds for public schools have long been critiqued for their approach to providing an equitable and adequate distribution of educational goods. Inherent in these core concepts of fairness are ethical questions that drive how policy and practice evolve to generate revenue for the education of children. This paper…

Immigration Reporting Laws: Ethical Dilemmas in Pediatric Practice

PubMed Central

Geltman, Paul L.; Meyers, Alan F.

1998-01-01

Objectives. This study assessed the potential impact of immigration reporting requirements on pediatricians' referrals to child protective services. Methods. A random sample of 200 Massachusetts pediatricians were surveyed. Chi-square and logistic regression analyses were performed. Results. Asked whether potential deportation of the family would cause them to question or alter a decision to refer, 50% of the respondents said yes. Conclusions. Pediatricians, as mandated reporters of child abuse, will face ethical dilemmas if laws requiring reporting of immigration status are enacted. (Am J Public Health. 1998;88:967-968) PMID:9618632

The use of virtual patient scenarios as a vehicle for teaching professionalism.

PubMed

Marei, H F; Al-Eraky, M M; Almasoud, N N; Donkers, J; Van Merrienboer, J J G

2018-05-01

This study aimed to measure students' perceptions of virtual patient scenarios (VPs) for developing ethical reasoning skills and to explore features in VP design that are necessary to promote professionalism. Sixty-five dental students participated in learning sessions that involved collaborative practice with five VPs (four high fidelity and one low fidelity), followed by reflection sessions. Students' perceptions towards the use of VPs in developing ethical reasoning skills were assessed using a questionnaire that involved 10 closed and three open-ended questions. High-fidelity VPs were perceived as significantly better for developing ethical reasoning skills than low-fidelity VPs. Analyses of answers to open-ended questions revealed two new features that are specific for VPs intended for teaching professionalism, which are VP dramatic structure and how it should end. VPs intended for teaching professionalism need to have high fidelity, follow a specific dramatic structure and should include multiple plausible endings. The use of VPs as part of a collaborative activity that is followed by a reflection session is perceived as an effective tool for the development of ethical reasoning skills in dental education. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Knowledge translation at the macro level: legal and ethical considerations.

PubMed

Larkin, Gregory Luke; Hamann, Cara J; Monico, Edward P; Degutis, Linda; Schuur, Jeremiah; Kantor, Walter; Graffeo, Charles S

2007-11-01

Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT.

Ethicist as designer: a pragmatic approach to ethics in the lab.

PubMed

van Wynsberghe, Aimee; Robbins, Scott

2014-12-01

Contemporary literature investigating the significant impact of technology on our lives leads many to conclude that ethics must be a part of the discussion at an earlier stage in the design process i.e., before a commercial product is developed and introduced. The problem, however, is the question regarding how ethics can be incorporated into an earlier stage of technological development and it is this question that we argue has not yet been answered adequately. There is no consensus amongst scholars as to the kind of ethics that should be practiced, nor the individual selected to perform this ethical analysis. One school of thought holds that ethics should have pragmatic value in research and design and that it should be implemented by the (computer) engineers and/or (computer) scientists themselves, while another school of thought holds that ethics need not be so pragmatic. For the latter, the ethical reflection can aim at a variety of goals, and be carried out by an ethicist. None of the approaches resulting from these lines of thinking have been adopted on a wide-scale basis. To that end, the approach presented here is intended to bridge the gap between these schools of thought. It is our contention that ethics ought to be pragmatic and to provide utility for the design process and we maintain that adequate ethical reflection, and all that it entails, ought to be conducted by an ethicist. Thus, we propose a novel role for the ethicist--the ethicist as designer--who subscribes to a pragmatic view of ethics in order to bring ethics into the research and design of artifacts-no matter the stage of development. In this paper we outline the series of steps that a pragmatic value analysis entails: uncovering relevant values, scrutinizing these values and, working towards the translation of values into technical content. In conclusion, we present a list of tasks for the ethicist in his/her role as designer on the interdisciplinary team.

The French bioethics debate: norms, values and practices.

PubMed

Fournier, Véronique; Spranzi, Marta

2013-02-01

In 1994, France passed bioethics laws regulating assisted reproductive technologies, organ donations and prenatal diagnosis. These laws were based upon a few principles considered as fundamental: the anonymity and gratuity of all donations concerning the elements of the human body, free and informed consent, and the interdiction of all commercial transactions on the human body. These laws have been the object of heated debates which continue to this day. On the basis on a few clinical ethics studies conducted by the Center for clinical ethics at the Cochin Hospital in Paris, the articles presented in this special issues explore several aspects of the bioethics debate, and relate it to the more general question of the complex relationship between norms, practices and values.

A review of ethical issues in dementia.

PubMed

Johnson, Rebecca A; Karlawish, Jason

2015-10-01

Dementia raises many ethical issues. The present review, taking note of the fact that the stages of dementia raise distinct ethical issues, focuses on three issues associated with stages of dementia's progression: (1) how the emergence of preclinical and asymptomatic but at-risk categories for dementia creates complex questions about preventive measures, risk disclosure, and protection from stigma and discrimination; (2) how despite efforts at dementia prevention, important research continues to investigate ways to alleviate clinical dementia's symptoms, and requires additional human subjects protections to ethically enroll persons with dementia; and (3) how in spite of research and prevention efforts, persons continue to need to live with dementia. This review highlights two major themes. First is how expanding the boundaries of dementias such as Alzheimer's to include asymptomatic but at-risk persons generate new ethical questions. One promising way to address these questions is to take an integrated approach to dementia ethics, which can include incorporating ethics-related data collection into the design of a dementia research study itself. Second is the interdisciplinary nature of ethical questions related to dementia, from health policy questions about insurance coverage for long-term care to political questions about voting, driving, and other civic rights and privileges to economic questions about balancing an employer's right to a safe and productive workforce with an employee's rights to avoid discrimination on the basis of their dementia risk. The review highlights these themes and emerging ethical issues in dementia.

On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients.

PubMed

Varelius, Jukka

2016-05-01

Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'. © 2015 John Wiley & Sons Ltd.

Naturalness as an ethical stance: idea(l)s and practices of care in western herbal medicine in the UK.

PubMed

Nissen, Nina

2015-01-01

An association of non-biomedical healthcare with appeals to nature and naturalness, and an invocation of a rhetoric of gentleness, goodness, purity and moral power has been noted previously, and some scholars argue that nature has taken on a meaning broadly opposed to the rational scientific order of modernity. Drawing on an ethnographic study of women's practice and use of western herbal medicine (WHM) in the UK, the intertwining of the perceived naturalness of WHM with distinct care practices points to a further avenue for exploration. To examine patients' and herbalists' discourses of the naturalness of WHM and associated idea(l)s and practices of care, understandings of nature and a feminist ethics of care are utilized as analytical frameworks. The analysis presented suggests that, through WHM, patients and herbalists become embedded in a complex spatio-temporal wholeness and web of care that intertwines past, present and future, self and others, and local and global concerns. In the emerging 'ordinary ethics of care', naturalness constitutes a sign of goodness and of a shared humanity within the organic world, while care, underpinned by idea(l)s of natural and holistic care practices, links human and non-human others. Thus, the naturalness of WHM, as perceived by some patients and herbalists, engages and blends with a continually unfolding field of relationships in the lifeworld(s), where care practices, caring relations and collective wellbeing may constitute an ethical stance that raises deeper questions about the significance of relationality, the values of care/caring and the mutual involvement of nature and human being(s).

Commentary: Mapping a changing landscape in the ethics of forensic psychiatry.

PubMed

Grubin, Don

2008-01-01

In 1984, Alan Stone, writing in the Bulletin of the American Academy of Psychiatry and the Law, stated that "forensic psychiatrists are without any clear guidelines as to what is proper and ethical," adding that because of the nature of psychiatry and the realities of the law, no such guidelines can be drawn. Put starkly, his conclusion was that the practice of forensic psychiatry is fundamentally unethical. In the same issue, several contemporary commentators criticized his position, arguing that he misunderstood the social context of forensic psychiatry and that, in any case, he was wrong to say that ethics standards did not exist. In this article, these questions are reviewed again, starting from the principle articulated by the philosopher, A. J. Ayer, that that there is no such thing as an ethical fact.

Genomics and Ethics: The Case of Cloned and/or Transgenic Animals

PubMed Central

2003-01-01

The point of the present study is to illustrate and, if possible, promote the existing link between genomics and ethics, taking the example of cloned and transgenic animals. These ‘new animals’ raise theoretical and practical problems that concern applied ethics. We will explore more particularly an original strategy showing that it is possible, starting from philosophical questioning about the nature of identity, to use a genomic approach, based on amplification fragment length polymorphism (AFLP) and methylation-sensitive amplification polymorphism (MSAP) detection, to provide useful tools to define more rigorously what cloned animals are, by testing their genetic and epigenetic identity. We expect from the future results of this combined approach to stimulate the creativity of the philosophical and ethical reflection about the impact of biotechnology on animals, and to increase scientific involvement in such issues. PMID:18629111

The Search for a Legal Ethic: The Adversary System, Liberalism and Beyond

ERIC Educational Resources Information Center

Verkuil, Paul R.

1977-01-01

The Code of Professional Responsibility of lawyers is examined in terms of ethical responsibility. Two major questions are addressed: to what degree does the profession understand and act consistently with its own ethic; and to what extent should legal ethics relate to larger questions of societal and political ethics? (LBH)

MOMENTS OF UNCERTAINTY: ETHICAL CONSIDERATIONS AND EMERGING CONTAMINANTS

PubMed Central

Cordner, Alissa; Brown, Phil

2013-01-01

Science on emerging environmental health threats involves numerous ethical concerns related to scientific uncertainty about conducting, interpreting, communicating, and acting upon research findings, but the connections between ethical decision making and scientific uncertainty are under-studied in sociology. Under conditions of scientific uncertainty, researcher conduct is not fully prescribed by formal ethical codes of conduct, increasing the importance of ethical reflection by researchers, conflicts over research conduct, and reliance on informal ethical standards. This paper draws on in-depth interviews with scientists, regulators, activists, industry representatives, and fire safety experts to explore ethical considerations of moments of uncertainty using a case study of flame retardants, chemicals widely used in consumer products with potential negative health and environmental impacts. We focus on the uncertainty that arises in measuring people’s exposure to these chemicals through testing of their personal environments or bodies. We identify four sources of ethical concerns relevant to scientific uncertainty: 1) choosing research questions or methods, 2) interpreting scientific results, 3) communicating results to multiple publics, and 4) applying results for policy-making. This research offers lessons about professional conduct under conditions of uncertainty, ethical research practice, democratization of scientific knowledge, and science’s impact on policy. PMID:24249964

Virtuous acts as practical medical ethics: an empirical study.

PubMed

Little, Miles; Gordon, Jill; Markham, Pippa; Rychetnik, Lucie; Kerridge, Ian

2011-10-01

To examine the nature, scope and significance of virtues in the biographies of medical practitioners and to determine what kind of virtues are at play in their ethical behaviour and reflection. A case study involving 19 medical practitioners associated with the Sydney Medical School, using semi-structured narrative interviews. Narrative data were analysed using dialectical empiricism, constant comparison and iterative reformulation of research questions. Participants represented virtuous acts as centrally important in their moral assessments of both themselves and others. Acts appeared to be contextually virtuous, rather than expressions of stable character traits, and virtue was linked to acts that served to protect or enhance fundamental values attached to ontological security and human flourishing. Virtue ethics, in this sense, was the single most important ethical system for each of the participants. Virtue ethics, construed as the appraisal of acts in contexts of risk, danger or threat to foundational values, emerged as the 'natural' ethical approach for medical practitioners in this case study. Teaching medical ethics to students and graduates alike needs to accommodate the priority attached to virtuous acts. © 2011 Blackwell Publishing Ltd.

Ethical evaluation of "retainer fee" medical practice.

PubMed

Needell, Mervin H; Kenyon, John S

2005-01-01

This article examines the reasons that some physicians have recently opted to reduce the size of their practice rosters to allow more time for each patient in exchange for a retainer fee from patients. These physicians also offer supplementary, nonmedical amenities to patients as part of their service. Because physicians have reduced the size of their practice rosters and have increased the price tag for their services, some patients have lost access to their care. We have tried to assess the ethical propriety of such a change in the design of medical practices by weighing plausible, ethically relevant arguments favoring and opposing RFMP. Physicians are ethically obligated first and foremost to promote and protect the health of their patients. RFMP fulfills this duty directly by ensuring prompt and ample professional time for the care of patients. It does so indirectly by allowing time for physicians' continuing education, which in turn should upgrade the quality of care. It also advances the ethical goals of autonomy as it allows patients to choose their own physicians and to spend their money as they please. On the other hand, these ethical positives are offset by the cost of retainer fees that may exclude access of patients to their physicians' care. Even if ethical tradition obligates physicians primarily to patients under their specific care, as professionals and as private citizens, they also have a responsibility to support the health of the entire community. RFMP does little to advance this cause, except that by optimizing the conditions under which their own private patients receive healthcare, they call attention to shortcomings in prevailing public healthcare policies, which by comparison fall short of that standard. An assumption that health is not properly a market commodity, and that all people should receive healthcare on equal terms, would expose RFMP to moral reproof. From an ethical perspective, we find sufficient cause for concern and caution in this innovative style of practice. Nevertheless, the weight of arguments presented here does not seem to justify unequivocal moral condemnation of RFMP. As neither pro nor con views seem to have settled the ethical question, definitive moral judgment on RFMP will probably depend on the outcome of future experience and ongoing evaluation. The implications of RFMP for any future healthcare system are not clear, at least to us.

"Let Me Keep My Dead Husband's Sperm": Ethical Issues in Posthumous Reproduction.

PubMed

Panagiotopoulou, Nikoletta; Karavolos, Stamatios

2015-01-01

The feasibility of posthumous reproduction when the surviving partner is female has brought to light many ethical, moral, social, and legal issues. This review aims to summarize these issues and to assist clinicians who may be faced with such requests. A question list, used for health technologies assessment, was utilized in a question-answer approach as the review methodology. Of the 1,208 publications identified through a comprehensive literature search in biomedical, psychological, and ethical databases, 31 articles included arguments related to one or more questions from the predefined question set. Key stakeholders identified include the deceased, the requesting party, the resultant child, the physician, and society. Key ethical issues relevant to posthumous reproduction include the four traditional pillars of medical ethics--autonomy, beneficence, nonmaleficence, justice--as well as the stakeholders' rights and sociocultural attitudes. The ethical framework formulated by these issues has been incorporated in a clinical ethics decision-making tool that could prove useful to clinicians and decision makers. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Ethical quandaries in caring for primary-care patients with chronic pain.

PubMed

Robinson, Patricia J; Rickard, Julie A

2013-03-01

In the past decade, more and more behavioral health providers have begun consultation practices in primary-care settings. Their availability makes multidisciplinary care a reality and the possibility of improved outcomes for patients with chronic pain more feasible. However, behavioral health providers encounter new ethical quandaries in providing services to patients with chronic pain and to the primary-care providers who plan their treatment. This article presents two cases to illustrate the questions that arise in delivery of primary-care behavioral health services to patients with chronic pain. Relevant professional ethical guidelines for psychologists, social workers, and physicians are examined and recommendations for addressing the gaps in extant guides are offered. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Introduction to the article collection 'Translation in healthcare: ethical, legal, and social implications'.

PubMed

Morrison, Michael; Dickenson, Donna; Lee, Sandra Soo-Jin

2016-11-14

New technologies are transforming and reconfiguring the boundaries between patients, research participants and consumers, between research and clinical practice, and between public and private domains. From personalised medicine to big data and social media, these platforms facilitate new kinds of interactions, challenge longstanding understandings of privacy and consent, and raise fundamental questions about how the translational patient pathway should be organised.This editorial introduces the cross-journal article collection "Translation in healthcare: ethical, legal, and social implications", briefly outlining the genesis of the collection in the 2015 Translation in healthcare conference in Oxford, UK and providing an introduction to the contemporary ethical challenges of translational research in biology and medicine accompanied by a summary of the papers included in this collection.

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.

Media debates and 'ethical publicity' on social sex selection through preimplantation genetic diagnosis (PGD) technology in Australia.

PubMed

Whittaker, Andrea

2015-01-01

This paper offers a critical discourse analysis of media debate over social sex selection in the Australian media from 2008 to 2014. This period coincides with a review of the National Health and Medical Research Council's Ethical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research (2007), which underlie the regulation of assisted reproductive clinics and practice in Australia. I examine the discussion of the ethics of pre-implatation genetic diagnosis (PGD) within the media as 'ethical publicity' to the lay public. Sex selection through PGD is both exemplary of and interconnected with a range of debates in Australia about the legitimacy of certain reproductive choices and the extent to which procreative liberties should be restricted. Major themes emerging from media reports on PGD sex selection in Australia are described. These include: the spectre of science out of control; ramifications for the contestation over the public funding of abortion in Australia; private choices versus public authorities regulating reproduction; and the ethics of travelling overseas for the technology. It is concluded that within Australia, the issue of PGD sex selection is framed in terms of questions of individual freedom against the principle of sex discrimination - a principle enshrined in legislation - and a commitment to publically-funded medical care.

Self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

PubMed

Grignol, Valerie P; Gans, Alyssa; Booth, Branyan A; Markert, Ronald; Termuhlen, Paula M

2010-08-01

A correlation exists between people who engage in academic dishonesty as students and unethical behaviors later as professionals. Academic dishonesty has been assessed among medical students, but not among general surgery residents. We sought to describe the attitudes of general surgery residents with regard to ethical practices in test taking. A survey with 4 scenarios describing activities related to examination taking that may or may not be considered unethical was administered. Participants were asked about participation in the activities-either personally or any knowledge of others-and whether the activities were unethical. Fifty-seven of 62 residents (92%) participated. For each scenario, >70% indicated that neither they nor anyone else they knew had participated in the activities. Behaviors deemed unethical included memorizing or using memorized questions to prepare for future tests (52%), selling questions for financial gain (90%), and purchasing previously used questions (57%). No difference in attitudes was seen among incoming interns, junior-level (postgraduate year [PGY]1-3), or senior-level (PGY4-6) residents. Overall, general surgery residents indicated that they had not participated in activities they felt to be unethical. Defining what is unethical was less clear. This represents an area for further education. Copyright 2010 Mosby, Inc. All rights reserved.

Educational Research: Educational Purposes, the Nature of Knowledge and Ethical Issues

ERIC Educational Resources Information Center

López-Alvarado, Julio

2017-01-01

Educational research should aim at improving educational practice by analysing the world of Education to understand it and make it better. It should be a critical, reflective and professionally oriented activity. Educational research should have three objectives: to explore issues and find answers to questions (for academics), to share policy…

Ethics, Education Policy and Research: The Phonics Question Reconsidered

ERIC Educational Resources Information Center

Ellis, Sue; Moss, Gemma

2014-01-01

This paper argues that direct control of the early years literacy curriculum recently exercised by politicians in England has made the boundaries between research, policy and practice increasingly fragile. It describes how policy came to focus most effort on the use of synthetic phonics programmes in the early years. It examines why the…

Learning To Control Democratically: Ethical Questions in Situated Adult Education.

ERIC Educational Resources Information Center

Heaney, Tom

Lave and Wenger (1991) reject individualistic and psychologistic theories of learning in favor of a more broadly social and contextual approach. They observe that all learning is situated not only in space and time, but also inextricably in relation to social practice. Learning is "legitimate peripheral participation in a community of…

Caring for Nature 101, or Alternative Perspectives on Educating Natural Resource Managers and Ecologically Conscious Citizens.

ERIC Educational Resources Information Center

Booth, Annie L.

1998-01-01

Examines the contributions of alternative perspectives from environmental philosophy to university teaching practices that address the question of how to produce ecologically educated citizens. Considers the challenges to modern resource education found in feminist and ecofeminist philosophies and in Aldo Leopold's "Land Ethic."…

On the Responsible Use of Communication Media for Learning

ERIC Educational Resources Information Center

Yeaman, Andrew R. J.

2009-01-01

Just as Bob Heinich states that technology makes instruction visible (1970, 1971), putting the professional ethics into practice makes technology visible. The window for social insight into teachers' professional field is open to a particular view at the present. There are learner questions surrounding the use of media which need answering and…

Ergonomics and sustainability: towards an embrace of complexity and emergence.

PubMed

Dekker, Sidney W A; Hancock, Peter A; Wilkin, Peter

2013-01-01

Technology offers a promising route to a sustainable future, and ergonomics can serve a vital role. The argument of this article is that the lasting success of sustainability initiatives in ergonomics hinges on an examination of ergonomics' own epistemology and ethics. The epistemology of ergonomics is fundamentally empiricist and positivist. This places practical constraints on its ability to address important issues such as sustainability, emergence and complexity. The implicit ethical position of ergonomics is one of neutrality, and its positivist epistemology generally puts value-laden questions outside the parameters of what it sees as scientific practice. We argue, by contrast, that a discipline that deals with both technology and human beings cannot avoid engaging with questions of complexity and emergence and seeking innovative ways of addressing these issues. Ergonomics has largely modelled its research on a reductive science, studying parts and problems to fix. In sustainability efforts, this can lead to mere local adaptations with a negative effect on global sustainability. Ergonomics must consider quality of life globally, appreciating complexity and emergent effects of local relationships.

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.

Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review.

PubMed

Salman Popattia, Amber; Winch, Sarah; La Caze, Adam

2018-04-01

The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review. Fifty-eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict. There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice-specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines. © 2018 Royal Pharmaceutical Society.

US medical researchers, the Nuremberg Doctors Trial, and the Nuremberg Code. A review of findings of the Advisory Committee on Human Radiation Experiments.

PubMed

Faden, R R; Lederer, S E; Moreno, J D

1996-11-27

The Advisory Committee on Human Radiation Experiments (ACHRE), established to review allegations of abuses of human subjects in federally sponsored radiation research, was charged with identifying appropriate standards to evaluate the ethics of cold war radiation experiments. One central question for ACHRE was to determine what role, if any, the Nuremberg Code played in the norms and practices of US medical researchers. Based on the evidence from ACHRE's Ethics Oral History Project and extensive archival research, we conclude that the Code, at the time it was promulgated, had little effect on mainstream medical researchers engaged in human subjects research. Although some clinical investigators raised questions about the conduct of research involving human beings, the medical profession did not pursue this issue until the 1960s.

The possibility of a universal declaration of biomedical ethics

PubMed Central

Hedayat, K M

2007-01-01

Statements on issues in biomedical ethics, purporting to represent international interests, have been put forth by numerous groups. Most of these groups are composed of thinkers in the tradition of European secularism, and do not take into account the values of other ethical systems. One fifth of the world's population is accounted for by Islam, which is a universal religion, with more than 1400 years of scholarship. Although many values are held in common by secular ethical systems and Islam, their inferences are different. The question, “Is it possible to derive a truly universal declaration of biomedical ethics?” is discussed here by examining the value and extent of personal autonomy in Western and Islamic biomedical ethical constructs. These constructs are then tested vis‐à‐vis the issue of abortion. It is concluded that having a universal declaration of biomedical ethics in practice is not possible, although there are many conceptual similarities and agreements between secular and Islamic value systems, unless a radical paradigm shift occurs in segments of the world's deliberative bodies. The appellation “universal” should not be used on deliberative statements unless the ethical values of all major schools of thought are satisfied. PMID:17209104

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.

Religious morality (and secular humanism) in Western civilization as precursors to medical ethics: A historic perspective

PubMed Central

Faria, Miguel A.

2015-01-01

In discussing bioethics and the formulation of neuroethics, the question has arisen as to whether secular humanism should be the sole philosophical guiding light, to the exclusion of any discussion (or even mention) of religious morality, in professional medical ethics. In addition, the question has arisen as to whether freedom or censorship should be part of medical (and neuroscience) journalism. Should independent medical journals abstain from discussing certain issues, or should only the major medical journals — i.e., the New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA) or Lancet — be heard, speaking with one “consensual,” authoritative voice? This issue is particularly important in controversial topics impacting medical politics — e.g., public health policy, socio-economics, bioethics, and the so-called redistributive justice in health care. Should all sides be heard when those controversial topics are discussed or only a consensual (monolithic) side? This historical review article discusses those issues and opts for freedom in medical and surgical practice as well as freedom in medical journalism, particularly in opinion pieces such as editorials, commentaries, or letters to the editor, as long as they relate to medicine and, in our special case, to neuroscience and neurosurgery. After answering those questions, and in response to a critical letter to the editor, this review article then expounds comprehensively on the historical and philosophical origins of ethics and religious morality. Necessarily, we discuss the Graeco-Roman legacy and the Judeo-Christian inheritance in the development of ethics and religious morality in Western civilization and their impact on moral conduct in general and on medical and neuroscience ethics in particular. PMID:26110085

Unconventional combinations of prospective parents: ethical challenges faced by IVF providers.

PubMed

Klitzman, Robert

2017-02-28

Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members), but many questions arise regarding how providers view and make decisions about these and other such arrangements. Thirty-seven ART providers and 10 patients were interviewed in-depth for approximately 1 h each. Interviews were systematically analyzed. Providers faced a range of challenges and ethical dilemmas concerning both the content and the process of decisions about requests for unconventional interfamilial and other reproductive combinations. Providers vary in how they respond - what they decide, who exactly decides (e.g., an ethics committee or not), and how - often undergoing complex decision-making processes. These combinations can involve creating or raising the child, and can shift over time - from initial ART treatment through to the child's birth. Patients' requests can vary from fully established to mere possibilities. Arrangements may also be unstable, fluid, or unexpected, posing challenges. Difficulties emerge concerning not only familial but social, combinations (e.g., between friends). These arrangements can involve blurry and confusing roles, questions about the welfare of the unborn child, and unanticipated and unfamiliar questions about how to weigh competing moral and scientific concerns - e.g., the autonomy of the individuals involved, and the potential risks and benefits. Clinicians may feel that these requests do not "smell right"; and at first respond with feelings of "yuck," and only later, carefully and explicitly consider the ethical principles involved. Proposed arrangements may, for instance, initially be felt to involve consanguineous individuals, but not in fact do so. Obtaining and verifying full and appropriate informed consent can be difficult, given implicit familial and/or cultural expectations and senses of duty. Social attitudes are changing, yet patients' views of these issues may also vary, based on their cultural backgrounds. These data, the first to examine how clinicians make decisions about unconventional reproductive arrangements, highlight several critical ethical questions and ambiguities, and variations in clinicians' responses. While several professional guidelines exist, the current data highlight additional challenges, and have vital implications for improving future guidelines, practice, education and research. Not applicable.

The viewing room: A lens for developing ethical comportment.

PubMed

McAllister, Margaret; Levett-Jones, Tracy; Petrini, Marcia A; Lasater, Kathie

2016-01-01

Healthcare is dynamic and complex, and against this background, nursing students must negotiate the transition from lay person to healthcare professional. Diverse life experiences and learning styles can further complicate this journey of transformation. The contemporary role of the nurse includes caring for and making clinical decisions about patients based on ethical principles. Learning about and integrating ethical comportment as part of the transformative journey requires nurse educators to create and implement learning experiences that challenge nursing students to think deeply and broadly about the experiences they encounter, to question their previous assumptions and prejudices, to consider the world of healthcare through a new lens, and to reflect on and learn from the process. The judicious use of film has the potential to assist students to recognize and develop ethical comportment as they prepare for real-world clinical practice experiences. In this paper, we present three film exemplars and related teaching strategies designed to facilitate transformative learning and development of ethical comportment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ethics in cryptomarket research.

PubMed

Martin, James; Christin, Nicolas

2016-09-01

The recent proliferation of cryptomarkets and the associated emergence of a sub-field of research on the anonymous web have outpaced the development of an ethical consensus regarding research methods and dissemination amongst scholars working in this unique online space. The peculiar characteristics of cryptomarket research, which often involves encryption, illegal activity, large-scale data collection, and geographical separation from research participants, challenge conventional ethical frameworks. A further complicating factor for reaching ethical consensus is the confluence of scholars drawn from a variety of academic disciplines, each with their own particular norms, practices and perspectives. This paper is intended to stimulate awareness and debate, and to prompt further reflection amongst scholars studying these fascinating online phenomena. The paper explores tensions and addresses some of the more prominent and pressing ethical questions, including public vs. private online spaces, anonymity, data sharing and ownership, risks and threats to research subjects and researchers. Also discussed is how best to balance the potential harms of cryptomarket research against benefits to the public. Copyright © 2016 Elsevier B.V. All rights reserved.

Ebola, Quarantine, and the Scale of Ethics.

PubMed

Koch, Tom

2016-08-01

The West African Ebola epidemic has raised fundamental questions about the ethical and practical use of quarantine measures during infectious disease events. This article first reviews the idea of containment in response to disease and the means by which containment has been perceived. It then proposes that disaster medicine, whose focus is the individual, and public health in its focus on populations have related but distinct ethical imperatives. The means by which both were deployed in the West African Ebola epidemic are considered. The argument is made that a narrow focus on the individual patient or community prevented an early recognition of the potential for disease expansion. In this case, a broad public health perspective was overshadowed by localized attention. In the future, a public health perspective is a necessary and ethical priority and thus the use of isolation and containment in conjunction with the imperative to treat that is the focus of medical ethics. (Disaster Med Public Health Preparedness. 2016;10:654-661).

Curriculum changes and moral issues in nursing education.

PubMed

Karseth, Berit

2004-11-01

Through history nursing education has strongly advocated the importance of educating students towards moral and ethical responsibility. In today's society however, it has become increasingly difficult to honour this concern. One peephole to capture the ongoing struggle is to look into the curriculum where different stakeholders voice different opinions. Following a social constructive perspective the curriculum texts represent specific interest among stakeholders related to nursing education in a certain historical periods. By analysing the two last versions of the curriculum we get an insight into moral and ethical issues at stake and different ways of addressing these questions. While moral and ethical issues in the curriculum of 1987 follow a disciplinary discourse emphasising the importance of learning ethical concepts and modes of arguments, the curriculum of 2000 places ethical and moral issues within an employability discourse. In this curriculum moral issues are seen as an obligation linked to students practical and technical skills. The 2000 curriculum represents a shift from emphasising the independent and reflective professional to underline the skillful and morally obliged practitioner.

Caring for one and all - Exploring ethical challenges in an ICU.

PubMed

Jones, Jennifer; Mitchell, Marion; Milligan, Eleanor

2016-08-01

This discussion paper explores some of the complex ethical and moral issues confronting contemporary critical care nurses. In contemporary healthcare discussions, there is an increased appreciation of the complexity of ethical challenges, the multiplicity of stakeholders and that a broad range of possible and practical outcomes exist. Furthermore, many scholars also acknowledge the limitations of principle based ethical frameworks. In seeking to build critical care nurses' capacity to negotiate the complex - and often conflicting - ethical challenges, the authors have adopted a person-centred, values-based approach in this case study. Furthermore, by exploring these complex issues, this paper supports and builds upon critical care nurses' decision making capacities in the clinical area. This case study has been purposefully left open-ended with the aim of inviting the reader to consider the questions posed in a collegial, collaborative manner within the particular context in which she/he is embedded. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times.

PubMed

Askitopoulou, Helen; Vgontzas, Antoniοs N

2017-10-27

The present paper discusses the relevance and significance of the Hippocratic Oath to contemporary medical ethical and moral values. It attempts to answer the questions about some controversial issues related to the Oath. The text is divided in two parts. Part I discusses the general attributes and ethical values of the Oath, while Part II presents a detailed analysis of each passage of the Oath with regard to perennial ethical principles and moral values. Part I starts with the contribution of Hippocrates and his School of Cos to medicine. It continues by examining the moral dilemmas concerning physicians and patients in the Classical Times and in the Modern World. It also investigates how the Hippocratic Oath stands nowadays, with regard to the remarkable and often revolutionary advancements in medical practice and the significant evolution in medical ethics. Further, it presents the debate and the criticism about the relevance of the general attributes and ethical values of the Oath to those of modern societies. Finally, it discusses the endurance of the ethical values of the Hippocratic Oath over the centuries until today with respect to the physicians' commitment to the practice of patient-oriented medicine. Part I concludes with the Oath's historic input in the Judgment delivered at the close of the Nuremberg "Doctors' Trial"; this Judgement has become legally binding for the discipline in the Western World and was the basis of the Nuremberg Code. The ethical code of the Oath turned out to be a fundamental part of western law not only on medical ethics but also on patients' rights regarding research.

[Single or double moral standards? Professional ethics of psychiatrists regarding self-determination, rights of third parties and involuntary treatment].

PubMed

Pollmächer, T

2015-09-01

The current intensive discussion on the legal and moral aspects of involuntary treatment of psychiatric patients raises a number of ethical issues. Physicians are unambiguously obligated to protect patient welfare and autonomy; however, in psychiatric patients disease-related restrictions in the capacity of self-determination and behaviors endangering the rights of third parties can seriously challenge this unambiguity. Therefore, psychiatry is assumed to have a double function and is also obligated to third parties and to society in general. Acceptance of such a kind of double obligation carries the risk of double moral standards, placing the psychiatrist ethically outside the community of physicians and questioning the unrestricted obligation towards the patient. The present article formulates a moral position, which places the psychiatrist, like all other physicians, exclusively on the side of the patient in terms of professional ethics and discusses the practical problems arising from this moral position.

Science, ethics and war: a pacifist's perspective.

PubMed

Kovac, Jeffrey

2013-06-01

This article considers the ethical aspects of the question: should a scientist engage in war-related research, particularly use-inspired or applied research directed at the development of the means for the better waging of war? Because scientists are simultaneously professionals, citizens of a particular country, and human beings, they are subject to conflicting moral and practical demands. There are three major philosophical views concerning the morality of war that are relevant to this discussion: realism, just war theory and pacifism. In addition, the requirements of professional codes of ethics and common morality contribute to an ethical analysis of the involvement of scientists and engineers in war-related research and technology. Because modern total warfare, which is facilitated by the work of scientists and engineers, results in the inevitable killing of innocents, it follows that most, if not all, war-related research should be considered at least as morally suspect and probably as morally prohibited.

Shattered, Suffering, and Silenced: Sharon's Story.

PubMed

Shafer, Michaela R

2016-01-01

This chapter presents a case study of a 30-year-old female news reporter in Albuquerque, New Mexico, named Sharon Fullilove. The case is presented as a personal narrative by her mother, who is a critical care nurse, former chief nurse, Level I trauma unit commander, and colonel in the U.S. Air Force. The narrative is followed by excerpts from Sharon's chart that confirm a series of decisions made by both the hospital and the providers. The subsequent narrative is meant to give the reader an opportunity to reflect on the variety of clinical ethics questions that emerge when a patient enters into a contract with a physician and hospital for care. The goal is not to perform a thorough ethical analysis of the case but to let the reader experience what it is like when best practice standards, attention to patient care, and compassionate concern for family members are set aside. The case concludes with a set of broad questions that can be used for further discussion. Hopefully, this case will bring to the forefront the centrality of ethics in professional decision-making within the context of medical care.

The effects of low doses of ionizing radiation - A question of ethics

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

Tschaeche, A.N.

1996-12-31

Three ethical questions are asked and answered about the current state of affairs concerning how those in power manipulate public understanding of the effects of low doses of ionizing radiation. The questions are as follows: (1) Is it ethical to frighten people when you do not know that there is anything to be frightened of? (2) Is it ethical to be so conservative that resources are spent to solve a problem that may not exist? (3) Is it ethical not to tell the whole truth about the effects of low levels of ionizing radiation?

Physician-Assisted Suicide and Euthanasia in the Intensive Care Unit: A Dialogue on Core Ethical Issues

PubMed Central

Goligher, Ewan C.; Ely, E. Wesley; Sulmasy, Daniel P.; Bakker, Jan; Raphael, John; Volandes, Angelo E.; Patel, Bhavesh M.; Payne, Kate; Hosie, Annmarie; Churchill, Larry; White, Douglas B.; Downar, James

2016-01-01

Objective Many patients are admitted to the intensive care unit at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia (PAS/E) holds implications for the practice of critical care medicine. The objective of this manuscript is to explore core ethical issues related to PAS/E from the perspective of healthcare professionals and ethicists on both sides of the debate. Synthesis We identified four issues highlighting the key areas of ethical tension central to evaluating PAS/E in medical practice: (1) the benefit or harm of death itself, (2) the relationship between PAS/E and withholding or withdrawing life support, (3) the morality of a physician deliberately causing death, and (4) the management of conscientious objection related to PAS/E in the critical care setting. We present areas of common ground as well as important unresolved differences. Conclusions We reached differing positions on the first three core ethical questions and achieved significant agreement on how critical care clinicians should manage conscientious objections related to PAS/E. The alternative positions presented in this paper may serve to promote open and informed dialogue within the critical care community. PMID:28098622

Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues.

PubMed

Goligher, Ewan C; Ely, E Wesley; Sulmasy, Daniel P; Bakker, Jan; Raphael, John; Volandes, Angelo E; Patel, Bhavesh M; Payne, Kate; Hosie, Annmarie; Churchill, Larry; White, Douglas B; Downar, James

2017-02-01

Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting. We present areas of common ground and important unresolved differences. We reached differing positions on the first three core ethical questions and achieved unanimity on how critical care clinicians should manage conscientious objections related to physician-assisted suicide and euthanasia. The alternative positions presented in this article may serve to promote open and informed dialogue within the critical care community.

Reflections on the ethics of recruiting foreign-trained human resources for health

PubMed Central

2011-01-01

Background Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. By attracting and/or facilitating migration for foreign-trained HHR, notably those from poorer, less well-resourced nations, recruitment practices and policies may be compromising the ability of developing countries to meet the health care needs of their own populations. Little is known, however, about actual recruitment practices. In this study we focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. Methods We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. Results and discussion We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. Conclusions We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels. PMID:21251293

Reflections on the ethics of recruiting foreign-trained human resources for health.

PubMed

Runnels, Vivien; Labonté, Ronald; Packer, Corinne

2011-01-20

Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. By attracting and/or facilitating migration for foreign-trained HHR, notably those from poorer, less well-resourced nations, recruitment practices and policies may be compromising the ability of developing countries to meet the health care needs of their own populations. Little is known, however, about actual recruitment practices. In this study we focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.

Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal.

PubMed

Adhikari, Samaj; Paudel, Kumar; Aro, Arja R; Adhikari, Tara Ballav; Adhikari, Bipin; Mishra, Shiva Raj

2016-11-08

Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal. This was a cross sectional study conducted among resident doctors (n = 118) and ward nurses (n = 86) in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer's V value was assessed to ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05. Our study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath (33 % of doctors and 51 % of nurses were unaware), Nuremberg code (90 % of both groups were unaware) and Helsinki Declaration (85 % of doctors and 88 % of nurses were unaware). A high percentage of respondents said that their major source of information on healthcare ethics were lectures (67.5 % doctors versus 56.6 % nurses), books (62.4 % doctors versus 89.2 % nurses), and journals (59 % doctors versus 89.2 % nurses). Attitude of doctors and nurses were significantly different (p < 0.05) in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula (97.4 % doctors versus 81.3 % nurses),paternalistic attitude of doctor was disagreed more by doctors (20.3 % doctors versus 9.3 % nurses). Notably, only few (9.3 % doctors versus 14.0 % nurses) doctors stood in support of physician-assisted dying. Significant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics.

Performance and palliative care: a drama module for medical students.

PubMed

Jeffrey, Ewan James; Goddard, Jen; Jeffrey, David

2012-12-01

This paper describes an innovative 2 weeks module for medical students facilitated by drama educators and a palliative medicine doctor. The module incorporates drama, end-of-life care, teamwork and reflective practice. The module contents, practical aspects of drama teaching and learning outcomes are discussed. Various themes emerged from a study of Harold Pinter's play, The Caretaker, which were relevant to clinical practice: silence, power, communication, uncertainty and unanswered questions. Drama teaching may be one way of enhancing students' confidence, increasing self- awareness, developing ethical thinking and fostering teamworking.

The forensic evaluation and report: an agenda for research.

PubMed

Buchanan, Alec; Norko, Michael

2013-01-01

The written report is a central component of forensic psychiatric practice. In the report, an evaluator assembles and organizes data, interprets results of an evaluation, and offers an opinion in response to legal questions. The past 30 years have seen substantial development in principles and practice of forensic report writing. Drawing on recent advances in the psychiatric report, the authors explore topics including narrative, forensic ethics, coercion within the justice system, and implications of limitations on data in forming forensic opinions. They offer an analysis of unanswered questions in these areas, suggesting opportunities for further empirical study and theoretical development. This proposed agenda is important in training, in the development of policy, and in establishing professional guidelines.

The right not to hear: the ethics of parental refusal of hearing rehabilitation.

PubMed

Byrd, Serena; Shuman, Andrew G; Kileny, Sharon; Kileny, Paul R

2011-08-01

To explore the ethics of parental refusal of auditory-oral hearing rehabilitation. Case study with medical ethical discussion and review. Two young brothers present with severe-to-profound congenital sensorineural hearing loss. The parents, both of whom have normal hearing and work as sign language interpreters, have decided to raise their children with American Sign Language as their only form of communication. They have chosen not to pursue cochlear implantation nor support the use of hearing aids. This case raises significant questions concerning whether hearing rehabilitation should be mandated, and if there are circumstances in which parental preferences should be questioned or overridden with regard to this issue. In addition, legal concerns may be raised regarding the possible need to file a report with Child Protective Services. Although similar cases involving the Deaf community have historically favored parental rights to forego hearing rehabilitation with either cochlear implantation or hearing aids, we explore whether conclusions should be different because the parents in this case are not hearing impaired. The ethics of parental rights to refuse hearing rehabilitation are complex and strikingly context-dependent. A comprehensive appreciation of the medical, practical, and legal issues is crucial prior to intervening in such challenging situations. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

The Right Not To Hear: The Ethics of Parental Refusal of Hearing Rehabilitation

PubMed Central

Byrd, Serena; Shuman, Andrew G.; Kileny, Sharon; Kileny, Paul R.

2015-01-01

Objective To explore the ethics of parental refusal of auditory-oral hearing rehabilitation. Study Design Case study with medical ethical discussion and review. Methods Two young brothers present with severe-to-profound congenital sensorineural hearing loss. The parents, both of whom have normal hearing and work as sign language interpreters, have decided to raise their children with American Sign Language as their only form of communication. They have chosen not to pursue cochlear implantation nor support the use of hearing aids. Discussion This case raises significant questions concerning whether hearing rehabilitation should be mandated, and if there are circumstances in which parental preferences should be questioned or overridden with regard to this issue. In addition, legal concerns may be raised regarding the possible need to file a report with child protective services. Although similar cases involving the Deaf community have historically favored parental rights to forego hearing rehabilitation with either cochlear implantation or hearing aids, we explore whether conclusions should be different because the parents in this case are not hearing impaired. Conclusions The ethics of parental rights to refuse hearing augmentation are complex and strikingly context-dependent. A comprehensive appreciation of the medical, practical and legal issues is crucial prior to intervening in such challenging situations. PMID:21792972

Tracing "Ethical Subjectivities" in Science Education: How Biology Textbooks Can Frame Ethico-Political Choices for Students

NASA Astrophysics Data System (ADS)

Bazzul, Jesse

2015-02-01

This article describes how biology textbooks can work to discursively constitute a particular kind of "ethical subjectivity." Not only do textbooks constrain the possibilities for thought and action regarding ethical issues, they also require a certain kind of "subject" to partake in ethical exercises and questions. This study looks at how ethical questions/exercises found in four Ontario textbooks require students and teachers to think and act along specific lines. These include making ethical decisions within a legal-juridical frame; deciding what kinds of research should be publically funded; optimizing personal and population health; and regulation through policy and legislation. While engaging ethical issues in these ways is useful, educators should also question the kinds of (ethical) subjectivities that are partially constituted by discourses of science education. If science education is going to address twenty-first century problems such as climate change and social inequality, educators need to address how the possibilities for ethical engagement afforded to students work to constitute specific kinds of "ethical actors."

Questions about environmental ethics: toward a research agenda with a focus on public policy

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

Deknatel, C.Y.

Despite common elements and antecedents of environmental ethics, their implied application to related policy or action is not always clear. An attempt is made to develop a set of questions and a preliminary framework for considering some of the issues raised by environmental ethics as they might appear in public policy. These examples are merely meant to illustrate the questions which surround environmental ethics and to suggest the beginnings of an approach. The goal of this approach is to clarify the properties of environmental ethics and those of specific situations to which ethics might be applied. It may then bemore » easier to say what the meaning, role, and effect of environmental ethics can be. 42 references, 2 figures.« less

Reconsidering 'ethics' and 'quality' in healthcare research: the case for an iterative ethical paradigm.

PubMed

Stevenson, Fiona A; Gibson, William; Pelletier, Caroline; Chrysikou, Vasiliki; Park, Sophie

2015-05-08

UK-based research conducted within a healthcare setting generally requires approval from the National Research Ethics Service. Research ethics committees are required to assess a vast range of proposals, differing in both their topic and methodology. We argue the methodological benchmarks with which research ethics committees are generally familiar and which form the basis of assessments of quality do not fit with the aims and objectives of many forms of qualitative inquiry and their more iterative goals of describing social processes/mechanisms and making visible the complexities of social practices. We review current debates in the literature related to ethical review and social research, and illustrate the importance of re-visiting the notion of ethics in healthcare research. We present an analysis of two contrasting paradigms of ethics. We argue that the first of these is characteristic of the ways that NHS ethics boards currently tend to operate, and the second is an alternative paradigm, that we have labelled the 'iterative' paradigm, which draws explicitly on methodological issues in qualitative research to produce an alternative vision of ethics. We suggest that there is an urgent need to re-think the ways that ethical issues are conceptualised in NHS ethical procedures. In particular, we argue that embedded in the current paradigm is a restricted notion of 'quality', which frames how ethics are developed and worked through. Specific, pre-defined outcome measures are generally seen as the traditional marker of quality, which means that research questions that focus on processes rather than on 'outcomes' may be regarded as problematic. We show that the alternative 'iterative' paradigm offers a useful starting point for moving beyond these limited views. We conclude that a 'one size fits all' standardisation of ethical procedures and approach to ethical review acts against the production of knowledge about healthcare and dramatically restricts what can be known about the social practices and conditions of healthcare. Our central argument is that assessment of ethical implications is important, but that the current paradigm does not facilitate an adequate understanding of the very issues it aims to invigilate.

Changing opinions of Mexican geneticists on ethical issues.

PubMed

Lisker, Rubén; Carnevale, Alessandra

2006-08-01

The discussion of ethical issues in the practice of medical genetics is quite recent in Mexico. However, in the present report we were able to compare the results obtained with the same instrument in two surveys performed with a 12-year interval. A semistructured questionnaire including 52 questions that explore many different situations in the form of case vignettes related to ethical dilemmas was sent on two occasions to geneticists certified by the Mexican Board of Human Genetics. The first survey was performed in 1993, obtaining a response rate of 72% (64 individuals) and the second in 2005 with a 61% response rate (86 individuals). The areas explored were fairness of access to genetic services, full disclosure of all relevant information, respect for parental choices, protection of patients' privacy, use of prenatal diagnosis only for information about the health of the fetus, voluntary vs. mandatory screening and patients' confidentiality vs. the defense of third party interests. All questions analyzed in the paper were answered by at least 80% of the geneticists surveyed, although in many instances their experience with the situation explored was limited. The complete results of the 2005 survey are given in the text and tables, whereas the 1993 results are used mainly for comparison and given in full only when practical. There was a tendency to answer general questions one way and later change opinions when confronted with specific cases. There was a clear paternalistic attitude and a generalized opinion that one of the goals of medical genetics is to diminish the proportion of individuals with genetic diseases, not for eugenics reasons, but to avoid suffering of the patients and their families. Comparison of both surveys clearly shows a tendency towards increasing respect for privacy and autonomy of the patients.

Reflexive Research Ethics for Environmental Health and Justice: Academics and Movement-Building

PubMed Central

Cordner, Alissa; Ciplet, David; Brown, Phil; Morello-Frosch, Rachel

2012-01-01

Community-engaged research on environmental problems has reshaped researcher-participant relationships, academic-community interaction, and the role of community partners in human subjects protection and ethical oversight. We draw on our own and others’ research collaborations with environmental health and justice social movement organizations to discuss the ethical concerns that emerge in community-engaged research. In this paper we introduce the concept of reflexive research ethics: ethical guidelines and decision-making principles that depend on continual reflexivity concerning the relationships between researchers and participants. Seeing ethics in this way can help scientists conduct research that simultaneously achieves a high level of professional conduct and protects the rights, well-being, and autonomy of both researchers and the multiple publics affected by research. We highlight our research with community-based organizations in Massachusetts, California, and Alaska, and discuss the potential impacts of the community or social movement on the research process and the potential impacts of research on community or social movement goals. We conclude by discussing ways in which the ethical concerns that surface in community-engaged research have led to advances in ethical research practices. This type of work raises ethical questions whose answers are broadly relevant for social movement, environmental, and public health scholars. PMID:22690133

Ethical considerations when employing fake identities in online social networks for research.

PubMed

Elovici, Yuval; Fire, Michael; Herzberg, Amir; Shulman, Haya

2014-12-01

Online social networks (OSNs) have rapidly become a prominent and widely used service, offering a wealth of personal and sensitive information with significant security and privacy implications. Hence, OSNs are also an important--and popular--subject for research. To perform research based on real-life evidence, however, researchers may need to access OSN data, such as texts and files uploaded by users and connections among users. This raises significant ethical problems. Currently, there are no clear ethical guidelines, and researchers may end up (unintentionally) performing ethically questionable research, sometimes even when more ethical research alternatives exist. For example, several studies have employed "fake identities" to collect data from OSNs, but fake identities may be used for attacks and are considered a security issue. Is it legitimate to use fake identities for studying OSNs or for collecting OSN data for research? We present a taxonomy of the ethical challenges facing researchers of OSNs and compare different approaches. We demonstrate how ethical considerations have been taken into account in previous studies that used fake identities. In addition, several possible approaches are offered to reduce or avoid ethical misconducts. We hope this work will stimulate the development and use of ethical practices and methods in the research of online social networks.

Using routinely collected health data for surveillance, quality improvement and research: Framework and key questions to assess ethics, privacy and data access.

PubMed

De Lusignan, Simon; Liyanage, Harshana; Di Iorio, Concetta Tania; Chan, Tom; Liaw, Siaw-Teng

2016-01-19

The use of health data for public health, surveillance, quality improvement and research is crucial to improve health systems and health care. However, bodies responsible for privacy and ethics often limit access to routinely collected health data. Ethical approvals, issues around protecting privacy and data access are often dealt with by different layers of regulations, making approval processes appear disjointed. To create a comprehensive framework for defining the ethical and privacy status of a project and for providing guidance on data access. The framework comprises principles and related questions. The core of the framework will be built using standard terminology definitions such as ethics-related controlled vocabularies and regional directives. It is built in this way to reduce ambiguity between different definitions. The framework is extensible: principles can be retired or added to, as can their related questions. Responses to these questions should allow data processors to define ethical issues, privacy risk and other unintended consequences. The framework contains three steps: (1) identifying possible ethical and privacy principles relevant to the project; (2) providing ethics and privacy guidance questions that inform the type of approval needed; and (3) assessing case-specific ethics and privacy issues. The outputs from this process should inform whether the balance between public interests and privacy breach and any ethical considerations are tipped in favour of societal benefits. If they are then this should be the basis on which data access is permitted. Tightly linking ethical principles to governance and data access may help maintain public trust.

Combining value of information analysis and ethical argumentation in decisions on participation of vulnerable patients in clinical research.

PubMed

van der Wilt, Gert J; Grutters, Janneke P C; Maas, Angela H E M; Rolden, Herbert J A

2018-02-05

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research.

When the "twilight of justice" meets the "dawn of nanotechnology": A critique of transhumanism and the technological imperative in the light of George Grant's moral philosophy

NASA Astrophysics Data System (ADS)

Rosales, Janna Metcalfe

This dissertation examines how contemporary Western ethical perspectives frame moral judgements about technologies intended to expand or enhance human abilities. Of particular interest are technological advances that involve nanotechnology, a realm of technoscience that seeks the precise control of matter through deliberately designing structures, devices, and processes with novel and useful properties at the molecular scale. In this thesis I analyze trends in the emerging dialogue about the social and ethical implications of nanotechnology. There is growing awareness that technological "progress" should not outpace critical reflection over the means and ends of those advances, but I argue that there is a tension between the role of ethics and the practice of technoscience. By ethics I mean ongoing public discussion that contemplates what it means to live a "good life" and that maintains limits to human actions. By contrast, the practice of technoscience appears to be guided by the "technological imperative" which holds that we can only know what is good by first figuring out what is possible. Despite concerted interdisciplinary efforts to address the broad range of ethical issues posed by nanotechnology's proposed goals, the prevailing tone of the current discussion tends to reveal what I call a "technoprogressive" bias, or the belief that technological development is a primary way to improve the human estate and that it leads inevitably to cumulative progress. However, because technoprogressive commentary on nanotechnology focuses on concerns that are framed mainly in terms of risk assessment, cost-benefit analyses, and utilitarian principles, technoprogressive ethics overlooks crucial ethical questions of a different nature, questions that deal with the limits of human action, the nature of justice, and the meaning of being human. To analyze the implications of technoprogressive ethics, I employ the moral philosophy of Canadian thinker George Grant because he articulates an underrepresented yet valuable critique of Western society's relationship with technology. Grant speaks for a type of transcendental moral realism that challenges the primacy of the technological imperative, insisting that justice ultimately must be grounded upon non-negotiable limits, and that there are objective norms to which human freedom and human self-assertion have to answer.

The Teaching of Socioscientific Issues in Interdisciplinarity Biology-philosophy, an Ethical Stake and Citizenship Issue

ERIC Educational Resources Information Center

Kacem, Saida; Simonneaux, Laurence

2009-01-01

This research starts from a relatively optimistic thinking based on the fact that the teaching of the socioscientific issues through the practice of argued debates can contribute positively towards education in scientific citizenship. The teaching of techno-sciences raises topical questions which interfere in the classroom and at the same time…

Cosmopolitan Literacies, Social Networks, and "Proper Distance": Striving to Understand in a Global World

ERIC Educational Resources Information Center

Hull, Glynda A.; Stornaiuolo, Amy

2014-01-01

How are identities as cosmopolitan citizens realized in practice, and how can dialogue be fostered across differences in culture, language, ideology, and geography? More particularly, how might young people be positioned to develop effective and ethical responses, in our digital age, to local and global concerns? Such are the questions we…

The Gandhi Project: Dialogos Philosophical Dialogues and the Ethics and Politics of Intercultural and Interfaith Friendship

ERIC Educational Resources Information Center

Helskog, Guro Hansen

2015-01-01

The overarching question addressed in this paper is the following: Can Dialogos dialogues conducted over time lead to the development of respect, mutual understanding and friendship among participants with diverse cultural and life stance backgrounds? Dialogos is a pedagogical approach to practical philosophy aimed at enhancing human maturity and…

[Ethics and ritual circumcision].

PubMed

Castagnola, C; Faix, A

2014-12-01

Circumcision dates back to ancient times, nowadays, this ritual is practiced mainly in the context of Jewish and Muslim religions. The purpose of this article is to give urologists elements of reflection on the act according to the ethical principles of autonomy, beneficence, non-maleficence and justice. According to a Kantian vision, priority should be given to the respect and wishes of the individuals. In contrast, for the utilitarian theory, circumcision can be justified by a contribution to the happiness of the majority of community members at the expense of a given few. In the event of a request for ritual circumcision, urologists find themselves in the middle, uncomfortable for some, questioning the ethics of its meaning. The main pitfall for the surgeon remains in respecting the child's autonomy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

World blindness and the medical profession: conflicting medical cultures and the ethical dilemmas of helping.

PubMed

Gray, B H

1992-01-01

This is an account of a thwarted humanitarian effort and the strategic and ethical issues that is raised. Between 14 and 17 million people in the world are blind with cataract, a condition readily corrected by surgery. In 1989 a proposal was developed to attack this problem by supplying volunteer ophthalmologists to the world's leading private voluntary organizations that carry out programs in less developed countries. The proposal was rejected. This article describes the proposal and the issues on which it foundered: cost effectiveness, appropriate technology, changing ideologies of assistance, and conflict between the cultures of medicine and public health. The account illustrates the far-flung consequences of technological change in medicine, as well as the practical and ethical questions facing organizations that carry out overseas assistance programs.

Black money in white coats: whither medical ethics?

PubMed

Chattopadhyay, Subrata

2008-01-01

There has been a sea change in the ethos of medicine in India in recent decades. Academic dishonesty of an alarming nature has been reported in medical colleges. Moral degeneration and corruption have engulfed the establishment at the highest level. The head of the Medical Council of India was found guilty of corruption and stripped of his position a few years ago. Many professors in private medical colleges draw a part of their salary as "black"money. There is little discussion on this growing malady within the profession. Professional medical associations have turned a blind eye towards unethical practices; sincere efforts to take a stand on ethical medicine are lacking. Marginalisation of ethics raises questions about the professional integrity, moral sensitivity and social responsibility of practitioners of modern medicine in India.

[Nursing ethics and new challenges].

PubMed

Barrio, I M; Molina, A; Sánchez, C M; Ayudarte, M L

2006-01-01

The nursing profession has always placed great importance on the ethical requirements linked to its activities. However, the understanding and content to these activities has evolved over the course of history. Two approaches have been developed as the principal issues of nursing ethics: the ethics of virtue and the ethics of principles. The first approach enquires into the attitudes that must be held by a person in order to act as a good nurse. The second follows an inverse course and considers the actions and principles that must be respected in order to be a good professional. An approach that harmonises both perspectives must pose the following questions: What do we understand by nursing care? On what ethical principles is this form of understanding care based? What moral attitudes are related to caring correctly? In a modern professional model, the definition and exercise of care necessarily include consideration of team work. Similarly, carrying out a good caring function, that is to say quality nursing, requires apprenticeship on the one hand, and, on the other, the assimilation of the attitudes that are required in a person involved in caring. Both elements improve the capacity of the professionals to prevent and resolve ethical conflicts in the practice of care.

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.

Pragmatic neuroethics: the social aspects of ethics in disorders of consciousness.

PubMed

Racine, Eric

2013-01-01

In this chapter, evolution of ethics and bioethics is traced to show how an abstract and individualistic paradigm was at the core of mainstream ethics prior to the advent of bioethics and applied ethics. Bioethics has transformed this individualistic paradigm because of its inherent interdisciplinarity and real-world connection. This evolution has raised questions regarding how nonabstract (e.g., experiential) and nonindividualistic (e.g., social, relational) components of ethics could be married to normative theory and ethics reflection, the latter usually not amenable to empiric research. In the first part of this chapter, pragmatism is introduced as an approach offering perspectives on the integration of social, nonindividualistic aspects of ethics, supporting the use of social science methods within ethics and neuroethics. In the second part of this chapter, using the example of disorders of consciousness, a pragmatic perspective is explored to reframe questions and help foster nonreductionistic understandings of ethical questions and ethical dilemmas. This chapter aims to generate reflections on a set of specific clinical contexts that will also stimulate a discussion on the nature of ethical approaches. © 2013 Elsevier B.V. All rights reserved.

Evaluating programs that address ideological issues: ethical and practical considerations for practitioners and evaluators.

PubMed

Lieberman, Lisa D; Fagen, Michael C; Neiger, Brad L

2014-03-01

There are important practical and ethical considerations for organizations in conducting their own, or commissioning external, evaluations and for both practitioners and evaluators, when assessing programs built on strongly held ideological or philosophical approaches. Assessing whether programs "work" has strong political, financial, and/or moral implications, particularly when expending public dollars, and may challenge objectivity about a particular program or approach. Using a case study of the evaluation of a school-based abstinence-until-marriage program, this article discusses the challenges, lessons learned, and ethical responsibilities regarding decisions about evaluation, specifically associated with ideologically driven programs. Organizations should consider various stakeholders and views associated with their program to help identify potential pitfalls in evaluation. Once identified, the program or agency needs to carefully consider its answers to two key questions: Do they want the answer and are they willing to modify the program? Having decided to evaluate, the choice of evaluator is critical to assuring that ethical principles are maintained and potential skepticism or criticism of findings can be addressed appropriately. The relationship between program and evaluator, including agreements about ownership and eventual publication and/or promotion of data, should be addressed at the outset. Programs and organizations should consider, at the outset, their ethical responsibility when findings are not expected or desired. Ultimately, agencies, organizations, and programs have an ethical responsibility to use their data to provide health promotion programs, whether ideologically founded or not, that appropriately and effectively address the problems they seek to solve.

The questions of scientific literacy and the challenges for contemporary science teaching: An ecological perspective

NASA Astrophysics Data System (ADS)

Kim, Mijung

This study began with questions about how science education can bring forth humanity and ethics to reflect increasing concerns about controversial issues of science and technology in contemporary society. Discussing and highlighting binary epistemological assumptions in science education, the study suggests embodied science learning with human subjectivity and integrity between knowledge and practice. The study questions (a) students' understandings of the relationships between STSE and their everyday lifeworld and (b) the challenges of cultivating scientific literacy through STSE teaching. In seeking to understand something about the pedagogical enactment of embodied scientific literacy that emphasizes the harmony of children's knowledges and their lifeworlds, this study employs a mindful pedagogy of hermeneutics. The intro- and intra-dialogical modes of hermeneutic understanding investigate the pedagogical relationship of parts (research texts of students, curriculum, and social milieu) and the whole (STSE teaching in contemporary time and place). The research was conducted with 86 Korean 6 graders at a public school in Seoul, Korea in 2003. Mixed methods were utilized for data collection including a survey questionnaire, a drawing activity, interviews, children's reflective writing, and classroom teaching and observation. The research findings suggest the challenges and possibilities of STSE teaching as follows: (a) children's separated knowledge from everyday practice and living, (b) children's conflicting ideas between ecological/ethical aspects and modernist values, (c) possibilities of embodied knowing in children's practice, and (d) teachers' pedagogical dilemmas in STSE teaching based on the researcher's experiences and reflection throughout teaching practice. As further discussion, this study suggests an ecological paradigm for science curriculum and teaching as a potential framework to cultivate participatory scientific literacy for citizenship in contemporary science teaching.

The ethics and politics of mindfulness-based interventions.

PubMed

Schmidt, Andreas T

2016-07-01

Recently, there has been a lot of enthusiasm for mindfulness practice and its use in healthcare, businesses and schools. An increasing number of studies give us ground for cautious optimism about the potential of mindfulness-based interventions (MBIs) to improve people's lives across a number of dimensions. This paper identifies and addresses some of the main ethical and political questions for larger-scale MBIs. First, how far are MBIs compatible with liberal neutrality given the great diversity of lifestyles and conceptions of the good characteristic of modern societies? It will be argued that the potential benefits of contemporary secular mindfulness practice are indeed of a sufficiently primary or all-purpose nature to qualify as suitable goals of liberal public policy. Second, what challenges are brought up if mindfulness is used in contexts and applications-such as military settings-whose goals seem incompatible with the ethical and soteriological views of traditional mindfulness practice? It will be argued that, given concerns regarding liberal neutrality and reasonable disagreement about ethics, MBIs should avoid strong ethical commitments. Therefore, it should, in principle, be applicable in contexts of controversial moral value. Finally, drawing on recent discussions within the mindfulness community, it is argued that we should not overstate the case for mindfulness and not crowd out discussion of organisational and social determinants of stress, lowered well-being, and mental illness and the collective measures necessary to address them. 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/

Ethical principles in the work of nurse educator-A cross-sectional study.

PubMed

Salminen, Leena; Stolt, Minna; Metsämäki, Riikka; Rinne, Jenni; Kasen, Anne; Leino-Kilpi, Helena

2016-01-01

The application of ethical principles within the teaching profession and nursing practice forms the core of the nurse educator's professional ethics. However, research focusing on the professional ethics of nurse educators is scarce. To describe ethical principles and issues relating to the work of nurse educators from the perspectives of both nurse educators themselves and nursing students. A descriptive study using cross-sectional data and content analysis. Nursing education program involving students from nine polytechnics in Finland. Nursing students (n=202) and nurse educators (n=342). Data were derived from an online survey, with two open-ended questions: Nursing students and nurse educators were asked to name the three main ethical principles that guide the work of nurse educators and also to describe ethical issues involved in the work. Students most often named professionalism, justice, and equality as the main ethical principles for a nurse educator. Nurse educators considered justice, equality, and honesty as the main ethical principles. The content analysis showed that professionalism and the relationship between educator and student were the key categories for ethical issues as perceived by nursing students. Nursing students most often identified inequality between the nurse educator and nursing student as the ethical issue faced by the nurse educator. Nursing students and nurse educators differed somewhat both in their views of the ethical principles guiding an educator's work and in the ethical issues arising in the work. Copyright © 2015 Elsevier Ltd. All rights reserved.

A call for responsibility in ethical issues for IS professionals

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

Palmiter, C.W.

1994-12-31

In recent years there has been increased interest in the ethical values, beliefs and behavior of persons in the business world. Public abhorrence of questionable behavior of politicians, the savings and loan scandal and insider trading violations are just a few examples of many problems in business and professional life. A 1992 study by the Josephson Institute of Ethics involving 9,000 young people and adults revealed alarmingly low ethical characteristics in American institutions. Ferrell and Fraedrick have concluded that {open_quotes}business ethics is one of the most important concerns in today`s business world.{close_quote} A few professional organizations have tried to comprehendmore » the ethical values, beliefs and behavior of their constituents. Vittrell has studied the frequency of ethical behavior for management information specialists. Martin and Peterson have examined the ethical issues of insider trading. Fimbel and Burstein have investigated the ethical values of technology professionals. Thornburg made use of a survey concerning the ethical beliefs and practices of human resources professionals. On a preliminary basis, these studies indicate the various ethical issues and uncertainties which are problematic for members of the various professions. Most business people are ethical segregationists, that is they tend to segregate their ethical values into one type of behavior for business and another type of behavior away from business. Managers accused of unethical behavior respond with, III am not that type of person. I am active in my church, in community affairs, a good family man, and so on.« less

Ethics and health promotion practice: exploring attitudes and practices in Western Australian health organisations.

PubMed

Reilly, T; Crawford, G; Lobo, R; Leavy, J; Jancey, J

2016-04-01

Issue addressed Evidence-informed practice underpinned by ethics is fundamental to developing the science of health promotion. Knowledge and application of ethical principles are competencies required for health promotion practice. However, these competencies are often inconsistently understood and applied. This research explored attitudes, practices, enablers and barriers related to ethics in practice in Western Australian health organisations. Methods Semistructured, in-depth interviews were conducted with 10 health promotion practitioners, purposefully selected to provide a cross-section of government and non-government organisations. Interviews were recorded, transcribed and then themed. Results The majority of participants reported consideration of ethics in their practice; however, only half reported seeking Human Research Ethics Committee (HREC) approval for projects in the past 12 months. Enablers identified as supporting ethics in practice and disseminating findings included: support preparing ethics applications; resources and training about ethical practice; ability to access HRECs for ethics approval; and a supportive organisational culture. Barriers included: limited time; insufficient resourcing and capacity; ethics approval not seen as part of core business; and concerns about academic writing. Conclusion The majority of participants were aware of the importance of ethics in practice and the dissemination of findings. However, participants reported barriers to engaging in formal ethics processes and to publishing findings. So what? Alignment of evidence-informed and ethics-based practice is critical. Resources and information about ethics may be required to support practice and encourage dissemination of findings, including in the peer-reviewed literature. Investigating the role of community-based ethics boards may be valuable to bridging the ethics-evidence gap.

Practice considerations in providing cancer risk assessment and genetic testing in women's health.

PubMed

Mahon, Suzanne M; Crecelius, Mary E

2013-01-01

Providers of women's health services are often confronted with questions about cancer genetic testing. The provision of these services is complex. The process begins with accurate risk assessment and identification of individuals who might benefit from genetic testing services. There are practice, administrative, legal, and ethical considerations that should be considered when developing policies for the referral of at-risk individuals or before deciding to provide genetic services. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

PubMed

Grignol, Valerie P; Grannan, Kevin; Sabra, John; Cromer, Robert M; Jarman, Benjamin; Dent, Daniel; Sticca, Robert P; Nelson, Timothy M; Kukora, John S; Daley, Brian J; Treat, Robert W; Termuhlen, Paula M

2013-01-01

Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear. We sought to verify these results in a multi-institutional study. A scenario-based survey describing potentially unethical activities related to the American Board of Surgery In-training Examination (ABSITE) was administered. Participants were asked about their knowledge of or participation in the activities and whether the activity was unethical. Program directors were surveyed about the use of ABSITE results for resident evaluation and promotion. Ten programs participated in the study. The resident response rate was 67% (186/277). Of the respondents, 43% felt that memorizing questions to study for future examinations was unethical and 50% felt that using questions another resident memorized was unethical. Most felt that buying (86%) or selling (79%) questions was unethical. Significantly more senior than junior residents have memorized (30% vs 16%; p = 0.04) or used questions others memorized (33% vs 12%; p = 0.002) to study for future ABSITE examinations and know of other residents who have done so (42% vs 20%; p = 0.004). Most programs used results of the ABSITE in promotion (80%) and set minimum score expectations and consequences (70%). Similar to our single-institution study, residents had not participated in activities they felt to be unethical; however the definition of what constitutes cheating remains unclear. Differences were identified between senior and junior residents with regard to memorizing questions for study. Cheating and unethical behavior is not always clear to the learner and represents an area for further education. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Postmortem procedures in the emergency department: using the recently dead to practise and teach.

PubMed Central

Iserson, K V

1993-01-01

In generations past, it was common practice for doctors to learn lifesaving technical skills on patients who had recently died. But this practice has lately been criticised on religious, legal, and ethical grounds, and has fallen into disuse in many hospitals and emergency departments. This paper uses four questions to resolve whether doctors in emergency departments should practise and teach non-invasive and minimally invasive procedures on the newly dead: Is it ethically and legally permissible to practise and teach non-invasive and minimally invasive procedures on the newly dead emergency-department patient? What are the alternatives or possible consequences of not practising non-invasive and minimally invasive procedures on newly dead patients? Is consent from relatives required? Should doctors in emergency departments allow or even encourage this use of newly dead patients? PMID:8331644

Real-time Responsiveness for Ethics Oversight During Disaster Research.

PubMed

Eckenwiler, Lisa; Pringle, John; Boulanger, Renaud; Hunt, Matthew

2015-11-01

Disaster research has grown in scope and frequency. Research in the wake of disasters and during humanitarian crises--particularly in resource-poor settings--is likely to raise profound and unique ethical challenges for local communities, crisis responders, researchers, and research ethics committees (RECs). Given the ethical challenges, many have questioned how best to provide research ethics review and oversight. We contribute to the conversation concerning how best to ensure appropriate ethical oversight in disaster research and argue that ethical disaster research requires of researchers and RECs a particular sort of ongoing, critical engagement which may not be warranted in less exceptional research. We present two cases that typify the concerns disaster researchers and RECs may confront, and elaborate upon what this ongoing engagement might look like--how it might be conceptualized and utilized--using the concept of real-time responsiveness (RTR). The central aim of RTR, understood here as both an ethical ideal and practice, is to lessen the potential for research conducted in the wake of disasters to create, perpetuate, or exacerbate vulnerabilities and contribute to injustices suffered by disaster-affected populations. Well cultivated and deployed, we believe that RTR may enhance the moral capacities of researchers and REC members, and RECs as institutions where moral agency is nurtured and sustained. © 2015 John Wiley & Sons Ltd.

Ethics and the University. Professional Ethics Series.

ERIC Educational Resources Information Center

Davis, Michael

This book brings together the closely related topics of the practice of ethics in the university, "academic ethics," and the teaching of practical, or applied, ethics in the university. The volume considers practical ethics, research ethics, the teaching of ethics, and sexual ethics as related to the university. The chapters are: (1) "The Ethics…

[DEONTOLOGICAL QUESTIONS IN PROPHYLACTIC OF ENDOSCOPIC COMPLICATIONS: THE SIGNIFICANCE OF RATIONAL AND PSYCHOLOGICAL FACTORS (analytical overview)].

PubMed

Vernik, N V; Ivantsova, M A; Yashin, D I

2015-01-01

To evaluate the ways of reduction complications during endoscopic procedures based on principals of professional ethics and improving the quality of working area. Data of fundamental literature, evidence based medicine, science publications and internet portals. Deontology is the fundamental principle of medical practice and one of the main factors of professional effectiveness. Complications in endoscopy are often the investigations of deviation from the deontological principals. The whole number of psychological factors influences on professional activity of endoscopists, where the emotional "burn-out" syndrome (EBS) occupies one of the main places. Prophylactic and timely relief of EBS serves improvement of the practical work quality. Creation of favorable working area is the strategically important task in prophylactics of endoscopy complications. The questions of practical realization of deontological principles in endoscopy are the subject of further discussion.

Captain America, Tuskegee, Belmont, and Righteous Guinea Pigs: Considering Scientific Ethics through Official and Subaltern Perspectives

NASA Astrophysics Data System (ADS)

Weinstein, Matthew

2008-09-01

With an eye towards a potential scientific ethics curriculum, this paper examines four contrasting discourses regarding the ethics of using human subjects in science. The first two represent official statements regarding ethics. These include the U.S.’s National Science Education Standards, that identify ethics with a professional code, and the Belmont Report, that conceptualizes ethics in three principles to guide research oversight boards. Contrasting this view of ethics as decorum and practice in line with a priori principles is the conception of ethics from unofficial sources representing populations who have been human subjects. The first counter-discourse examined comes from Guinea Pig Zero, an underground magazine for professional human subjects. Here ethics emerges as a question of politics over principle. The good behavior of the doctors and researchers is an effect of the politics and agency of the communities that supply science with subjects. The second counter-discourse is a comic book called Truth, which tells the story of Black soldiers who were used as guinea pigs in World War II. Ethics is both more political and more uncertain in this narrative. Science is portrayed as complicit with the racism of NAZI Germany; at the same time, and in contrast to the professional guinea pigs, neither agency nor politics are presented as effective tools for forcing the ethical conduct of the scientific establishment. The conclusion examines the value of presenting all of these views of scientific ethics in science education.

What makes public health studies ethical? Dissolving the boundary between research and practice.

PubMed

Willison, Donald J; Ondrusek, Nancy; Dawson, Angus; Emerson, Claudia; Ferris, Lorraine E; Saginur, Raphael; Sampson, Heather; Upshur, Ross

2014-08-08

The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary - whether on grounds of primary purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants - have been unsatisfactory.Public Health Ontario has eschewed this distinction between research and other evaluative activities, choosing to adopt a common framework and process to guide ethical reflection on all public health evaluative projects throughout their lifecycle - from initial planning through to knowledge exchange. The Public Health Ontario framework was developed by a working group of public health and ethics professionals and scholars, in consultation with individuals representing a wide range of public health roles. The first part of the framework interprets the existing Canadian research ethics policy statement (commonly known as the TCPS 2) through a public health lens. The second part consists of ten questions that guide the investigator in the application of the core ethical principles to public health initiatives.The framework is intended for use by those designing and executing public health evaluations, as well as those charged with ethics review of projects. The goal is to move toward a culture of ethical integrity among investigators, reviewers and decision-makers, rather than mere compliance with rules. The framework is consonant with the perspective of the learning organization and is generalizable to other public health organizations, to health services organizations, and beyond. Public Health Ontario has developed an ethics framework that is applicable to any evidence-generating activity, regardless of whether it is labelled research. While developed in a public health context, it is readily adaptable to other health services organizations and beyond.

Dr. Robert G. Heath: a controversial figure in the history of deep brain stimulation.

PubMed

O'Neal, Christen M; Baker, Cordell M; Glenn, Chad A; Conner, Andrew K; Sughrue, Michael E

2017-09-01

The history of psychosurgery is filled with tales of researchers pushing the boundaries of science and ethics. These stories often create a dark historical framework for some of the most important medical and surgical advancements. Dr. Robert G. Heath, a board-certified neurologist, psychiatrist, and psychoanalyst, holds a debated position within this framework and is most notably remembered for his research on schizophrenia. Dr. Heath was one of the first physicians to implant electrodes in deep cortical structures as a psychosurgical intervention. He used electrical stimulation in an attempt to cure patients with schizophrenia and as a method of conversion therapy in a homosexual man. This research was highly controversial, even prior to the implementation of current ethics standards for clinical research and often goes unmentioned within the historical narrative of deep brain stimulation (DBS). While distinction between the modern practice of DBS and its controversial origins is necessary, it is important to examine Dr. Heath's work as it allows for reflection on current neurosurgical practices and questioning the ethical implication of these advancements.

Informed consent in otolaryngologic surgery: case scenario from a nigerian specialist hospital.

PubMed

Afolabi, O A; Fadare, J O; Ajiboye, O T

2014-01-01

Informed consent is a foundational concept necessary for ethical conduct of clinical research and practice. It is a technical tool that shifts the autonomy to decide whether a medical procedure should be performed-from the doctor to the patient. However there is an ongoing discussion in bioethical circles on the level of comprehension of the informed consent process by the patients and research participants. We present this case vignette and the discussion afterwards to explore the question of to what extent a patient comprehends the information given to him/her before a surgical procedure is carried out. In other words, the question being asked here is how informed is informed consent in the context of oto-laryngological practice.

Why (School) Teachers Should Be Trusted. Review of "Professionalism and Ethics in Teaching" by David Carr.

ERIC Educational Resources Information Center

McPherson, Ian

2002-01-01

This book offers ways to answer questions about public trust in teachers. Discourses on teachers as transmitters of moral and cognitive virtues and on the unsatisfactory nature of competing models of theory-practice relationships are grounded in an interpretation of Aristotle's Phronesis as moral wisdom. Education is only one of the purposes of…

Minnesota Journalists as Elected Officials, 1923-1938: An Historical Study of an Ethical/Conflict of Interest Question.

ERIC Educational Resources Information Center

Dooley, Patricia L.

In an effort to document the historical evolution of journalists' political involvement and determine when it began to affect journalistic behavior, a case study examined the personal and professional lives of journalists in Minnesota practicing in the 1920s and 1930s. The study investigated whether these journalists (1) were elected to public…

The Welcoming of Levinas in the Philosophy of Education--At the Cost of the Other?

ERIC Educational Resources Information Center

Nordtug, Birgit

2013-01-01

This article focuses on the turn towards the philosopher Emmanuel Levinas's (1906-1995) ethical perspective in educational philosophy, which many theorists promise can promote an educational practice that is more sensitive of the diversity of teaching and learning, and the uniqueness of students and teachers. I call this into question by…

The evolution of ethics for community practice.

PubMed

Racher, Frances E

2007-01-01

Defining the community as client or partner requires a different ethical approach, an approach focused on the aggregate, community, or societal level. A discussion of rule ethics, virtue ethics, and feminist ethics transports the community practitioner beyond traditional ethical principles to consider a more contemporary ethical foundation for public health and community practice. Inclusion, diversity, participation, empowerment, social justice, advocacy, and interdependence create an evolving ethical foundation to support community practice. Collaboration among health care professionals and members of the organizations, communities, and societies in which they practice will facilitate the further development of moral thought and ethical theory to underpin community practice.

The Complexity of Primary Care Psychology: Theoretical Foundations.

PubMed

Smit, E H; Derksen, J J L

2015-07-01

How does primary care psychology deal with organized complexity? Has it escaped Newtonian science? Has it, as Weaver (1991) suggests, found a way to 'manage problems with many interrelated factors that cannot be dealt by statistical techniques'? Computer simulations and mathematical models in psychology are ongoing positive developments in the study of complex systems. However, the theoretical development of complex systems in psychology lags behind these advances. In this article we use complexity science to develop a theory on experienced complexity in the daily practice of primary care psychologists. We briefly answer the ontological question of what we see (from the perspective of primary care psychology) as reality, the epistemological question of what we can know, the methodological question of how to act, and the ethical question of what is good care. Following our empirical study, we conclude that complexity science can describe the experienced complexity of the psychologist and offer room for personalized client-centered care. Complexity science is slowly filling the gap between the dominant reductionist theory and complex daily practice.

Ethics of human testing.

PubMed

Salter, D C

1990-08-01

What should one do, and why? Anyone asking such questions--and everyone does so hundreds of time each day--is concerned with ethics. Product development and testing raise many ethical questions. Particularly since the rise of 'green consumerism', these are of increasing concern to people outside the cosmetics industry, and so should be of interest to those inside it. The major problem seems to be that of reaching agreement on moral and ethical issues. Overcoming this problem involves investigating what is meant by 'ethics', and how decisions depend not on facts but on 'facts-as-perceived'. These in turn depend on many factors, with one's philosophy being the most fundamental. The range of philosophical options is reviewed and it is proposed that wider discussion is the only just way to achieve agreement. Yet some things are not negotiable. There are certain key moral concepts in terms of which discussion must take place for it to be relevant. In ethics of human testing, 'respect for others', that is, avoiding exploitation, is the principal one. Some synthesis of the key moral concepts like that of Immanuel Kant is therefore recommended as the soundest and most widely acceptable basis for the necessary discussion. Defining the responsible use of human subjects covers a range of issues, moral, historical, legal and professional. For example, there may be ethical difficulties in deliberate damage induction as in SPF and irritancy testing. But above all, to avoid exploitation, there is a moral and also a legal requirement that subjects are truly volunteers. This is the basis of the concept of 'informed consent', required but not generally explained in current professional codes of practice. It is unjustified to exploit those who may be under duress, such as 'in-house volunteers' and those with low incomes. Hence in conclusion, criteria for obtaining valid informed consent are briefly reviewed. By considering issues such as these, we can help ensure that cosmetic scientists are true professionals, that is, those who recognise and are concerned with the ethical basis of their work.

Critical thinking by nurses on ethical issues like the termination of pregnancies.

PubMed

Botes, A

2000-09-01

This research forms part of a larger interdisciplinary research project on the termination of pregnancies. The focus of this part of the project is on the ethical issues related to termination of pregnancies. The practice of the professional nurse is confronted with ethical dilemmas and disputes. Whether the nurse chooses to participate in the termination of pregnancies or not, the core function of the nurse is that of counseling and ethical decision-making. Effective counseling requires empathy, respect for human rights and unconditional acceptance of a person. Making ethical decisions implies making critical decisions. It is self-evident, therefore, that such decisions should be based on sound arguments and logical reasoning. It is of vital importance that ethical decisions can be justified on rational ground. Decision-making is a critical thinking approach process for choosing the best action to meet a desired goal. The research question that is relevant for this paper is: Are nurses thinking critically about ethical issues like the termination of pregnancies? To answer the research question a qualitative, exploratory, descriptive design was used (Mouton, 1996:103-169). Registered nurses were selected purposively (Creswell, 1994:15). 1200 registered nurses completed the open-ended questionnaires. Focus group interviews were conducted with 22 registered nurses from a public hospital for women and child health services. Data analysis, using secondary data from open-ended questionnaires and transcribed focus group interviews, were based on the approach of Morse and Field (1994:25-34) and Strauss and Corbin (1990). The themes and categories from open coding were compared, conceptualized and linked with theories on critical thinking (Paul, 1994; Watson & Glaser, 1991 and the American Philosophical Association, 1990). The measures of Lincoln and Guba (1985) and Morse (1994) related to secondary data analysis were employed to ensure trustworthiness. Based on these findings the researcher concluded that nurses are not thinking critically when making ethical decisions concerning the termination of pregnancies. Recommendations are made as a possible solution for this problem.

Ethical and legal implications in IVF and prenatal diagnosis in the U.K.

PubMed

Ferguson-Smith, M E

1991-08-01

The natural desire for couples to be parents and the medical practitioner's inability to treat most genetic diseases have been responsible for some of the most exciting research into infertility and genetic disorders. This has led in the United Kingdom to the establishment of the Warnock Committee of Inquiry into Human Fertilization and its report in 1984, and to a Review of the guidance on Research Use of Fetuses and Fetal Material published in 1989 and known as the Polkinghorne Report. The Warnock Report, among other ethical issues, considers the most fundamental question which has been debated for thousands of years, namely, What is life and when does it begin? More recently, the report has been responsible for new legislation which imposes ethical and legal restrictions on the scientific and medical community. The Polkinghorne Report recommends a voluntary code of practice which is morally and ethically acceptable within our society. We are also fortunate in the U.K. to have a parliamentary structure which allows debate on such important human issues and is prepared to impose ethical restrictions.

Assessing the Growth of Ethical Banking: Some Evidence from Spanish Customers

PubMed Central

Callejas-Albiñana, Fernando E.; Martínez-Rodríguez, Isabel; Callejas-Albiñana, Ana I.; de Vidales-Carrasco, Irene M.

2017-01-01

Aristotle, who, having predated Adam Smith by 2000 years, deserves to be recognized as the world’s first economist (Solomon, 1995), distinguished between two different senses of what we call economics: oikonomikos, or household trading, which he approved of and considered essential to the working of any even slightly complex society, and chrematisike, or trade for profit, which he considered selfish and utterly devoid of virtue, calling those who engaged in such practices “parasites”. Of course, consumers do not purchase and invest for solely economic reasons (Polanyi, 1944). Interest in ethics in economics has been the subject of continuous study. In this regard, the recent financial crisis has had not only economic, but also social, psychological, political, and ethical consequences, which have impacted the financial and banking system. Consumers are no longer drawn only by the economic return but also by ethical factors. Ethical banking is on the rise. This paper aims to explain the reasons for the growth in ethical banking and to answer the following questions: can banking consumers-investors change the characterization of the banking system? Can ethical banking gain ground on traditional banking? And is ethical banking really effective? To this end, it will examine the Spanish case, using econometric causal regression models to identify the reasons why consumers decide to invest in ethical banking and determine its role in the Spanish economy. PMID:28596742

Assessing the Growth of Ethical Banking: Some Evidence from Spanish Customers.

PubMed

Callejas-Albiñana, Fernando E; Martínez-Rodríguez, Isabel; Callejas-Albiñana, Ana I; de Vidales-Carrasco, Irene M

2017-01-01

Aristotle, who, having predated Adam Smith by 2000 years, deserves to be recognized as the world's first economist (Solomon, 1995), distinguished between two different senses of what we call economics : oikonomikos , or household trading, which he approved of and considered essential to the working of any even slightly complex society, and chrematisike , or trade for profit, which he considered selfish and utterly devoid of virtue, calling those who engaged in such practices "parasites". Of course, consumers do not purchase and invest for solely economic reasons (Polanyi, 1944). Interest in ethics in economics has been the subject of continuous study. In this regard, the recent financial crisis has had not only economic, but also social, psychological, political, and ethical consequences, which have impacted the financial and banking system. Consumers are no longer drawn only by the economic return but also by ethical factors. Ethical banking is on the rise. This paper aims to explain the reasons for the growth in ethical banking and to answer the following questions: can banking consumers-investors change the characterization of the banking system? Can ethical banking gain ground on traditional banking? And is ethical banking really effective? To this end, it will examine the Spanish case, using econometric causal regression models to identify the reasons why consumers decide to invest in ethical banking and determine its role in the Spanish economy.

Relevance of the rationalist-intuitionist debate for ethics and professionalism in medical education.

PubMed

Leffel, G Michael; Oakes Mueller, Ross A; Curlin, Farr A; Yoon, John D

2015-12-01

Despite widespread pedagogical efforts to modify discrete behaviors in developing physicians, the professionalism movement has generally shied away from essential questions such as what virtues characterize the good physician, and how are those virtues formed? Although there is widespread adoption of medical ethics curricula, there is still no consensus about the primary goals of ethics education. Two prevailing perspectives dominate the literature, constituting what is sometimes referred to as the "virtue/skill dichotomy". The first perspective argues that teaching ethics is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. The second perspective suggests that teaching ethics is a means of creating virtuous physicians. The authors argue that this debate about medical ethics education mirrors the Rationalist-Intuitionist debate in contemporary moral psychology. In the following essay, the authors sketch the relevance of the Rationalist-Intuitionist debate to medical ethics and professionalism. They then outline a moral intuitionist model of virtuous caring that derives from but also extends the "social intuitionist model" of moral action and virtue. This moral intuitionist model suggests several practical implications specifically for medical character education but also for health science education in general. This approach proposes that character development is best accomplished by tuning-up (activating) moral intuitions, amplifying (intensifying) moral emotions related to intuitions, and strengthening (expanding) intuition-expressive, emotion-related moral virtues, more than by "learning" explicit ethical rules or principles.

[Nursing ethics and the access to nursing care].

PubMed

Monteverde, Settimio

2013-08-01

The increasing number of ethical issues highlighted in everyday nursing care demonstrates the connectedness between nursing ethics and nursing practice. However, what is the role of ethical theories in this context? This question will be examined in this article by analysing the contribution made by the ethics of care, in particular in understandings of gender roles, asymmetries of power, professional knowledge and experience. The adoption and criticism of an emergent nursing ethics is discussed and stated from different viewpoints. The actuality of the caring approach is affirmed by a new reading of the given situation. This article first describes the traditional perception of nurses as marginalised actors in the health sector. By making reference to the current and growing global scarcity of nursing care, it contends that nursing will no longer be marginalised, but instead at the centre of public health attention and reputation. Nevertheless, marginalisation will persist by increasingly affecting the care receivers, especially those groups that are pushed to the fringes by the consequences of the healthcare market, such as persons of extreme old age, suffering from multiple morbidities, or with poor health literacy. Whereas the "classical" understanding of the ethics of care focuses on the nurse-patient relationship and on individual care and understanding of ethics, the new understanding confirms the classical, but adds an understanding of social ethics: caring for the access to care is seen as a main ethical goal of social justice within a nursing ethic.

Photography and Social Media Use in Community-Based Participatory Research with Youth: Ethical Considerations.

PubMed

Kia-Keating, Maryam; Santacrose, Diana; Liu, Sabrina

2017-12-01

Community-based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community-based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co-producing ethical practices with one's participants. © Society for Community Research and Action 2017.

Photography and Social Media Use in Community-Based Participatory Research with Youth: Ethical Considerations

PubMed Central

Santacrose, Diana; Liu, Sabrina

2017-01-01

Community-based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community-based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co-producing ethical practices with one’s participants. PMID:28944473

What Are the Professional, Political, and Ethical Challenges of Co-Creating Health Care Systems?

PubMed

Singh, Guddi; Owens, John; Cribb, Alan

2017-11-01

Co-creation is seen by many as a means of meeting the multiple challenges facing contemporary health care systems by involving institutions, professionals, patients, and stakeholders in new roles, relationships, and collaborative practices. While co-creation has the potential to positively transform health care systems, it generates a number of political and ethical challenges that should not be overlooked. We suggest that those involved in envisioning and implementing co-creation initiatives pay close attention to significant questions of equity, power, and justice and to the fundamental challenge of securing a common vision of the aims of and agendas for health care systems. While such initiatives present significant opportunities for improvement, they need to be viewed in light of their accompanying professional, political, and ethical challenges. © 2017 American Medical Association. All Rights Reserved.

Ethical Barriers in Adolescent Oncofertility Counseling.

PubMed

Runco, Daniel V; Taylor, Julia F; Helft, Paul R

2017-01-01

Adult survivors of pediatric cancers are at substantial risk for infertility. Oncofertility is an emerging field in medicine that has focused on the fertility preservation of these patients. As the field continues to develop, there are several areas in which our practice has improved. However, several ethical concerns still exist involving beneficence, nonmaleficence, informed consent, adolescent assent, and posthumous use of reproductive tissues. Because the field is still developing, great disparities exist in available options depending on age, ability to pay, and geographic location. Such discrepancies in access may lead to health disparities in the adolescent patient population. As the science continues to make future fertility more feasible, the ethical questions will continue to be more complex. The purpose of this article is to review some of the developments regarding oncoferility and address future directions for research and inquiry in specific areas.

Learning from the Codes of the Academic Disciplines

ERIC Educational Resources Information Center

Woody, William D.

2008-01-01

Ethical questions have long been the impetus for philosophical inquiry around the world. When ethical questions arise in the classroom, during advising or in other academic settings, university and college instructors may appeal to the ethical codes within their own discipline for guidance. The materials presented in this article review…

When is informed consent required in cluster randomized trials in health research?

PubMed Central

2011-01-01

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation. This paper addresses the second of the questions posed, namely, from whom, when, and how must informed consent be obtained in CRTs in health research? The ethical principle of respect for persons implies that researchers are generally obligated to obtain the informed consent of research subjects. Aspects of CRT design, including cluster randomization, cluster level interventions, and cluster size, present challenges to obtaining informed consent. Here we address five questions related to consent and CRTs: How can a study proceed if informed consent is not possible? Is consent to randomization always required? What information must be disclosed to potential subjects if their cluster has already been randomized? Is passive consent a valid substitute for informed consent? Do health professionals have a moral obligation to participate as subjects in CRTs designed to improve professional practice? We set out a framework based on the moral foundations of informed consent and international regulatory provisions to address each of these questions. First, when informed consent is not possible, a study may proceed if a research ethics committee is satisfied that conditions for a waiver of consent are satisfied. Second, informed consent to randomization may not be required if it is not possible to approach subjects at the time of randomization. Third, when potential subjects are approached after cluster randomization, they must be provided with a detailed description of the interventions in the trial arm to which their cluster has been randomized; detailed information on interventions in other trial arms need not be provided. Fourth, while passive consent may serve a variety of practical ends, it is not a substitute for valid informed consent. Fifth, while health professionals may have a moral obligation to participate as subjects in research, this does not diminish the necessity of informed consent to study participation. PMID:21906277

The role of emotions in moral case deliberation: theory, practice, and methodology.

PubMed

Molewijk, Bert; Kleinlugtenbelt, Dick; Widdershoven, Guy

2011-09-01

In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation. According to Aristotle, emotions are an original and integral part of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method. © 2011 Blackwell Publishing Ltd.

[National Database of Genotypes--ethical and legal issues].

PubMed

Franková, Vera; Tesínová, Jolana; Brdicka, Radim

2011-01-01

National Database of Genotypes--ethical and legal issues The aim of the project National Database of Genotypes is to outline structure and rules for the database operation collecting information about genotypes of individual persons. The database should be used entirely for health care. Its purpose is to enable physicians to gain quick and easy access to the information about persons requiring specialized care due to their genetic constitution. In the future, another introduction of new genetic tests into the clinical practice can be expected thus the database of genotypes facilitates substantial financial savings by exclusion of duplicates of the expensive genetic testing. Ethical questions connected with the creating and functioning of such database concern mainly privacy protection, confidentiality of personal sensitive data, protection of database from misuse, consent with participation and public interests. Due to necessity of correct interpretation by qualified professional (= clinical geneticist), particular categorization of genetic data within the database is discussed. The function of proposed database has to be governed in concordance with the Czech legislation together with solving ethical problems.

Fallibility: a new perspective on the ethics of clinical trial enrollment.

PubMed

Shamy, Michel C F; Stahnisch, Frank W; Hill, Michael D

2015-01-01

The ethical principle of 'equipoise', introduced in 1974, represents the most widely influential justification for the enrollment of patients into randomized clinical trials. However, definitions of equipoise vary, and its terms are not universally accepted. In this paper, we suggest a new way of approaching the ethics of clinical trial enrollment, which we call fallibility. The principle of fallibility argues that all physician opinions are sufficiently uncertain to warrant investigation, and that the ethical justification for any trial becomes a question of its epistemic validity, by which we mean the strength of its hypotheses and methods. The principle of fallibility can be translated into practice through the virtues of humility, skepticism and caring. While we cite recent examples from stroke medicine to demonstrate the limitations of equipoise, we propose that fallibility may offer a more general means of addressing the controversies that arise surrounding randomized controlled trials in many disciplines of medicine. © 2014 World Stroke Organization.

Ethics expertise for health technology assessment: a Canadian national survey.

PubMed

Bond, Kenneth; Oremus, Mark; Duthie, Katherine M; Griener, Glenn G

2014-04-01

The aim of this study was to identify individuals with expertise in ethics analysis in Canada, who might contribute to health technology assessment (HTA); to gauge these individuals' familiarity with, and experience participating in, the production of HTA. A contact list was developed using the Canadian Bioethics Society membership list and faculty listings of Canadian universities, bioethics centers, and health agencies. An eighteen-question email survey was distributed to potential respondents to collect data on demographic information, education and work experience in applied ethics, and involvement in HTA. The survey response rate was 52.8 percent (350/663). Respondents worked primarily in academic institutions (50.4 percent) or hospitals (15.4 percent). Many respondents (83.1 percent) had education, formal training, or work-related experience in practical ethics related to health care, with many having a doctorate (34.5 percent) or master's degree (19.0 percent). One quarter (24.5 percent; n = 87) of respondents indicated they had been involved in an analysis of ethical issues for HTA. Almost two-thirds (65.4 percent; n = 165) of those who had not previously participated in ethics analysis believed they might usefully contribute to an analysis of ethical issues in HTA. Experts who have conducted ethics analysis in HTA had more than twice the odds of having education and training in ethics and a PhD than those who might contribute to ethics analysis. Many people have contributed to ethics analysis in HTA in Canada, and more are willing to do so. Given the absence of a reliable credential for ethics expertise, HTA producers should exercise caution when enlisting ethics experts.

[Ethical case discussions in the intensive care unit : from testing to routine].

PubMed

Meyer-Zehnder, B; Barandun Schäfer, U; Albisser Schleger, H; Reiter-Theil, S; Pargger, H

2014-06-01

The daily work of many healthcare professionals has become more complex and demanding in recent years. Apart from purely medical issues, ethical questions and problems arise quite often. Managing these problems requires ethical knowledge. Questions about the usefulness of a therapy and treatment occur especially at the end of life. So-called medical futility, a useless futile therapy, is often perceived by nurses and physicians in intensive care units who themselves often develop symptoms of depression or burnout. The clinical ethical model METAP (acronym from module, ethics, therapy decision, allocation and process) provides methods and criteria that allow the clinical team to treat and solve ethical issues according to a solution-oriented approach. The ethical decision-making of this model addresses these issues according to a series of sequential stages in the form of a so-called escalation model. When it is not possible to tackle and solve an ethical problem or dilemma in one stage, one moves to the next. The implementation of this approach in everyday practice requires the commitment of all team members in addition to certain basic conditions. In a surgical intensive care unit a fixed date in the schedule is reserved for ethical case discussions (level 3 of the escalation model). At this level a team member who has been specified according to a quarterly plan is responsible for the organization and performance of the discussion. All protocols of the 44 ethical case discussions in 41 patients between January 2011 and July 2012 were collected and summarized. A short questionnaire to all participants recorded their assessment of the benefits for the patient and the team as well as their perception of personal stress reduction. Also queried was the impact of this method on the collaboration between nurses and physicians and the ethical competence. Ethical case discussions among the care team took place regularly (44 case discussions between January 2011 and June 2012). The duration of these discussions ranged from 30 to 60 min. On average 6.2 persons took part, including 2.7 nurses and 3.2 physicians. Of the 41 patients (16 female, 25 male) for whom a discussion was carried out, 23 died during the continued hospital stay. The respondents (response rate 52 %) assessed the benefit for patients and team as high (slightly higher benefit for physicians than nurses) and 55 % of physicians and 71 % of nurses perceived a reduction in the burden of decision-making in difficult cases due to the case discussions. All physicians and 66 % of the nurses reported an improvement in the cooperation between the professional groups and 80 % of the nurses and more than half of the physicians noticed an increase in their own ethical competence. A methodically structured ethical decision-making process can and should be integrated into the clinical routine. This process requires a fixed place in everyday practice and the defined responsibility for the actual organization and performance. Support by medical and nursing management personnel is also essential for the implementation. The regular occurrence of ethical case discussions among the care team relieves the participants and improves collaboration between nurses and physicians.

Beyond procedural ethics: Foregrounding questions of justice in global health research ethics training for students

PubMed Central

Hunt, Matthew R.; Godard, Beatrice

2013-01-01

Interest in global health is growing among students across many disciplines and fields of study. In response, an increasing number of academic programmes integrate and promote opportunities for international research, service or clinical placements. These activities raise a range of ethical issues and are associated with important training needs for those who participate. In this paper, we focus on research fieldwork conducted in lower income nations by students from more affluent countries and the ethics preparation they would benefit from receiving prior to embarking on these projects. Global health research is closely associated with questions of justice and equity that extend beyond concerns of procedural ethics. Research takes place in and is shaped by matrices of political, social and cultural contexts and concerns. These realities warrant analysis and discussion during research ethics training. Training activities present an opportunity to encourage students to link global health research to questions of global justice, account for issues of justice in planning their own research, and prepare for ‘ethicsin-practice’ issues when conducting research in contexts of widespread inequality. Sustained engagement with questions of justice and equity during research ethics training will help support students for involvement in global health research. PMID:23706108

Development of a research ethics knowledge and analytical skills assessment tool.

PubMed

Taylor, Holly A; Kass, Nancy E; Ali, Joseph; Sisson, Stephen; Bertram, Amanda; Bhan, Anant

2012-04-01

The goal of this project was to develop and validate a new tool to evaluate learners' knowledge and skills related to research ethics. A core set of 50 questions from existing computer-based online teaching modules were identified, refined and supplemented to create a set of 74 multiple-choice, true/false and short answer questions. The questions were pilot-tested and item discrimination was calculated for each question. Poorly performing items were eliminated or refined. Two comparable assessment tools were created. These assessment tools were administered as a pre-test and post-test to a cohort of 58 Indian junior health research investigators before and after exposure to a new course on research ethics. Half of the investigators were exposed to the course online, the other half in person. Item discrimination was calculated for each question and Cronbach's α for each assessment tool. A final version of the assessment tool that incorporated the best questions from the pre-/post-test phase was used to assess retention of research ethics knowledge and skills 3 months after course delivery. The final version of the REKASA includes 41 items and had a Cronbach's α of 0.837. The results illustrate, in one sample of learners, the successful, systematic development and use of a knowledge and skills assessment tool in research ethics capable of not only measuring basic knowledge in research ethics and oversight but also assessing learners' ability to apply ethics knowledge to the analytical task of reasoning through research ethics cases, without reliance on essay or discussion-based examination. These promising preliminary findings should be confirmed with additional groups of learners.

A trade secret model for genomic biobanking.

PubMed

Conley, John M; Mitchell, Robert; Cadigan, R Jean; Davis, Arlene M; Dobson, Allison W; Gladden, Ryan Q

2012-01-01

Genomic biobanks present ethical challenges that are qualitatively unique and quantitatively unprecedented. Many critics have questioned whether the current system of informed consent can be meaningfully applied to genomic biobanking. Proposals for reform have come from many directions, but have tended to involve incremental change in current informed consent practice. This paper reports on our efforts to seek new ideas and approaches from those whom informed consent is designed to protect: research subjects. Our model emerged from semi-structured interviews with healthy volunteers who had been recruited to join either of two biobanks (some joined, some did not), and whom we encouraged to explain their concerns and how they understood the relationship between specimen contributors and biobanks. These subjects spoke about their DNA and the information it contains in ways that were strikingly evocative of the legal concept of the trade secret. They then described the terms and conditions under which they might let others study their DNA, and there was a compelling analogy to the commonplace practice of trade secret licensing. We propose a novel biobanking model based on this trade secret concept, and argue that it would be a practical, legal, and ethical improvement on the status quo. © 2012 American Society of Law, Medicine & Ethics, Inc.

Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective

PubMed Central

2016-01-01

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare. PMID:27775247

The Rise of Hospitalists: An Opportunity for Clinical Ethics.

PubMed

McCarthy, Matthew W; Real de Asua, Diego; Fins, Joseph J

2017-01-01

Translating ethical theories into clinical practice presents a perennial challenge to educators. While many suggestions have been put forth to bridge the theory-practice gap, none have sufficiently remedied the problem. We believe the ascendance of hospital medicine, as a dominant new force in medical education and patient care, presents a unique opportunity that could redefine the way clinical ethics is taught. The field of hospital medicine in the United States is comprised of more than 50,000 hospitalists-specialists in inpatient medicine-representing the fastest growing subspecialty in the history of medicine, and its members have emerged as a dominant new force around which medical education and patient care pivot. This evolution in medical education presents a unique opportunity for the clinical ethics community. Through their proximity to patients and trainees, hospitalists have the potential to teach medical ethics in real time on the wards, but most hospitalists have not received formal training in clinical ethics. We believe it is time to strengthen the ties between hospital medicine and medical ethics, and in this article we outline how clinical ethicists might collaborate with hospitalists to identify routine issues that do not rise to the level of an "ethics consult," but nonetheless require an intellectual grounding in normative reasoning. We use a clinical vignette to explore how this approach might enhance and broaden the scope of medical education that occurs in the inpatient setting: A patient with an intra-abdominal abscess is admitted to the academic hospitalist teaching service for drainage of the fluid, hemodynamic support, and antimicrobial therapy. During the initial encounter with the hospitalist and his team of medical students and residents, the patient reports night sweats and asks if this symptom could be due to the abscess. How should the hospitalist approach this question? Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

[Ethical aspects of pharmacological cognition enhancement and the use of psychostimulants by children and young persons].

PubMed

Walcher-Andris, Elfriede

2006-03-01

Pharmacological cognition enhancement aims at an improvement of cognitive activity and performance in healthy people by means of appropriate drugs. Ethical implications of this kind of cognition enhancement stand in need of reflection. For a number of reasons, the distinction between treatment and enhancement is fuzzy with regard to Attention Deficit Hyperactivity Disorder (ADHD). In consideration of the growing number methylphenidate prescriptions, one question addressed in this article is whether or not psychostimulants are used not only for therapy but also for cognitive enhancement by children and young people. The possibility of a "grey zone" between treatment and enhancement seems to open the field for medicalization of social and pedagogical problems as well as for "hidden enhancement." In clinical practice, the use of stimulants is associated with certain ethical problems concerning diagnosis, treatment and prevention of ADHD. Some of these problems are associated with the possibility of cognition enhancement. In order to evaluate ethical problems of pharmacological cognition enhancement, short-term and long-term consequences of stimulant use need to be taken into account. This refers to the level of transmitter balance in the learning process, to the level of individual learning strategies as well as to the level of interaction. This raises the question (1) of how well adapted the means of enhancement are with regard to the end of a comprehensive education and socialization, and (2) whether there are justifiable limits to the standardization of behavior and knowledge. (3) Moreover, stipulating an autonomous decision as a minimum prerequisite for legitimate cognition enhancement seems inadequate in the case of children and young persons. Considering the evidence and the many open questions associated with pharmacological cognition enhancement for children and young persons, it is concluded that it is indeed a morally problematic technique.

Ethics Regulation in Social Computing Research: Examining the Role of Institutional Review Boards.

PubMed

Vitak, Jessica; Proferes, Nicholas; Shilton, Katie; Ashktorab, Zahra

2017-12-01

The parallel rise of pervasive data collection platforms and computational methods for collecting, analyzing, and drawing inferences from large quantities of user data has advanced social computing research, investigating digital traces to understand mediated behaviors of individuals, groups, and societies. At the same time, methods employed to access these data have raised questions about ethical research practices. This article provides insights into U.S. institutional review boards' (IRBs) attitudes and practices regulating social computing research. Through descriptive and inferential analysis of survey data from staff at 59 IRBs at research universities, we examine how IRBs evaluate the growing variety of studies using pervasive digital data. Findings unpack the difficulties IRB staff face evaluating increasingly technical research proposals while highlighting the belief in their ability to surmount these difficulties. They also indicate a lack of consensus among IRB staff about what should be reviewed and a willingness to work closely with researchers.

Amenable to reason: Aristotle's rhetoric and the moral psychology of practical ethics.

PubMed

London, A J

2000-12-01

An Aristotelian conception of practical ethics can be derived from the account of practical reasoning that Aristotle articulates in is Rhetoric and this has important implications for the way we understand the nature and limits of practical ethics. an important feature of this conception of practical ethics is its responsiveness to the complex ways in which agents form and maintain moral commitments, and this has important implications for the debate concerning methods of ethics in applied ethics. In particular, this feature enables us to understand casuistry, narrative, and principlism as mutually supportive modes of moral inquiry, rather than divergent and mutually exclusive methods of ethics. As a result, an Aristotelian conception of practical ethics clears the conceptual common ground upon which practical ethicists can forge a stable and realistic self-understanding.

Questions of English: Ethics, Aesthetics, Rhetoric and the Formation of the Subject in England, Australia and the United States.

ERIC Educational Resources Information Center

Peel, Robin; Patterson, Annette; Gerlach, Jeanne

This book sets out to map the development of English as a subject and how it has come to encompass the diversity of ideas that currently characterize it. Drawing on a combination of historical analysis and recent research findings, it brings together and compares important new insights on curriculum development and teaching practices from England,…

Ethical questions identified in a study of local and expatriate responders' perspectives of vulnerability in the 2010 Haiti earthquake.

PubMed

Durocher, Evelyne; Chung, Ryoa; Rochon, Christiane; Henrys, Jean-Hugues; Olivier, Catherine; Hunt, Matthew

2017-09-01

Situations of disaster that prompt international humanitarian responses are rife with ethical tensions. The 2010 Haiti earthquake caused great destruction and prompted a massive humanitarian response. The widespread needs experienced by the population and the scale of the response inevitably rendered priority-setting difficult, and gave rise to ethical challenges. This paper presents four ethical questions identified in the analysis of a study on vulnerability and equity in the humanitarian response to the 2010 Haiti earthquake. Using interpretive description methodology, the interdisciplinary research team analysed 24 semi-structured in-depth interviews conducted with expatriate and Haitian health workers and decision-makers involved in the response. Ethical questions identified through the analysis were: (1) How should limited resources be allocated in situations of widespread vulnerability and elevated needs? (2) At what point does it become ethically problematic to expend (considerable) resources to sustain expatriate disaster responders? (3) How ought rapid and reactive interventions be balanced with more deliberated and coordinated approaches? (4) What trade-offs are justified when interventions to address acute needs could contribute to long-term vulnerabilities? The questions arise in light of an immense gap between available resources and widespread and elevated needs. This gap is likely unavoidable in large-scale crises and may be a source of ethical distress for both local and international responders. The analysis of ethical questions associated with crisis response can advance discussions about how relief efforts can best be designed and implemented to minimise ethical distress and improve assistance to local populations. 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/.

Environmental philosophy: from theory to practice.

PubMed

Sarkar, Sahotra

2014-03-01

Environmental philosophy is a hybrid discipline drawing extensively from epistemology, ethics, and philosophy of science and analyzing disciplines such as conservation biology, restoration ecology, sustainability studies, and political ecology. The book being discussed both provides an overview of environmental philosophy and develops an anthropocentric framework for it. That framework treats natural values as deep cultural values. Tradeoffs between natural values are analyzed using decision theory to the extent possible, leaving many interesting question for philosophical deliberation. This framework is supposed to be applicable in practical contexts. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Philosophy of psychiatry and phenomenology of everyday life: The disruptions of ordinary experience in schizophrenia].

PubMed

Troubé, Sarah

2016-12-01

The paper considers the philosophy of psychiatry from the perspective of everyday life, as a particular structure of experience. We outline some questions raised by disturbances typical of psychotic disorders with regard to a phenomenology of the everyday and common sense. As a link between philosophy and clinical psychopathology, this phenomenology implies a transcendental point of view, embedded in concrete and practical forms of ordinary experience, along with social norms. This opens the possibility of a mutual questioning between philosophy and psychiatry, drawing on its clinical, epistemological, and ethical dimensions.

Abortion and neonaticide: ethics, practice, and policy in four nations.

PubMed

Gross, Michael L

2002-06-01

Abortion, particularly later-term abortion, and neonaticide, selective non-treatment of newborns, are feasible management strategies for fetuses or newborns diagnosed with severe abnormalities. However, policy varies considerably among developed nations. This article examines abortion and neonatal policy in four nations: Israel, the US, the UK and Denmark. In Israel, late-term abortion is permitted while non-treatment of newborns is prohibited. In the US, on the other hand, later-term abortion is severely restricted, while treatment to newborns may be withdrawn. Policy in the UK and Denmark bridges some of these gaps with liberal abortion and neonatal policy. Disparate policy within and between nations creates practical and ethical difficulties. Practice diverges from policy as many practitioners find it difficult to adhere to official policy. Ethically, it is difficult to entirely justify perinatal policy in these nations. In each nation, there are elements of ethically sound policy, while other aspects cannot be defended. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. These include 1) a grant of full moral and legal status to the newborn but only partial moral and legal status to the late-term fetus 2) a general prohibition against feticide unless to save the life of the mother or prevent the birth of a fetus facing certain death or severe pain or suffering and 3) a general endorsement of neonaticide subject to a parent's assessment of the newborn's interest broadly defined to consider physical harm as well as social, psychological and or financial harm to related third parties. Policies in each of the nations surveyed diverging from these norms should be the subject of public discourse and, where possible, legislative reform.

Ethical experiential learning in medical, nursing and allied health education: A narrative review.

PubMed

Grace, Sandra; Innes, Ev; Patton, Narelle; Stockhausen, Lynette

2017-04-01

Students enrolled in medical, nursing and health science programs often participate in experiential learning in their practical classes. Experiential learning includes peer physical examination and peer-assisted learning where students practise clinical skills on each other. To identify effective strategies that enable ethical experiential learning for health students during practical classes. A narrative review of the literature. Pubmed, Cinahl and Scopus databases were searched because they include most of the health education journals where relevant articles would be published. A data extraction framework was developed to extract information from the included papers. Data were entered into a fillable form in Google Docs. Findings from identified studies were extracted to a series of tables (e.g. strategies for fostering ethical conduct; facilitators and barriers to peer-assisted learning). Themes were identified from these findings through a process of line by line coding and organisation of codes into descriptive themes using a constant comparative method. Finally understandings and hypotheses of relevance to our research question were generated from the descriptive themes. A total of 35 articles were retrieved that met the inclusion criteria. A total of 13 strategies for ethical experiential learning were identified and one evaluation was reported. The most frequently reported strategies were gaining written informed consent from students, providing information about the benefits of experiential learning and what to expect in practical classes, and facilitating discussions in class about potential issues. Contexts that facilitated participation in experiential learning included allowing students to choose their own groups, making participation voluntary, and providing adequate supervision, feedback and encouragement. A total of 13 strategies for ethical experiential learning were identified in the literature. A formal process for written consent was evaluated as effective; the effectiveness of other strategies remains to be determined. A comprehensive framework that integrates all recommendations from the literature is needed to guide future research and practise of ethical experiential learning in health courses. Copyright © 2017 Elsevier Ltd. All rights reserved.

Is inclusive education a human right?

PubMed

Gordon, John-Stewart

2013-01-01

In this article, I question the general idea that inclusive education--i.e., to teach all students in one class--is a moral human right. The following discussion shows that the widespread view in disability studies that there is a moral human right to inclusive education can be reasonably called into question by virtue of the proposed counter arguments, but without denying that inclusive education is of utmost importance. Practically speaking, the legal human right to inclusive education is of great practical value for impaired students, and for their basic right to be free from discrimination in education, since their concern thereby gains great legal and moral force. But, theoretically speaking, this particular human right lacks an attainable consensus concerning proper moral justification. © 2013 American Society of Law, Medicine & Ethics, Inc.

Participatory workplace wellness programs: reward, penalty, and regulatory conflict.

PubMed

Pomeranz, Jennifer L

2015-06-01

POLICY POINTS: Workplace wellness programs that provide incentives for completing a health risk assessment are a form of participatory programs. There are legal and ethical concerns when employers assess penalties for not completing a health risk assessment, raising questions about the voluntariness of such a program. The Departments of Treasury, Labor, and Health and Human Services' 2013 regulations for participatory programs and employers' current practices conflict with the Equal Employment Opportunity Commission's prevailing interpretation of the Americans with Disabilities Act of 1990. In keeping with the Patient Protection and Affordable Care Act, Congress revised the law related to workplace wellness programs. In June 2013, the Departments of Treasury, Labor, and Health and Human Services passed the final regulations, updating their 2006 regulatory framework. Participatory programs that reward the completion of a health risk assessment are now the most common type of wellness program in the United States. However, legal and ethical concerns emerge when employers utilize incentives that raise questions about the voluntariness of such programs. At issue is that under the Americans with Disabilities Act (ADA) of 1990, employers cannot require health-related inquiries and exams. To analyze the current interpretation of the ADA, I conducted research on both LexisNexis and federal agency websites. The resulting article evaluates the differences in the language of Congress's enabling legislation and the federal departments' regulations and how they may conflict with the ADA. It also reviews the federal government's authority to address both the legal conflict and ethical concerns related to nonvoluntary participatory programs. Employers' practices and the federal departments' regulations conflict with the current interpretation of the ADA by permitting employers to penalize employees who do not complete a health risk assessment. The departments' regulations may be interpreted as conflicting with Congress's legislation, which mentions penalties only for health-contingent wellness programs. Furthermore, the regulatory protections for employees applicable to health-contingent wellness programs do not apply to participatory programs. Either Congress or the federal agencies should address the conflict among employers' practices, the wellness regulations, and the ADA and also consider additional protections for employees. Employers can avoid ethical and legal complications by offering voluntary programs with positive incentives. © 2015 Milbank Memorial Fund.

Ethical Orientations for Understanding Business Ethics.

ERIC Educational Resources Information Center

Lewis, Phillip V.; Speck, Henry E., III

1990-01-01

Argues that history provides the necessary framework in which both to discuss and to seek answers to the three necessary and sequential questions about business ethics: (1) What is ethics and what does it mean to be ethical? (2) Why be ethical?; and (3) How can one be ethical? (SG)

[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?

WASP (Write a Scientific Paper): Special cases of selective non-treatment and/or DNR.

PubMed

Mallia, Pierre

2018-05-03

Fetuses at low gestational age limit of viability, neonates with life threatening or life limiting congenital anomalies and deteriorating acutely ill newborn babies in intensive care, pose taxing ethical questions on whether to forego or stop treatment and allow them to die naturally. Although there is essentially no ethical difference between end of life decision between neonates and other children and adults, in the former, the fact that we are dealing with a new life, may pose greater problems to staff and parents. Good communication skills and involvement of all the team and the parents should start from the beginning to see which treatment can be foregone or stopped in the best interests of the child. This article deals with the importance of clinical ethics to avoid legal and moral showdowns and discusses accepted moral practice in this difficult area. Copyright © 2018. Published by Elsevier B.V.

Toward a procedure for integrating moral issues in health technology assessment.

PubMed

Hofmann, Bjørn

2005-01-01

Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA. Literature review of existing approaches together with application of various theories in moral philosophy and axiology. The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs. The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.

Genetic secrets: Protecting privacy and confidentiality in the genetic era

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

Rothstein, M.A.

1998-07-01

Few developments are likely to affect human beings more profoundly in the long run than the discoveries resulting from advances in modern genetics. Although the developments in genetic technology promise to provide many additional benefits, their application to genetic screening poses ethical, social, and legal questions, many of which are rooted in issues of privacy and confidentiality. The ethical, practical, and legal ramifications of these and related questions are explored in depth. The broad range of topics includes: the privacy and confidentiality of genetic information; the challenges to privacy and confidentiality that may be projected to result from the emergingmore » genetic technologies; the role of informed consent in protecting the confidentiality of genetic information in the clinical setting; the potential uses of genetic information by third parties; the implications of changes in the health care delivery system for privacy and confidentiality; relevant national and international developments in public policies, professional standards, and laws; recommendations; and the identification of research needs.« less

Genetic secrets: Protecting privacy and confidentiality in the genetic era. Final report

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

Rothstein, M.A.

1998-09-01

Few developments are likely to affect human beings more profoundly in the long run than the discoveries resulting from advances in modern genetics. Although the developments in genetic technology promise to provide many additional benefits, their application to genetic screening poses ethical, social, and legal questions, many of which are rooted in issues of privacy and confidentiality. The ethical, practical, and legal ramifications of these and related questions are explored in depth. The broad range of topics includes: the privacy and confidentiality of genetic information; the challenges to privacy and confidentiality that may be projected to result from the emergingmore » genetic technologies; the role of informed consent in protecting the confidentiality of genetic information in the clinical setting; the potential uses of genetic information by third parties; the implications of changes in the health care delivery system for privacy and confidentiality; relevant national and international developments in public policies, professional standards, and laws; recommendations; and the identification of research needs.« less

Economics of Ethics in the Business of Education.

ERIC Educational Resources Information Center

Broglio, Lawrence

1992-01-01

Raises numerous questions concerning ethical dilemmas faced by theater educators from the point of view of higher education as big business. Presents four categories of questions: philosophy, pedagogy, production, and administration. (RS)

An overview of ethical frameworks in public health: can they be supportive in the evaluation of programs to prevent overweight?

PubMed Central

2010-01-01

Background The prevention of overweight sometimes raises complex ethical questions. Ethical public health frameworks may be helpful in evaluating programs or policy for overweight prevention. We give an overview of the purpose, form and contents of such public health frameworks and investigate to which extent they are useful for evaluating programs to prevent overweight and/or obesity. Methods Our search for frameworks consisted of three steps. Firstly, we asked experts in the field of ethics and public health for the frameworks they were aware of. Secondly, we performed a search in Pubmed. Thirdly, we checked literature references in the articles on frameworks we found. In total, we thus found six ethical frameworks. We assessed the area on which the available ethical frameworks focus, the users they target at, the type of policy or intervention they propose to address, and their aim. Further, we looked at their structure and content, that is, tools for guiding the analytic process, the main ethical principles or values, possible criteria for dealing with ethical conflicts, and the concrete policy issues they are applied to. Results All frameworks aim to support public health professionals or policymakers. Most of them provide a set of values or principles that serve as a standard for evaluating policy. Most frameworks articulate both the positive ethical foundations for public health and ethical constraints or concerns. Some frameworks offer analytic tools for guiding the evaluative process. Procedural guidelines and concrete criteria for solving important ethical conflicts in the particular area of the prevention of overweight or obesity are mostly lacking. Conclusions Public health ethical frameworks may be supportive in the evaluation of overweight prevention programs or policy, but seem to lack practical guidance to address ethical conflicts in this particular area. PMID:20969761

[Organ transplantation. Questions in the interface of ethics and anthropology].

PubMed

Birnbacher, D

2014-08-01

In the field of organ transplantation medical ethics is confronted with a number of problems where the particular difficulty lies in the fact that ethical and anthropological questions interpenetrate. This article discusses two of these problems in this interface both of which are highly controversial: the real or apparent contradiction between the dead-donor rule and the traditional definition of death and the real or apparent contradiction between the ethical desirability of harvesting organs from non-heart beating donors and the irreversibility of brain death.

The practice setting: site of ethical conflict for some mothers and midwives.

PubMed

Thompson, Faye E

2003-11-01

Practitioners' ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong 'action' for resolving dilemmas. They exclude context and relationship. Personal narratives of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between workplace/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics.

Empirical ethics and its alleged meta-ethical fallacies.

PubMed

de Vries, Rob; Gordijn, Bert

2009-05-01

This paper analyses the concept of empirical ethics as well as three meta-ethical fallacies that empirical ethics is said to face: the is-ought problem, the naturalistic fallacy and violation of the fact-value distinction. Moreover, it answers the question of whether empirical ethics (necessarily) commits these three basic meta-ethical fallacies.

Provider biases and choices: the role of gender.

PubMed

Wertz, D C

1993-09-01

Genetic counseling provides a unique opportunity to test the influence of gender on moral reasoning. The theories of Carol Gilligan on women's "relationship based" framework for ethical decision making were contrasted with Kohlberg's research on men's resolution of conflicts based on abstract, universal principles in an impersonal and fair manner. Discussion also focussed on the theories of sociologists, such as Kanter's that a profession prestige and income as well as the proportion of women in profession determine the approach to ethical problems. This study reports on survey data in 1985 and 1986 collected from medical geneticists in 19 countries that had at least 10 medical geneticists, with at least one available to distribute questionnaires, and the appropriate geographic distribution. The survey did not include genetic counselors and allied professionals. The questionnaire asked for responses to 14 case studies, 4 questions on genetic screening and access to test results, and 12 questions on the goals and conduct of genetic counseling. 62% responded. Sociodemographic data were also collected and analyzed in stepwise logistic regressions. THe results showed that gender was the single most important determinant of ethical decision making and ethical reasoning. There were gender differences in responses to 6 of the 14 cases and, in the US, for a 7th case: sex selection. In the US, women were 4.4 times more likely to counsel indirectly about XYY fetuses and 3.6 more likely to bring up issues like false paternity or genetic carriers in other family members. Patient autonomy was an issued in a case involving a 25-year-old woman who demanded prenatal diagnosis with no genetic or medical indications and another case involving a couple desiring a son after having 4 daughters. Rights based responses were provided by 49% and relationship based responses by 44%. Gilligan's hypothesis was not supported. Similar results were found in a survey of genetic counselors, who were 94% women. A summary of other studies involving actual practices was given. Further research is needed to determine the processes of professionals' self definition, ethical views, and extent to which views and practices are gender or profession related; training programs may affect provider attitudes.

Moral distress and the contemporary plight of health professionals.

PubMed

Austin, Wendy

2012-03-01

Once a term used primarily by moral philosophers, "moral distress" is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? "Plight" encompasses not only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of "efficiency," is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals' moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim.

Intercultural Ethics: Questions of Methods in Language and Intercultural Communication

ERIC Educational Resources Information Center

Phipps, Alison

2013-01-01

This paper explores how questions of ethics and questions of method are intertwined and unavoidable in any serious study of language and intercultural communication. It argues that the focus on difference and solution orientations to intercultural conflict has been a fundamental driver for theory, data collection and methods in the field. These…

The old faith and the new science: the Nuremberg Code and human experimentation ethics in Britain, 1946-73.

PubMed

Hazelgrove, Jenny

2002-04-01

This article explores the impact of the Nuremberg Code on post-Second World War research ethics in Britain. Against the background of the Nuremberg Medical Trial, the Code received international endorsement, but how much did its ethical percepts influence actual research? This paper shows that, despite British involvement in the formulation of the Code, the experience of war-time and changing career structures were more influential in shaping the approach of investigators to their subjects. Where medical debates ensued, primarily over controversial research practices at the British Postgraduate Medical School, Hammersmith Hospital, they were set in the context of a much older division between 'bedside' and 'scientific' medicine. But whatever differences there may have been between those physicians who advocated research and those who questioned its use and ethical basis, most clung to the paternalist assumption that it was the doctor's place to decide what was best for his patients. Faced with rising public and medical criticism of contemporary research practices, the medical élite of the 1960s and 1970s safeguarded the reputation of the profession and medical control of research by negotiating new voluntary codes. In a similar move, their predecessors had helped to negotiate the Nuremberg Code in anticipation of public criticism of experimentation arising from the Nuremberg Medical Trial.

PROBLEM-BASED LEARNING FOR PROFESSIONALISM AND ETHICS TRAINING OF BIOMEDICAL GRADUATE STUDENTS: PROCESS EVALUATION

PubMed Central

Jones, Nancy L.; Peiffer, Ann M.; Lambros, Ann; Eldridge, J. Charles

2013-01-01

Purpose A process evaluation was conducted to assess whether the newly developed Problem-Based Learning (PBL) curriculum designed to teach professionalism and ethics to biomedical graduate students was achieving its objectives. The curriculum was chosen to present realistic cases and issues in the practice of science, to promote skill development and to acculturate students to professional norms of science. Method The perception to which the objectives for the curriculum and courses were being reached was assessed using 5-step Likert-scaled questions, open-ended questions and interviews of students and facilitators. Results Process evaluation indicated that both facilitators and students perceived course objectives were being met. For example, active learning was preferred over lectures; both faculty and students percieved that the curriculum increased their understanding of norms, role obligations, and responsibilities of professional scientists; their ability to identify ethical situations was increased; skills in moral reasoning and effective group work were developed. Conclusions Information gathered was used to improve course implementation and instructional material. For example, a negative perception as an “ethics” course was addressed by redesigning case debriefing activities that reinforced learning objectives and important skills. Cases were refined to be more engaging and relevant for students, and facilitators were given more specific training and resources for each case. The PBL small group strategy can stimulate an environment more aware of ethical implications of science and increase socialization and open communication about professional behavior. PMID:20663754

Ethics of infant relinquishment, cultural considerations, and obstetric conveniences.

PubMed

Callister, Lynn Clark

2011-01-01

Ethical issues relating to infant relinquishment, caring for culturally diverse women, the importance of shared power between women and their caregivers, and the provision of evidence-based practice versus reliance on obstetric conveniences are addressed in this article. Respectful care of women relinquishing their infants including use of appropriate language demonstrates moral and ethical nursing practice; providing cultural competent care of multilinguistic, multicultural, and multiethnic childbearing women and their families is an ethical imperative. Nurses practicing ethically will foster adoption of best practices on perinatal and neonatal units, and generate a clearly articulated vision of woman and family centered organizational culture. In ethical terms, this demonstrates respect for others as well as beneficence. Promoting the use of ethical nursing practice and evidence-based practice requires that nurses identify change agents, those who are champions and facilitators of evidence-based practice, and then reward such innovators and make sure that clinical guidelines be developed based on best practices.

The Nazi engineers: reflections on technological ethics in hell.

PubMed

Katz, Eric

2011-09-01

Engineers, architects, and other technological professionals designed the genocidal death machines of the Third Reich. The death camp operations were highly efficient, so these technological professionals knew what they were doing: they were, so to speak, good engineers. As an educator at a technological university, I need to explain to my students-future engineers and architects-the motivations and ethical reasoning of the technological professionals of the Third Reich. I need to educate my students in the ethical practices of this hellish regime so that they can avoid the kind of ethical justifications used by the Nazi engineers. In their own professional lives, my former students should not only be good engineers in a technical sense, but good engineers in a moral sense. In this essay, I examine several arguments about the ethical judgments of professionals in Nazi Germany, and attempt a synthesis that can provide a lesson for contemporary engineers and other technological professionals. How does an engineer avoid the error of the Nazi engineers in their embrace of an evil ideology underlying their technological creations? How does an engineer know that the values he embodies through his technological products are good values that will lead to a better world? This last question, I believe, is the fundamental issue for the understanding of engineering ethics.

Effects of brain lesions on moral agency: ethical dilemmas in investigating moral behavior.

PubMed

Christen, Markus; Müller, Sabine

2015-01-01

Understanding how the "brain produces behavior" is a guiding idea in neuroscience. It is thus of no surprise that establishing an interrelation between brain pathology and antisocial behavior has a long history in brain research. However, interrelating the brain with moral agency--the ability to act in reference to right and wrong--is tricky with respect to therapy and rehabilitation of patients affected by brain lesions. In this contribution, we outline the complexity of the relationship between the brain and moral behavior, and we discuss ethical issues of the neuroscience of ethics and of its clinical consequences. First, we introduce a theory of moral agency and apply it to the issue of behavioral changes caused by brain lesions. Second, we present a typology of brain lesions both with respect to their cause, their temporal development, and the potential for neural plasticity allowing for rehabilitation. We exemplify this scheme with case studies and outline major knowledge gaps that are relevant for clinical practice. Third, we analyze ethical pitfalls when trying to understand the brain-morality relation. In this way, our contribution addresses both researchers in neuroscience of ethics and clinicians who treat patients affected by brain lesions to better understand the complex ethical questions, which are raised by research and therapy of brain lesion patients.

Ethics in neonatology: a look over Europe.

PubMed

Guimarães, Hercilia; Rocha, Gustavo; Almeda, Filipe; Brites, Marta; Van Goudoever, Johannes B; Iacoponi, Francesca; Bellieni, Carlo; Buonocore, Giuseppe

2012-07-01

Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision making for newborns with adverse prognosis is an ethical challenge, the ethical issues are controversial and little evidence exists on attitudes and values in Europe. to assess the attitudes of the neonatal departments in perinatal clinical practice in the hospitals of European countries. a questionnaire was send to 55 NICUs from 19 European countries. Forty five (81.8%) NICUs were Level III. Religion was Christian in 90.7% and we observed that in north countries the religion is more influent on clinical decisions (p = 0.032). Gestational age was considered with no significant difference for clinical investment. North countries consider birth weight (p = 0.011) and birth weight plus gestational age (p = 0.024) important for clinical investment. In north countries ethical questions should not prevail when the decision is made (p = 0.049) and from an ethical point of view, there is no difference between withdraw a treatment and do not initiate the treatment (p = 0.029). More hospitals in south countries administer any analgesia (p = 0.007). When the resuscitation is not successful 96.2% provide comfort care. Our study reveals that cultural and religious differences influenced ethical attitudes in NICUs of the European countries.

Ethical issues and dentists' practices with children with intellectual disability: A qualitative inquiry into a local French health network.

PubMed

Camoin, Ariane; Dany, Lionel; Tardieu, Corinne; Ruquet, Michel; Le Coz, Pierre

2018-01-29

The provision of dental care for children with intellectual disability raises many ethical questions. The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. Copyright © 2018 Elsevier Inc. All rights reserved.

Ethical issues in medical research in the developing world: a report on a meeting organised by Fondation Mérieux.

PubMed

Perrey, Christophe; Wassenaar, Douglas; Gilchrist, Shawn; Ivanoff, Bernard

2009-08-01

This paper reports on a multidisciplinary meeting held to discuss ethical issues in medical research in the developing world. Many studies, including clinical trials, are conducted in developing countries with a high burden of disease. Conditions under which this research is conducted vary because of differences in culture, public health, political, legal and social contexts specific to these countries. Research practices, including standards of care for participants, may vary as a result. It is therefore not surprising that ethical issues emerge. This meeting sought to identify and discuss these issues from the perspectives of the many actors in such research, including community representatives, with a view to finding ethical and pragmatic solutions to these issues. Dialogue between these actors was also promoted, with a view to identifying the need to develop such dialogue in future. Drawing from the experiences of the speakers, the colloquium attempted to outline some answers to several key questions characterising the field today. Experiences related to epidemiologic research, vaccine trials, drug trials, diagnostic tests and to some fundamental ethical issues in health research. Speakers were from different countries, disciplines and professions. The meeting provided a forum for consultation and debate between different ethics actors. Both encouraging findings and challenges emerged.

Lying to patients with dementia: Attitudes versus behaviours in nurses.

PubMed

Cantone, Daniela; Attena, Francesco; Cerrone, Sabrina; Fabozzi, Antonio; Rossiello, Riccardo; Spagnoli, Laura; Pelullo, Concetta Paola

2017-01-01

Using lies, in dementia care, reveals a common practice far beyond the diagnosis and prognosis, extending to the entire care process. In this article, we report results about the attitude and the behaviour of nurses towards the use of lies to patients with dementia. An epidemiological cross-sectional study was conducted between September 2016 and February 2017 in 12 elderly residential facilities and in the geriatric, psychiatric and neurological wards of six specialised hospitals of Italy's Campania Region. In all, 106 nurses compiled an attitude questionnaire (A) where the main question was 'Do you think it is ethically acceptable to use lies to patients with dementia?', instead 106 nurses compiled a behaviour questionnaire (B), where the main question was 'Have you ever used lies to patients with dementia?' Ethical considerations: Using lies in dementia care, although topic ethically still controversial, reveals a common practice far beyond the diagnosis and prognosis, extending to the entire care process. Only a small percentage of the interviewed nurses stated that they never used lies/that it is never acceptable to use lies (behaviour 10.4% and attitude 12.3%; p = 0.66). The situation in which nurses were more oriented to use lies was 'to prevent or reduce aggressive behaviors'. Indeed, only the 6.7% in the attitude group and 3.8% in the behaviour group were against using lies. On the contrary, the case in which the nurses were less oriented to use lies was 'to avoid wasting time giving explanations', in this situation were against using lies the 51.0% of the behaviour group and the 44.6% of the attitude group. Our results, according to other studies, support the hypothesis of a low propensity of nurses to ethical reflection about use of lies. In our country, the implementation of guidelines about a correct use of lie in the relationship between health operators and patients would be desirable.

Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

PubMed

Barrocas, Albert; Cohen, Michael L

2016-06-01

Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team. © 2016 American Society for Parenteral and Enteral Nutrition.

Applying for ethical approval for research: the main issues.

PubMed

Gelling, Leslie

2016-01-13

The need to obtain research ethical approval is common to all research involving human participants. This approval must be obtained before research participants can be approached and before data collection can begin. The process of ethical review is one way that research participants can be confident that possible risks have been considered, minimised and deemed acceptable. This article outlines some of the main issues researchers should consider when planning an application for research ethical approval by answering the following six questions: 'Do I need research ethical approval?', 'How many applications will I need to make?', 'Where should I apply for research ethical approval?', 'What do I need to include in my application?', 'What do research ethics committees look for?' and 'What other approvals might I need?' Answering these questions will enable researchers to navigate the ethical review process.

Principled leadership in public health: integrating ethics into practice and management.

PubMed

Bernheim, Ruth Gaare; Melnick, Alan

2008-01-01

Public health officials frequently face ethical tensions and conflicting obligations when making decisions and managing health departments. Leadership requires an ongoing approach to ethics that focuses on two dimensions of practice: the professional relationships of officials developed over time with their communities and the ethical aspects of day-to-day public health activities. Education and competencies in ethics may be helpful in practice, by providing, at a minimum, frameworks and ethical principles to help structure analysis, discussion, and decision making in health departments and with community stakeholders. Such a "practical ethics" approach in public health practice begins with a focus on public health values and an agency mission statement and integrates ethics throughout the organization by, for example, setting performance measures based on them. Using a case in emergency preparedness, this article describes ways in which ethical frameworks and the Code of Ethics can be used as tools for education and to integrate ethics into agency activities and programs.

Nurse ethical awareness: Understanding the nature of everyday practice.

PubMed

Milliken, Aimee; Grace, Pamela

2017-08-01

Much attention has been paid to the role of the nurse in recognizing and addressing ethical dilemmas. There has been less emphasis, however, on the issue of whether or not nurses understand the ethical nature of everyday practice. Awareness of the inherently ethical nature of practice is a component of nurse ethical sensitivity, which has been identified as a component of ethical decision-making. Ethical sensitivity is generally accepted as a necessary precursor to moral agency, in that recognition of the ethical content of practice is necessary before consistent action on behalf of patient interests can take place. This awareness is also compulsory in ensuring patient good by recognizing the unique interests and wishes of individuals, in line with an ethic of care. Scholarly and research literature are used to argue that bolstering ethical awareness and ensuring that nurses understand the ethical nature of the role are an obligation of the profession. Based on this line of reasoning, recommendations for education and practice, along with directions for future research, are suggested.

What makes public health studies ethical? Dissolving the boundary between research and practice

PubMed Central

2014-01-01

Background The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory. Public Health Ontario has eschewed this distinction between research and other evaluative activities, choosing to adopt a common framework and process to guide ethical reflection on all public health evaluative projects throughout their lifecycle – from initial planning through to knowledge exchange. Discussion The Public Health Ontario framework was developed by a working group of public health and ethics professionals and scholars, in consultation with individuals representing a wide range of public health roles. The first part of the framework interprets the existing Canadian research ethics policy statement (commonly known as the TCPS 2) through a public health lens. The second part consists of ten questions that guide the investigator in the application of the core ethical principles to public health initiatives. The framework is intended for use by those designing and executing public health evaluations, as well as those charged with ethics review of projects. The goal is to move toward a culture of ethical integrity among investigators, reviewers and decision-makers, rather than mere compliance with rules. The framework is consonant with the perspective of the learning organization and is generalizable to other public health organizations, to health services organizations, and beyond. Summary Public Health Ontario has developed an ethics framework that is applicable to any evidence-generating activity, regardless of whether it is labelled research. While developed in a public health context, it is readily adaptable to other health services organizations and beyond. PMID:25104180

The ethical practice of psychotherapy: easily within our reach.

PubMed

Barnett, Jeffrey E

2008-05-01

Psychotherapists confront a myriad of ethical dilemmas as they endeavor to provide effective services. This issue of the Journal of Clinical Psychology: In Session on Ethics in Psychotherapy provides psychotherapists with thoughtful reviews, case examples, and practical guidance in the major areas of ethics. Following this brief introduction, the subsequent seven articles cover Informed consent; confidentiality, privilege, and their limits; treatment of minors and their families; business matters of practice (e.g., money, fees, bartering, advertising); clinical competence and scope of practice; boundaries and nonsexual multiple relationships; and termination and abandonment. This issue is designed to promote ethical practice, to provide guidance on common ethical dilemmas, and to prevent ethical challenges before they occur.

An Analysis of Ethical Issues in Governmental Communication.

ERIC Educational Resources Information Center

Turner, John R.

A research review examined the ethical responsibilities of a communicator in contemporary American society, particularly in governmental communication. Various scholars have suggested standards of ethical governmental communication and have questioned the ethics of governmental officials in several cases. Ethical analysis of President Ronald…

Toward an ethics of psychoanalysis: a critical reading of Lacan's ethics.

PubMed

Kirshner, Lewis A

2012-12-01

Lacan's seminar The Ethics of Psychoanalysis (1959-1960) pursues, from a Freudian perspective, a fundamental philosophical question classically addressed by Aristotle's Nichomachean Ethics: How is human life best lived and fulfilled? Is there is an ethic of this type intrinsic to psychoanalysis? Lacan placed the problem of desire at the center of his Ethics. His notorious self-authorized freedom from convention and probable crossing of limits (see Roudinesco 1993) may have led mainstream analysts to ignore his admonition: "At every moment we need to know what our effective relationship is to the desire to do good, to the desire to cure" (Lacan 1959-1960, p. 219). This means that the analyst's desire, as well as the patient's, is always in play in his attempt to sustain an ethical position. An examination of Lacan's seminar highlights this link, but also points to a number of unresolved issues. The patient's desire is a complex matter, readily entangled in neurotic compromise, defense, and transference, and the analyst's commitment to it is also problematic because of the inevitable co-presence of his own desire. Lacan suggested that more emphasis be placed in training on the desire of the analyst, but beyond that a proposal is advanced for the institutionalization of a "third" as reviewer and interlocutor in routine analytic practice. Analysis may not be a discipline that can be limited to a dyadic treatment relationship.

Body Dysmorphic Disorder: Contraindication or Ethical Justification for Female Genital Cosmetic Surgery in Adolescents.

PubMed

Spriggs, Merle; Gillam, Lynn

2016-11-01

Is Female Genital Cosmetic Surgery for an adolescent with Body Dysmorphic Disorder ever ethically justified? Cosmetic genital surgery (specifically labioplasty) for adolescent girls is one of the most ethically controversial forms of cosmetic surgery and Body Dysmorphic Disorder is typically seen as a contraindication for cosmetic surgery. Two key ethical concerns are (1) that Body Dysmorphic Disorder undermines whatever capacity for autonomy the adolescent has; and (2) even if there is valid parental consent, the presence of Body Dysmorphic Disorder means that cosmetic surgery will fail in its aims. In this article, we challenge, in an evidence-based way, the standard view that Body Dysmorphic Disorder is a contraindication for genital cosmetic surgery in adolescents. Our argument gathers together and unifies a substantial amount of disparate research in the context of an ethical argument. We focus on empirical questions about benefit and harm, because these are ethically significant. Answers to these questions affect the answer to the ethical question. We question the claim that there would be no benefit from surgery in this situation, and we consider possible harms that might be done if treatment is refused. For an adolescent with Body Dysmorphic Disorder, the most important thing may be to avoid harm. We find ourselves arguing for the ethical justifiability of cosmetic labioplasty for an adolescent with Body Dysmorphic Disorder, even though we recognize that it is a counter intuitive position. We explain how we reached our conclusion. © 2016 John Wiley & Sons Ltd.

Resources to Support Ethical Practice in Evaluation: An Interview with the Director of the National Center for Research and Professional Ethics

ERIC Educational Resources Information Center

Goodyear, Leslie

2012-01-01

Where do evaluators find resources on ethics and ethical practice? This article highlights a relatively new online resource, a centerpiece project of the National Center for Professional and Research Ethics (NCPRE), which brings together information on best practices in ethics in research, academia, and business in an online portal and center. It…

An investigation of students' perceptions of ethical practice: engaging a reflective dialogue about ethics education in the health professions.

PubMed

Kinsella, Elizabeth Anne; Phelan, Shanon K; Park Lala, Anna; Mom, Vanna

2015-08-01

The ethical climate in which occupational therapists, and other health practitioners, currently practice is increasingly complex. There have been a number of calls for greater attention to ethics education within health science curricula. This study investigated occupational therapy students' perceptions of the meaning of ethical practice as a means of engaging in a dialogue about the aims of ethics education in contemporary health science contexts. A phenomenological methodological approach was adopted for the study. Interviews were conducted over 2 years with 25 student participants. The data were analyzed using phenomenological methods of analysis. Seven themes depict students' views about the meaning of ethical practice and include: being faithful to the tenets of your practice, being communicative, being in tune with your values, understanding the client's needs, weighing the pros and cons, negotiating the grey zones, and taking time to reflect. The findings contribute to understanding students' conceptions of the meaning of ethical practice that include and move beyond traditional codes, principles, and professional standards to encompass a range of dimensions of ethical practice. These additional dimensions raise insights of relevance to those who design and facilitate ethics education with health professionals.

Defining Neuromarketing: Practices and Professional Challenges

PubMed Central

Fisher, Carl Erik; Chin, Lisa; Klitzman, Robert

2011-01-01

Neuromarketing has recently generated controversies concerning the involvement of medical professionals, and many key questions remain—ones that have potentially important implications for the field of psychiatry. Conflicting definitions of neuromarketing have been proposed, and little is known about the actual practices of companies, physicians, and scientists involved in its practice. This article reviews the history of neuromarketing and uses an exploratory survey of neuromarketing Web sites to illustrate ethical issues raised by this new field. Neuromarketing, as currently practiced, is heterogeneous, as companies are offering a variety of technologies. Many companies employ academicians and professionals, but few list their clients or fees. Media coverage of neuromarketing appears disproportionately high compared to the paucity of peer-reviewed reports in the field. Companies may be making premature claims about the power of neuroscience to predict consumer behavior. Overall, neuromarketing has important implications for academic-industrial partnerships, the responsible conduct of research, and the public understanding of the brain. We explore these themes to uncover issues relevant to professional ethics, research, and policy. Of particular relevance to psychiatry, neuromarketing may be seen as an extension of the search for quantification and certainty in previously indefinite aspects of human behavior. PMID:20597593

Defining neuromarketing: practices and professional challenges.

PubMed

Fisher, Carl Erik; Chin, Lisa; Klitzman, Robert

2010-01-01

Neuromarketing has recently generated controversies concerning the involvement of medical professionals, and many key questions remain-ones that have potentially important implications for the field of psychiatry. Conflicting definitions of neuromarketing have been proposed, and little is known about the actual practices of companies, physicians, and scientists involved in its practice. This article reviews the history of neuromarketing and uses an exploratory survey of neuromarketing Web sites to illustrate ethical issues raised by this new field. Neuromarketing, as currently practiced, is heterogeneous, as companies are offering a variety of technologies. Many companies employ academicians and professionals, but few list their clients or fees. Media coverage of neuromarketing appears disproportionately high compared to the paucity of peer-reviewed reports in the field. Companies may be making premature claims about the power of neuroscience to predict consumer behavior. Overall, neuromarketing has important implications for academic-industrial partnerships, the responsible conduct of research, and the public understanding of the brain. We explore these themes to uncover issues relevant to professional ethics, research, and policy. Of particular relevance to psychiatry, neuromarketing may be seen as an extension of the search for quantification and certainty in previously indefinite aspects of human behavior.

Teaching Medical Ethics: Some Persistent Questions and Some Responses.

ERIC Educational Resources Information Center

Pellegrino, Edmund D.

1989-01-01

Issues in the inclusion of medical ethics in the medical curriculum are discussed, including its relevance, whether or not ethics can be taught, whose ethics should be taught, the contribution of the professional ethicist, and the relevance of humanistic studies outside ethics. (MSE)

Integrative Convergence in Neuroscience: Trajectories, Problems, and the Need for a Progressive Neurobioethics

NASA Astrophysics Data System (ADS)

Giordano, J.

The advanced integrative scientific convergence (AISC) model represents a viable approach to neuroscience. Beyond simple multi-disciplinarity, the AISC model unifies constituent scientific and technological fields to foster innovation, invention and new ways of addressing seemingly intractable questions. In this way, AISC can yield novel methods and foster new trajectories of knowledge and discovery, and yield new epistemologies. As stand-alone disciplines, each and all of the constituent fields generate practical and ethical issues, and their convergence may establish a unique set of both potential benefits and problems. To effectively attend to these contingencies requires pragmatic assessment of the actual capabilities and limits of neurofocal AISC, and an openness to what new knowledge and scientific/technological achievements may be produced, and how such outcomes can affect humanity, the human condition, society and the global environment. It is proposed that a progressive neurobioethics may be needed to establish both a meta-ethical framework upon which to structure ethical decisions, and a system and method of ethics that is inclusive, convergent and innovative, and in thus aligned with and meaningful to use of an AISC model in neuroscience.

Part of the fabric and mostly right: an ethnography of ethics in clinical practice.

PubMed

Doran, Evan; Fleming, Jennifer; Jordens, Christopher; Stewart, Cameron L; Letts, Julie; Kerridge, Ian H

2015-06-15

To describe how ethics is practised in a health care setting, and to ascertain whether there was interest in establishing clinical ethics support services. Observations and interviews undertaken between April and November 2012 in a large NSW urban hospital with newborn care, maternity and oncology departments and analysed by coding and categorising the data. Key themes in the participants' attitudes to professional ethics were identified. Ethics is not typically an explicit feature of clinical deliberations, and clinicians tend to apply basic ethical principles when ethical problems are identified. They also discuss difficult decisions with colleagues, and try to resolve ethical differences by discussion. Participants judged the ethics of clinical practice to be "mostly right", primarily because ethics is "part of the fabric" of everyday clinical work that aspires to "optimising care". Nevertheless, most clinicians would welcome ethics support because ethics is integral to health care practice, is not always "done well", and may be the source of conflict. Ethics is very much a part of the fabric of clinical practice, and the ethical challenges that arise in patient care in this particular setting are generally managed adequately. However, many clinicians have concerns about the ethical aspects of some practices and decisions, and believe that access to expert ethics support would be useful. Helping clinicians to provide ethically sound patient care should be a priority for health care providers across Australia.

The place for emotions in professional carers' thinking: reflections on two cases.

PubMed

Koren, E

2010-12-01

How do carers know what is right for their patient? What can they do further to relying on the two pillars of knowledge and ethics? Knowledge foregrounds rational decision-making based on scientific evidence. It allows cost-benefit rationalization and the choice of the best feasible objective. The steady advance of medical science drives responsible carers to keep their knowledge and skills up-to-date. Bioethics grants primary attention to the prevention of causing harm in general, to pursuant of patients' subjective wellbeing and to allow the latter enjoy their autonomy and to guarantee them the sense of justice. There are, however, cases where these values collide and any care decision violates one principle or another. How are carers expected to act then? This article concerns the choices made by carers, as presented and discussed in two cases. These cases deal with a clash between two principles: parenthood vs. fertility, religious rite vs. social affiliation. This class has generated an ethical dilemma. In each case carers try to justify their choices by expert knowledge and other ethical values, but later reflection reveals that the predominant element in 'solving' these dilemmas was "emotions." Professional training submits that: 'Set aside feelings in order to keep your thinking 'straight.' However, reality proves this simply infeasible. The more complex the medical-ethical situation, it is more likely that "emotions" take over. We have no choice as responsible carers but to allow our emotions the status of a factor of influence in their own right. Nowadays, a basic medical training for doctors and nurses offers an integrated body of knowledge and therapeutic skills. In addition, trainees are introduced to bioethics, supposedly sufficient to guide their future steps in their chosen profession. But how does this training in fact shape their future ethical conduct, if at all? How does it affect their ability to maintain ethical responsibility throughout therapeutic interactions? Perhaps there are other factors which govern the individual's conduct and his/her ethical responsibility? Simulation exercises were conducted, designed to induce healthcare professionals to reflect on the ethics of their own decision-making. The results demonstrated that therapeutic skills and familiarity with bioethical principles are not the sole factors governing the individual's ethical conduct. It turns out that emotions and feelings play a key part; this at once raises the question as to whether a medical training for doctors and nurses, in its current format, concerns itself with emotions and with how emotions shape a therapeutic personality. If not, then our training designers have food for thought. How can such training make trainees more aware of the power of their emotions? And, what are the ramifications on daily practice concerning ethical responsibility? Another question concerns the possible proper methods for mastering the theoretical materials and the practical techniques that promote emotional self-development?

Clinical Ethics Consultation After God: Implications for Advocacy and Neutrality.

PubMed

Parker, J Clint

2018-06-01

In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God's-eye perspective. In this paper, I focus on the implications of Engelhardt's views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants (CECs) should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt's views for this question. Finally, I discuss some of Engelhardt's foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation.

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice.

PubMed

Madani, Mansoureh; Larijani, Bagher; Madani, Ensieh; Ghasemzadeh, Nazafarin

2017-01-01

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians' practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine.

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice

PubMed Central

Madani, Mansoureh; Larijani, Bagher; Madani, Ensieh; Ghasemzadeh, Nazafarin

2017-01-01

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians’ practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine. PMID:29282423

Ethical challenges in developing drugs for psychiatric disorders.

PubMed

Carrier, Felix; Banayan, David; Boley, Randy; Karnik, Niranjan

2017-05-01

As the classification of mental disorders advances towards a disease model as promoted by the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC), there is hope that a more thorough neurobiological understanding of mental illness may allow clinicians and researchers to determine treatment efficacy with less diagnostic variability. This paradigm shift has presented a variety of ethical issues to be considered in the development of psychiatric drugs. These challenges are not limited to informed consent practices, industry funding, and placebo use. The consideration for alternative research models and quality of research design also present ethical challenges in the development of psychiatric drugs. The imperatives to create valid and sound research that justify the human time, cost, risk and use of limited resources must also be considered. Clinical innovation, and consideration for special populations are also important aspects to take into account. Based on the breadth of these ethical concerns, it is particularly important that scientific questions regarding the development of psychiatric drugs be answered collaboratively by a variety of stakeholders. As the field expands, new ethical considerations will be raised with increased focus on genetic markers, personalized medicine, patient-centered outcomes research, and tension over funding. We suggest that innovation in trial design is necessary to better reflect practices in clinical settings and that there must be an emphasized focus on expanding the transparency of consent processes, regard for suicidality, and care in working with special populations to support the goal of developing sound psychiatric drug therapies. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Conceptualizing boundaries for the professionalization of healthcare ethics practice: a call for empirical research.

PubMed

Brown, Nancy C; McGee, Summer Johnson

2014-12-01

One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Practicing healthcare ethicists in the performance of their role must navigate meanings, choices, decisions and actions embedded in complex cultural and social relationships amongst diverse individuals. In light of the evolving state of modern healthcare ethics practice and the recent move toward professionalization via certification, understanding boundary navigation in healthcare ethics practice is critical. Because healthcare ethics is endowed with many boundaries which often delineate concerns about professional expertise and authority, epistemological reflection on the relationship between theory and practice points toward the social context as relevant to the conceptualization of boundaries. The skills of social scientists may prove helpful to provide data and insights into the conceptualization and navigation of clinical ethics qua profession. Empirical ethics research, which combines empirical description (usually social scientific) with normative-ethical analysis and reflection, is a way forward as we engage and reflect upon issues which have implications for practice standards and professionalization of the role. This requires cooperative engagement of the descriptive and normative disciplines to explore our understandings of boundaries in healthcare ethics practice. This will contribute to the ongoing reflection not only as we envision the professional role but to ensure that it is enacted in practice.

Transparency ethics in practice: Revisiting financial conflicts of interest disclosure forms in clinical practice guidelines

PubMed Central

Sharara, Nour; Kaltenbach, Tonya; Laine, Loren; McQuaid, Kenneth; Soetikno, Roy; Subramanian, Venkataraman

2017-01-01

Background Authors of clinical practice guidelines (CPGs) disclose financial conflicts of interest (FCOIs) to promote transparency ethics. Typically, they do so on standard declaration forms containing generic open-ended questions on FCOIs. Yet, the literature is scant on the format and effect of alternative disclosure forms. Does supplementing a standard form with subsequent detailed disclosure forms tailored to the context of the CPG improve the yield or accuracy of FCOIs declarations? Methods For an international CPG in gastroenterology on the endoscopic surveillance for colorectal neoplasia in inflammatory bowel disease, we compared the use of a standard FCOIs disclosure form with a contextual FCOIs disclosure form that detailed commercial relations related to the CPG topic. This included manufacturers of endoscopes, endoscopy equipment and accessories. Participants completed the generic form early, and the supplementary contextual form six months later. We then compared the FCOI disclosures obtained. Findings 26 participants provided FCOIs disclosures using both disclosure forms. We found discrepancies regarding (1) the disclosure of FCOIs (presence/absence), and (2) the listing of financial entities. While the number of participants who disclosed a FCOI remained the same (30.8%) using the two forms, disclosures were not from the same individuals: two additional participants disclosed a FCOI, whereas two participants withdrew previous disclosures. Among those who reported a FCOI in either form, we noted inconsistencies in disclosures for 70% of the participants. This included changes in FCOIs disclosure status or modifications of "their commercial relations". Discussion Accurate reporting of FCOIs advances the transparency and ethical integrity of CPGs. Our experience suggests that a contextual FCOIs disclosure form tailored to content of the CPG with narrow, detailed questions provides supplementary, more complete FCOIs declarations than generic forms alone. The finding raises challenges on how forms are best written and formatted, optimally timed, and more effectively processed with sensitivity to professional behaviour, so as to heighten transparency. PMID:28841650

Philosophical methodology and strikes.

PubMed

Thomasma, David C

1991-01-01

...how do we train residents to employ ethical reasoning? This is a good question, not only for the problem of strikes, but also for all medical training. The best method is inductive, since that most closely parallels the clinical reasoning processes that define the reality of medical practice. The strengths of inductive reasoning are that it most closely matches the realities of practice, it arises from the particular circumstances of the case, and it leads to a casuistic conclusion that applies more directly than abstract reasoning models to the problem at hand. The weaknesses, though, require that inductive models include a check and balance.

[Hunger strike and forced feeding: a historical look at medical practices].

PubMed

Rieder, Jean-Pierre; Huber-Giseke, Tina; Getaz, Laurent; Kramer-Gauchat, Marie-Claire; Nyffenegger, Laurent; Gaspoz, Jean-Michel; Wolff, Hans

2010-12-01

Hunger strike is not a disease but a common situation in prisons. This article takes a historical look at medical practices in connection with the forced feeding of hunger strikers. We now know the fate of the strikers who were subjected to forced feeding. Depending on the context and the political situation in the country, the fate of these people, mostly political prisoners, is described as humiliating and abominable frequently ending in death or irreparable consequences. Particularly difficult for health professionals, this act raises clinical, ethical and legal questions and refers to the fundamental principles of medicine.

An Investigation of Students' Perceptions of Ethical Practice: Engaging a Reflective Dialogue about Ethics Education in the Health Professions

ERIC Educational Resources Information Center

Kinsella, Elizabeth Anne; Phelan, Shanon K.; Lala, Anna Park; Mom, Vanna

2015-01-01

The ethical climate in which occupational therapists, and other health practitioners, currently practice is increasingly complex. There have been a number of calls for greater attention to ethics education within health science curricula. This study investigated occupational therapy students' perceptions of the meaning of ethical practice as a…

Role of the independent donor advocacy team in ethical decision making.

PubMed

Rudow, Dianne LaPointe; Brown, Robert S

2005-09-01

Adult living donor liver transplantation has developed as a direct result of the critical shortage of deceased donors. Recent regulations passed by New York State require transplant programs to appoint an Independent Donor Advocacy Team to evaluate, educate, and consent to all potential living liver donors. Ethical issues surround the composition of the team, who appoints them, and the role the team plays in the process. Critics of living liver donation have questioned issues surrounding motivation and the ability of donors to provide true informed consent during a time of family crisis. This article will address issues surrounding the controversies and discuss how using the team can effectively evaluate and educate potential living liver donors and improve practice to ensure safety of living donors.

Guidelines for ethical and professional use of social media in a hand surgery practice.

PubMed

Lifchez, Scott D; McKee, Desirae M; Raven, Raymond B; Shafritz, Adam B; Tueting, Jonathan L

2012-12-01

In growing numbers, patients are using social media platforms as resources to obtain health information and report their experiences in the health care setting. More physicians are making use of these platforms as a means to reach prospective and existing patients, to share information with each other, and to educate the public. In this ever-expanding online dialogue, questions have arisen regarding appropriate conduct of the physician during these interactions. The purpose of this article is to review the laws that govern online communication as they pertain to physician presence in this forum and to discuss appropriate ethical and professional behavior in this setting. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The ethics of medical tourism: from the United Kingdom to India seeking medical care.

PubMed

Meghani, Zahra

2013-01-01

Is the practice of UK patients traveling to India as medical tourists morally justified? This article addresses that question by examining three ethically relevant issues. First, the key factor motivating citizens of the United Kingdom to seek medical treatment in India is identified and analyzed. Second, the life prospects of the majority of the citizens of the two nations are compared to determine whether the United Kingdom is morally warranted in relying on India to meet the medical needs of its citizens. Third, as neoliberal reforms are justified on the grounds that they will help the indigent populations affected by them, the impact of medical tourism--a neoliberal initiative--on India's socially and economically marginalized groups is scrutinized.

Ethics by opinion poll? The functions of attitudes research for normative deliberations in medical ethics.

PubMed

Salloch, Sabine; Vollmann, Jochen; Schildmann, Jan

2014-09-01

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: (a) The extent of empirical data which is needed, (b) the question of which kind of data is required and (c) the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of 'moral pragmatics'. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. 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.

Technology and its ethics in nursing and caring journals: An integrative literature review.

PubMed

Korhonen, Eila-Sisko; Nordman, Tina; Eriksson, Katie

2015-08-01

Over the past 20 years, the impact of technology has increased significantly in health care. The diversity of technology is growing and its knowledge scattered. The concept of technology is ambiguous in caring and nursing sciences and its ethics remains unidentified. To find evidence on how the concept of technology and its ethics are defined in caring and nursing sciences and practice. The purpose of this study is to describe and summarize the concept of technology and its ethics in the past nursing and caring literature. The integrative literature review of the past nursing and caring literature. The data were collected from caring and nursing journal articles from 2000 to 2013 focusing on technology and its ethics.The results were summarized and themed. Technology as a concept has three implications. First, technology is devices and products, including ICT and advanced, simple and assistive technology. Second, technology refers to a process consisting of methods for helping people. Third, technology as a service indicates the production of care by technology. The ethics of technology has not been established as a guiding principle. Some studies excluded ethical reflection completely. Many studies discussed the ethics of technology as benefits such as improved communication and symptoms management, and the simple use of e-health services whilst others remained critical presenting ethical problems such as unwillingness and the inability to use technology, or conflicts with human aspects or questions of inequality. In conclusion, this study indicates that technology as a concept is described diversely. The relation between technology and ethics is not a truism. Despite some evidence, more is needed to promote ethical care when using technology. © The Author(s) 2014.

Theoretical frameworks used to discuss ethical issues in private physiotherapy practice and proposal of a new ethical tool.

PubMed

Drolet, Marie-Josée; Hudon, Anne

2015-02-01

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

Clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland; a qualitative study.

PubMed

McSharry, Edel; Lathlean, Judith

2017-04-01

A preceptorship model of clinical teaching was introduced to support the new all-graduate nurse education programme in Ireland in 2002. Little is known about how this model impacts upon the pedagogical practices of the preceptor or student learning in clinical practice leading to question what constitutes effective teaching and learning in clinical practice at undergraduate level. This study aimed to explore the clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland and identify when best practice, based on current theoretical professional and educational principles occurred. A qualitative research study of a purposively selected sample of 13 students and 13 preceptors, working together in four clinical areas in one hospital in Ireland. Methods were semi-structured interviews, analysed thematically, complemented by documentary analysis relating to the teaching and assessment of the students. Ethical approval was gained from the hospital's Ethics Committee. Preceptor-student contact time within an empowering student-preceptor learning relationship was the foundation of effective teaching and learning and assessment. Dialoguing and talking through practice enhanced the students' knowledge and understanding, while the ability of the preceptor to ask higher order questions promoted the students' clinical reasoning and problem solving skills. Insufficient time to teach, and an over reliance on students' ability to participate in and contribute to practice with minimal guidance were found to negatively impact students' learning. Concepts such as cognitive apprenticeship, scaffolding and learning in communities of practice can be helpful in understanding the processes entailed in preceptorship. Preceptors need extensive educational preparation and support to ensure they have the pedagogical competencies necessary to provide the cognitive teaching techniques that foster professional performance and clinical reasoning. National competency based standards for preceptor preparation should be developed. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Implementation of ethics services. Opportunities and obstacles].

PubMed

Salomon, F

2015-04-01

Medical success in the last century has caused situations, in which the question arises whether therapy is right. In the same time autonomy has become more and more important. Furthermore, human beings want to decide on health, life and dying. Experience of limitations of life and desire of autonomy in healthcare lead to ethical questions. Different ethical services were established to deal with and to solve problems. Ethics committees with multiprofessional members and different qualifications will give guidance in critical decision making. Ethics services do not receive responsibility for the decision, but helps those who are responsible by structured reflection, estimation of values and including all concerned. Implementing ethics services also encounters obstructions and scepticism. Time, responsibility for therapy and criticism of customs and structures must be considered to perpetuate success. Instructions for implementing ethics services are presented.

A Heideggerian defense of therapeutic cloning.

PubMed

Svenaeus, Fredrik

2007-01-01

Debates about the legitimacy of embryonic stem-cell research have largely focused on the type of ethical value that should be accorded to the human embryo in vitro. In this paper, I try to show that, to broaden the scope of these debates, one needs to articulate an ontology that does not limit itself to biological accounts, but that instead focuses on the embryo's place in a totality of relevance surrounding and guiding a human practice. Instead of attempting to substantiate the ethical value of the embryo exclusively by pointing out that it has potentiality for personhood, one should examine the types of practices in which the embryo occurs and focus on the ends inherent to these practices. With this emphasis on context, it becomes apparent that the embryo's ethical significance can only be understood by elucidating the attitudes that are established towards it in the course of specific activities. The distinction between fertilized embryos and cloned embryos proves to be important in this contextual analysis, since, from the point of view of practice, the two types of embryos appear to belong to different human practices: (assisted) procreation and medical research, respectively. In my arguments, I highlight the concepts of practice, technology, and nature, as they have been analyzed in the phenomenological tradition, particularly by Martin Heidegger. I come to the conclusion that therapeutic cloning should be allowed, provided that it turns out to be a project that benefits medical science in its aim to battle diseases. Important precautions have to be taken, however, in order to safeguard the practice of procreation from becoming perverted by the aims and attitudes of medical science when the two practices intersect. The threat in question needs to be taken seriously, since it concerns the structure and goal of practices which are central to our very self understanding as human beings.

Institutional ethics policies on medical end-of-life decisions: a literature review.

PubMed

Lemiengre, Joke; de Casterlé, Bernadette Dierckx; Van Craen, Katleen; Schotsmans, Paul; Gastmans, Chris

2007-10-01

The responsibility of healthcare administrators for handling ethically sensitive medical practices, such as medical end-of-life decisions (MELDs), within an institutional setting has been receiving more attention. The overall aim of this paper is to thoroughly examine the prevalence, content, communication, and implementation of written institutional ethics policies on MELDs by means of a literature review. Major databases (Pubmed, Cinahl, PsycINFO, Cochrane Library, FRANCIS, and Philosopher's Index) and reference lists were systematically searched for all relevant papers. Inclusion criteria for relevance were that the study was empirically based and that it focused on the prevalence, content, communication, or implementation of written institutional ethics policies concerning MELDs. Our search yielded 19 studies of American, Canadian, Dutch and Belgian origin. The majority of studies dealt with do-not-resuscitate (DNR) policies (prevalence: 10-89%). Only Dutch and Belgian studies dealt with policies on pain and symptom control (prevalence: 15-19%) and policies on euthanasia (prevalence: 30-79%). Procedural and technical aspects were a prime focus, while the defining of the specific roles of involved parties was unclear. Little attention was given to exploring ethical principles that question the ethical function of policies. In ethics policies on euthanasia, significant consideration was given to procedures that dealt with conscientious objections of physicians and nurses. Empirical studies about the implementation of ethics policies are scarce. With regard to providing support for physicians and nurses, DNR and euthanasia policies expressed support by primarily providing technical and procedural guidelines. Further research is needed whether and in which way written institutional ethics policies on MELDs could contribute to better end-of-life care.

Politics and public health ethics in practice: right and left meet right and wrong.

PubMed

Gollust, Sarah E; Baum, Nancy M; Jacobson, Peter D

2008-01-01

As public health practitioners are no doubt aware, public health practice and politics are closely linked. Although theoretical discussion of the emerging field of public health ethics has been rich, scholars have paid little attention to the relationship between ethical issues and politics in public health practice. We conducted semistructured interviews with 45 public health practitioners across a range of occupations (eg, health officers, medical directors, sanitarians, nurses, educators, and commissioners) working at 12 local health departments across Michigan and the state health department. Practitioners were asked to describe the ethical issues they faced in their daily practice. Ethical issues that resulted from the political environment emerged as one major category of ethical issues our interviewees described. This article illustrates how political issues engender ethical challenges in 4 main areas: public health agenda-setting, political pressures, political conflicts with best practices, and the scope of public health practice. The findings suggest that politics and public health ethics intrinsically intersect, because political pressures and priorities often impose ethical challenges that practitioners negotiate in their daily work.

Ethical dilemmas experienced by speech-language pathologists working in private practice.

PubMed

Flatley, Danielle R; Kenny, Belinda J; Lincoln, Michelle A

2014-06-01

Speech-language pathologists experience ethical dilemmas as they fulfil their professional roles and responsibilities. Previous research findings indicated that speech-language pathologists working in publicly funded settings identified ethical dilemmas when they managed complex clients, negotiated professional relationships, and addressed service delivery issues. However, little is known about ethical dilemmas experienced by speech-language pathologists working in private practice settings. The aim of this qualitative study was to describe the nature of ethical dilemmas experienced by speech-language pathologists working in private practice. Data were collected through semi-structured interviews with 10 speech-language pathologists employed in diverse private practice settings. Participants explained the nature of ethical dilemmas they experienced at work and identified their most challenging and frequently occurring ethical conflicts. Qualitative content analysis was used to analyse transcribed data and generate themes. Four themes reflected the nature of speech-language pathologists' ethical dilemmas; balancing benefit and harm, fidelity of business practices, distributing funds, and personal and professional integrity. Findings support the need for professional development activities that are specifically targeted towards facilitating ethical practice for speech-language pathologists in the private sector.

Ethics Training: Facing the Tough Questions.

ERIC Educational Resources Information Center

Lee, Chris

1986-01-01

Discusses various aspects of ethics in business: recent trends in business, definitions of ethics, ways of applying the Golden Rule, management's role, educating people to think about ethics differently, beyond ethics training, making standards clear and sticking to them, and the belief that people want to do the right thing. (CT)

Cultural considerations and child maltreatment: in search of universal principles.

PubMed

Kolhatkar, Gauri; Berkowitz, Carol

2014-10-01

Cultural diversity poses challenges within the health care setting, particularly regarding the question of how health professionals can resolve the tension between respecting cultural norms or child-rearing practices and the importance of determining what constitutes harm and child maltreatment. Cultural competency and respect for cultural diversity does not imply universal tolerance of all practices. The United Nations provides a standard of universal child rights, protecting them from harmful practices. Pediatric providers must respect cross-cultural differences while maintaining legal and ethical standards of safety and wellbeing for children, promoting evidence-based prevention of maltreatment, and advocating for child wellness across all cultures. Copyright © 2014 Elsevier Inc. All rights reserved.

[Problems of study designs with randomization, blinding and placebos].

PubMed

Heusser, P

1999-04-01

As randomised double-blind trials are not rarely demanded as a prerequisite for the scientific acceptance of complementary medicine, the author has analysed the soundness of this demand on the basis of the international literature. As a result there appeared a number of methodological, practical and ethical problems which question the theoretically deduced primal value of this study design relative to the needs of medical practice and of health insurance issues. The experimental instruments of randomisation, blinding and placebo deliberately exclude essential therapeutic factors which are integral elements of complementary medical concepts; therefore, it is suggested to supplement quantitatively and collectively oriented experimental research by non-experimental procedures, which adequately reflect the context- and practice-related individual reality.

Age determination of unaccompanied asylum seeking minors in the European Union: a health law perspective.

PubMed

Abbing, Henriette D C Roscam

2011-01-01

In the European Union, unaccompanied asylum seekers below 18 years of age are entitled to specific treatment. Age assessment practices to verify the age-statement by the asylum seeker differ between EU Member States. Medical methods in use raise questions about accuracy, reliability and safety. The medical, legal and ethical acceptability of invasive methods (notably X-rays) in particular is controversial. Human rights are at stake. The lack of common practices results in different levels of protection (discrimination). The absence ofstandardisation is an obstacle for the functioning of the Common European Asylum System. EU Best Practice Guidelines should remedy the situation; such guidelines should reflect the best interest of the child.

Ethical preferences for the clinical practice of empowerment social work.

PubMed

Miley, Karla; DuBois, Brenda

2007-01-01

Social workers in health care and mental health benefit from interventions that integrate principles of contextual social work practice with standards for clinical practice. The authors articulate a conceptual framework for the ethical practice of social work that complements the social justice purpose. The sixteen ethical preferences in this framework are the ethics of care, autonomy, power, change, respect, critical thinking, praxis, discourse, critique, justice, contextual practice, inclusion, anti-oppression, advocacy, collaboration, and politicized practice.

Using typing techniques in a specific outbreak: the ethical reflection of public health professionals.

PubMed

Rump, B; Cornelis, C; Woonink, F; VAN Steenbergen, J; Verweij, M; Hulscher, M

2017-05-01

Typing techniques are laboratory methods used in outbreak management to investigate the degree to which microbes found within an outbreak are related. Knowledge about relational patterns between microbes benefits outbreak management, but inevitably also tells us something about the relational patterns of the people hosting them. Since the technique is often used without explicit consent of all individuals involved, this may raise ethical questions. The aim of this study was to unravel the complex ethical deliberation of professionals over the use of such techniques. We organised group discussions (n = 3) with Dutch outbreak managers (n = 23). The topic list was based on previously identified ethical issues and discussions were analysed for recurrent themes. We found that outbreak managers first and foremost reflect on the balance of individual harm with public health benefit. This key question was approached by way of discussing four more specific ethical themes: (1) justification of governmental intervention, (2) responsibility to prevent infections, (3) scientific uncertainty and (4) legal consequences. The themes found in this study, rephrased into accessible questions, represent the shared ethical understanding of professionals and can help to articulate the ethical dimensions of using molecular science in response to infectious disease outbreaks.

Engineering Student's Ethical Awareness and Behavior: A New Motivational Model.

PubMed

Bairaktarova, Diana; Woodcock, Anna

2017-08-01

Professional communities are experiencing scandals involving unethical and illegal practices daily. Yet it should not take a national major structure failure to highlight the importance of ethical awareness and behavior, or the need for the development and practice of ethical behavior in engineering students. Development of ethical behavior skills in future engineers is a key competency for engineering schools as ethical behavior is a part of the professional identity and practice of engineers. While engineering educators have somewhat established instructional methods to teach engineering ethics, they still rely heavily on teaching ethical awareness, and pay little attention to how well ethical awareness predicts ethical behavior. However the ability to exercise ethical judgement does not mean that students are ethically educated or likely to behave in an ethical manner. This paper argues measuring ethical judgment is insufficient for evaluating the teaching of engineering ethics, because ethical awareness has not been demonstrated to translate into ethical behavior. The focus of this paper is to propose a model that correlates with both, ethical awareness and ethical behavior. This model integrates the theory of planned behavior, person and thing orientation, and spheres of control. Applying this model will allow educators to build confidence and trust in their students' ability to build a professional identity and be prepared for the engineering profession and practice.

Philosophy of Healthcare Ethics Practice Statements: Quality Attestation and Beyond.

PubMed

Notini, Lauren

2018-06-13

One element of the American Society for Bioethics and Humanities' recently-piloted quality attestation portfolio for clinical ethics consultants is a "philosophy of clinical ethics consultation statement" describing the candidate's approach to clinical ethics consultation. To date, these statements have been under-explored in the literature, in contrast to philosophy statements in other fields such as academic teaching. In this article, I argue there is merit in expanding the content of these statements beyond clinical ethics consultation alone to describe the author's approach to other important "domains" of healthcare ethics practice (e.g., organizational policy development/review and ethics teaching). I also claim such statements have at least three additional uses outside quality attestation: (1) as a reflective practice learning tool to increase role clarity among practicing healthcare ethicists and bioethics fellows; (2) assisting practicing healthcare ethicists in clarifying role expectations with those they work with; and (3) helping inform developing professional practice standards.

When are do-gooders treated badly? Legitimate power, role expectations, and reactions to moral objection in organizations.

PubMed

Wellman, Ned; Mayer, David M; Ong, Madeline; DeRue, D Scott

2016-06-01

Organization members who engage in "moral objection" by taking a principled stand against ethically questionable activities help to prevent such activities from persisting. Unfortunately, research suggests that they also may be perceived as less warm (i.e., pleasant, nice) than members who comply with ethically questionable procedures. In this article, we draw on role theory to explore how legitimate power influences observers' responses to moral objection. We argue that individuals expect those high in legitimate power to engage in moral objection, but expect those low in legitimate power to comply with ethically questionable practices. We further propose that these contrasting role expectations influence the extent to which moral objectors are perceived as warm and subjected to social sanctions (i.e., insults, pressure, unfriendly behavior). We test our predictions with 3 experiments. Study 1, which draws on participants' prior workplace experiences, supports the first section of our mediated moderation model in which the negative association between an actor's moral objection (vs. compliance) and observers' warmth perceptions is weaker when the actor is high rather than low in legitimate power and this effect is mediated by observers' met role expectations. Study 2, an online experiment featuring a biased hiring task, reveals that the warmth perceptions fostered by the Behavior × Legitimate Power interaction influence observers' social sanctioning intentions. Finally, Study 3, a laboratory experiment which exposes participants to unethical behavior in a virtual team task, replicates Study 2's findings and extends the results to actual as well as intended social sanctions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

A Pragmatic Approach to Ethical Decision-Making in Engineering Practice: Characteristics, Evaluation Criteria, and Implications for Instruction and Assessment.

PubMed

Zhu, Qin; Jesiek, Brent K

2017-06-01

This paper begins by reviewing dominant themes in current teaching of professional ethics in engineering education. In contrast to more traditional approaches that simulate ethical practice by using ethical theories to reason through micro-level ethical dilemmas, this paper proposes a pragmatic approach to ethics that places more emphasis on the practical plausibility of ethical decision-making. In addition to the quality of ethical justification, the value of a moral action also depends on its effectiveness in solving an ethical dilemma, cultivating healthy working relationships, negotiating existing organizational cultures, and achieving contextual plausibility in everyday professional practice. This paper uses a cross-cultural ethics scenario to further elaborate how a pragmatic approach can help us rethink ethical reasoning, as well as ethics instruction and assessment. This paper is expected to be of interest to educators eager to improve the ability of engineers and other professional students to effectively and appropriately deal with the kinds of everyday ethical issues they will likely face in their careers.

Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

PubMed

Wanyonyi, Sikolia; Muriithi, Francis G

2015-10-01

Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

Academic dishonesty among undergraduates from private medical schools in India. Are we on the right track?

PubMed

Babu, Thirunavukkarasu Arun; Joseph, Noyal Mariya; Sharmila, Vijayan

2011-01-01

Though doctors are considered to be respectful role models of professionalism and ethics, medical students are no strangers to academic dishonesty. To assess the academic dishonesty practices among undergraduate students from private medical schools in India. A pre-tested and validated questionnaire containing 10 commonly done academic misconducts were administered and responses were collected. Out of 166 medical students enrolled in the study, 75% have given proxy for attendance and 49% have copied from others record book. During a theory exam, 74% of students have copied from their friends, 2% have tried to get the question paper before exam and 5% have influenced their teachers by unfair means to get more marks. During clinical/practical exam, 81% have got technical help, 45% had prior knowledge about the exam case, and 54% of them have falsely documented clinical findings. The prevalence of academic dishonesty is high. Academic integrity and ethics should be emphasized to the students which might help them in becoming professional and honest doctors.

A Model of Comparative Ethics Education for Social Workers

ERIC Educational Resources Information Center

Pugh, Greg L.

2017-01-01

Social work ethics education models have not effectively engaged social workers in practice in formal ethical reasoning processes, potentially allowing personal bias to affect ethical decisions. Using two of the primary ethical models from medicine, a new social work ethics model for education and practical application is proposed. The strengths…

Toward a Consensus in Ethics Education for the Doctor of Nursing Practice.

PubMed

Laabs, Carolyn A

2015-01-01

The purpose of this study was to begin to develop a consensus as to the essential content and methods of ethics education for advanced practice nurses. An online Delphi technique was used to survey ethics experts to determine whether items were essential, desirable, or unnecessary to ethics education for students in doctor of nursing practice programs. Only the American Nurses Association Code of Ethics and ethics terminology were deemed essential foundational knowledge.

Research ethics committees and community values: Devlin, Dworkin, Hart and beyond.

PubMed

Salako, Solomon E

2010-03-01

Two fundamental requirements ought to be met in any selection to research ethics committees: (i) professional scientific competence, and (ii) the understanding of moral values which prevail in any community. The question is: Should the verdicts of research ethics committees be based on community values? This article critically examines theories of community as were propounded by Devlin, Dworkin and Hart in answer to this question. It is argued that community values are complementary rather than conflicting, and that Dworkin's theory of community provides an analytical framework for research ethics on the new genetic technologies. Finally, it is submitted that the verdicts of research ethics committees should be based on community values.

Barriers to innovation: nurses' risk appraisal in using a new ethics screening and early intervention tool.

PubMed

Pavlish, Carol L; Hellyer, Joan Henriksen; Brown-Saltzman, Katherine; Miers, Anne G; Squire, Karina

2013-01-01

We developed and assessed feasibility of an Ethics Screening and Early Intervention Tool that identifies at-risk clinical situations and prompts early actions to mitigate conflict and moral distress. Despite intensive care unit and oncology nurses' reports of tool benefits, they noted some risk to themselves when initiating follow-up actions. The riskiest actions were discussing ethical concerns with physicians, calling for ethics consultation, and initiating patient conversations. When discussing why initiating action was risky, participants revealed themes such as "being the troublemaker" and "questioning myself." To improve patient care and teamwork, all members of the health care team need to feel safe in raising ethics-related questions.

Kamakahi vs ASRM and the future of compensation for human eggs.

PubMed

Klitzman, Robert L; Sauer, Mark V

2015-08-01

A recent lawsuit that alleges that the American Society for Reproductive Medicine (ASRM) engages in price-fixing by capping the amount of compensation paid for human oocytes has several critical ethical and policy implications that have received relatively little attention. ASRM has argued that ceilings on donor compensation prevent enticement, exploitation, and oocyte commodification. Critics counter that low donor compensation decreases supply, because fewer women are then interested in donating, which then increases prices for the service that physicians, not donors, accrue, and that ethical goals can be better achieved through enhanced informed consent, hiring egg donor advocates, and better counseling and screening. Yet, if compensation caps are removed, questions emerge concerning what the oocyte market would then look like. Informed consent is an imperfect process. Beyond the legal and economic questions of whether ASRM violates the Sherman Anti-trust Act also lie crucial questions of whether human eggs should be viewed as other products. We argue that human eggs differ from other factory-produced goods and should command moral respect. Although eggs (or embryos) are not equivalent to human beings, they deserve special consideration, because of their potential for human life, and thus have a different moral status. ASRM's current guidelines appear to address, even if imperfectly, ethical challenges that are related to egg procurement for infertility treatment. Given public concerns about oocyte commodification and ASRM's wariness of government regulations, existing guidelines may represent a compromise by aiding patients who seek eggs, while simultaneously trying to avoid undue influence, exploitation, and eugenics. Although the ultimate outcome of this lawsuit remains unclear, policy makers, providers, lawyers, judges, and others should attend seriously to these issues. Alternatives to current ASRM guidelines may be possible (eg, raising the current caps to, say, $12,000 or $15,000, potentially increasing donation, while still avoiding certain ethical difficulties) and warrant close consideration. These complex conflicting ethical issues deserve more attention than they have received because they affect key aspects of clinical practice and the lives of countless patients. Copyright © 2015. Published by Elsevier Inc.

Kamakahi vs ASRM and the future of compensation for human eggs

PubMed Central

Klitzman, Robert L.; Sauer, Mark V.

2015-01-01

A recent lawsuit that alleges that the American Society for Reproductive Medicine (ASRM) engages in price-fixing by capping the amount of compensation paid for human oocytes has several critical ethical and policy implications that have received relatively little attention. ASRM has argued that ceilings on donor compensation prevent enticement, exploitation, and oocyte commodification. Critics counter that low donor compensation decreases supply, because fewer women are then interested in donating, which then increases prices for the service that physicians, not donors, accrue, and that ethical goals can be better achieved through enhanced informed consent, hiring egg donor advocates, and better counseling and screening. Yet, if compensation caps are removed, questions emerge concerning what the oocyte market would then look like. Informed consent is an imperfect process. Beyond the legal and economic questions of whether ASRM violates the Sherman Anti-trust Act also lie crucial questions of whether human eggs should be viewed as other products. We argue that human eggs differ from other factory-produced goods and should command moral respect. Although eggs (or embryos) are not equivalent to human beings, they deserve special consideration, because of their potential for human life, and thus have a different moral status. ASRM’s current guidelines appear to address, even if imperfectly, ethical challenges that are related to egg procurement for infertility treatment. Given public concerns about oocyte commodification and ASRM’s wariness of government regulations, existing guidelines may represent a compromise by aiding patients who seek eggs, while simultaneously trying to avoid undue influence, exploitation, and eugenics. Although the ultimate outcome of this lawsuit remains unclear, policy makers, providers, lawyers, judges, and others should attend seriously to these issues. Alternatives to current ASRM guidelines may be possible (eg, raising the current caps to, say, $12,000 or $15,000, potentially increasing donation, while still avoiding certain ethical difficulties) and warrant close consideration. These complex conflicting ethical issues deserve more attention than they have received because they affect key aspects of clinical practice and the lives of countless patients. PMID:25816784

[Nursing students assessment in simulated conditions : in search of meaning and ethics].

PubMed

Homerin, Marie-Pierre; Roumanet, Marie-Cécile

2014-10-01

A thought about the assessment in simulated conditions is at the origin of this research-action conducted at the Institute of Nursing Education of Chambery, France. Indeed, the differences in the assessment procedures between units that require this kind of validation and the disappointing rate of success at the examinations in simulated situations have led the trainers to raise the following question : « How can these assessments be meaningful and consistent with the goal of training (help to become autonomous and reflexive practitioners) » ?This issue was addressed with concepts such as socioconstructivism, simulation in health, assessment and ethical principles. The change of practices has been the application of the principles of ?educative? assessment according to G. Nunziatti which strongly involves the students in the assessment?s process.In order to estimate the impact of these changes of practices, an unidentified online survey was offered to all students who benefited from this kind of assessment. The results between two classes of students having had different evaluation procedures have also been compared.The objectives were, after the implementation of this new kind of evaluation, to assess the students? satisfaction, to compare the failure rate at the tests in simulated conditions and to verify the compliance with the ethical principles.This study has shown the students? satisfaction about these new forms of assessment in simulated conditions, an increased success rate in the tests and the applicability of the ethical principles with this way of proceeding. However, the principles of justice and non-maleficence are difficult to implement. Nevertheless, this critical thinking on the procedures of assessment in simulated conditions has helped to change the practices and the assessment design by the teachers.

TTaPP: Together Take a Pause and Ponder: A Critical Thinking Tool for Exploring the Public/Private Lives of Patients.

PubMed

Kuhnel, Leslie

2018-01-01

The broad use of social networking and user-generated content has increased the online footprint of many individuals. A generation of healthcare professionals have grown up with online search activities as part of their everyday lives. Sites like Facebook, Twitter, and Instagram have given the public new ways to share intimate details about their public and private lives and the lives of their friends and families. As a result, careproviders have the ability to find out more about their patients with just the tap of a key or the click of a mouse. This type of online searching for patient information is known as patient-targeted googling or PTG. This article provides an overview of the emergence of PTG, identifies the potential benefits and possible pitfalls of engaging in PTG, and explores current ethical frameworks that guide decisions about PTG. The article describes the development of a critical thinking tool developed by the Behavioral Health Ethics Committee at CHI Health, that can serve as a best-practice model for other hospitals and health systems. Called TTaPP (Together Take a Pause and Ponder), this tool is designed to help healthcare professionals across settings practice collaborative critical thinking skills as they consider the ethical questions of whether or not to engage in PTG. Finally, this article suggests areas for further study, including ways to prompt collaboration and appropriate documentation by maximizing electronic medical records systems, exploring the effectiveness of the TTaPP tool as a way to promote a culture of collaborative critical thinking practices, and the attitudes of patients and the public regarding PTG. Copyright 2018 The Journal of Clinical Ethics. All rights reserved.

The ethics of social media in dental practice: ethical tools and professional responses.

PubMed

Peltier, Bruce; Curley, Arthur

2013-07-01

This article considers several important trends in dental practice that result from innovations in digital and social media. It provides ethical tools for analysis, Illuminates areas of ethical concern in the current practice environment and offers recommendations for future practice. A summary in the form of a checklist is posted at the end of this essay for dentists considering the use of social media in their practice.

The ethics of social media in dental practice: challenges.

PubMed

Peltier, Bruce; Curley, Arthur

2013-07-01

This is the first of two essays written to consider several important trends in dental practice that result from innovations in digital and social media. This essay reviews ethical and legal implications of the use of websites, Facebook, review sites, email and other digital innovations in dental practice. The second essay provides ethical tools for analysis, illuminates areas of ethical concern in today's practice environment and offers recommendations for future practice.

The Ethical Dimension of Leadership.

ERIC Educational Resources Information Center

Boatman, Sara; Adams, Todd C.

1992-01-01

Ethics begin personally but ultimately provide empowerment. Practicing ethical leadership requires three major interrelated activities: knowing (awareness of own and others' values); feeling (creating awareness of or sensing values and dilemmas); and acting (behavior). Ethical leadership is tested through ethical dilemmas, and practicing it…

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.

Theory and practice of clinical ethics support services: narrative and hermeneutical perspectives.

PubMed

Porz, Rouven; Landeweer, Elleke; Widdershoven, Guy

2011-09-01

In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of 'theory' and show how it is interwoven with 'practice' as we go along. First, we look at theory in its foundational role: in our case 'narrative ethics' and 'philosophical hermeneutics' provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like 'story', 'responsibility', or 'vulnerability' to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa. © 2011 Blackwell Publishing Ltd.

A scoping study to identify opportunities to advance the ethical implementation and scale-up of HIV treatment as prevention: priorities for empirical research.

PubMed

Knight, Rod; Small, Will; Pakula, Basia; Thomson, Kimberly; Shoveller, Jean

2014-07-03

Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and "scaling up" of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. We drew on the Arksey and O'Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader implementation contexts. Ongoing research and normative deliberation is required in order to successfully and ethically scale-up TasP within the continuum of HIV care models. Based on the results of this scoping review, we identify several ethical and implementation dimensions that hold promise for informing the process of scaling up TasP and that could benefit from new research.

A scoping study to identify opportunities to advance the ethical implementation and scale-up of HIV treatment as prevention: priorities for empirical research

PubMed Central

2014-01-01

Background Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and “scaling up” of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. Methods We drew on the Arksey and O’Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. Results Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader implementation contexts. Conclusion Ongoing research and normative deliberation is required in order to successfully and ethically scale-up TasP within the continuum of HIV care models. Based on the results of this scoping review, we identify several ethical and implementation dimensions that hold promise for informing the process of scaling up TasP and that could benefit from new research. PMID:24994501

Are Sex Effects on Ethical Decision-Making Fake or Real? A Meta-Analysis on the Contaminating Role of Social Desirability Response Bias.

PubMed

Yang, Jianfeng; Ming, Xiaodong; Wang, Zhen; Adams, Susan M

2017-02-01

A meta-analysis of 143 studies was conducted to explore how the social desirability response bias may influence sex effects on ratings on measures of ethical decision-making. Women rated themselves as more ethical than did men; however, this sex effect on ethical decision-making was no longer significant when social desirability response bias was controlled. The indirect questioning approach was compared with the direct measurement approach for effectiveness in controlling social desirability response bias. The indirect questioning approach was found to be more effective.

Emerging issues in paediatric health research consent forms in Canada: working towards best practices.

PubMed

Dove, Edward S; Avard, Denise; Black, Lee; Knoppers, Bartha M

2013-01-30

Obtaining a research participant's voluntary and informed consent is the bedrock of sound ethics practice. Greater inclusion of children in research has led to questions about how paediatric consent operates in practice to accord with current and emerging legal and socio-ethical issues, norms, and requirements. Employing a qualitative thematic content analysis, we examined paediatric consent forms from major academic centres and public organisations across Canada dated from 2008-2011, which were purposively selected to reflect different types of research ethics boards, participants, and studies. The studies included biobanking, longitudinal studies, and gene-environment studies. Our purpose was to explore the following six emerging issues: (1) whether the scope of parental consent allows for a child's assent, dissent, or future consent; (2) whether the concepts of risk and benefit incorporate the child's psychological and social perspective; (3) whether a child's ability to withdraw is respected and to what extent withdrawal is permitted; (4) whether the return of research results includes individual results and/or incidental findings and the processes involved therein; (5) whether privacy and confidentiality concerns adequately address the child's perspective and whether standard data and/or sample identifiability nomenclature is used; and (6) whether retention of and access to paediatric biological samples and associated medical data are addressed. The review suggests gaps and variability in the consent forms with respect to addressing each of the six issues. Many forms did not discuss the possibility of returning research results, be they individual or general/aggregate results. Forms were also divided in terms of the scope of parental consent (specific versus broad), and none discussed a process for resolving disputes that can arise when either the parents or the child wishes to withdraw from the study. The analysis provides valuable insight and evidence into how consent forms address current ethical issues. While we do not thoroughly explore the contexts and reasons behind consent form gaps and variability, we do advocate and formulate the development of best practices for drafting paediatric health research consent forms. This can greatly ameliorate current gaps and facilitate harmonised and yet contextualised approaches to paediatric health research ethics.

Ethical questions for resource managers.

Treesearch

G.H. Reeves; D.L. Bottom; M.H. Brookes

1992-01-01

The decisions of natural resource managers are not simply scientific issues but involve fundamental questions of ethics. Conflicts in fisheries management, forestry, and other applied sciences arise from social and economic factors that affect natural resource values. Administrative processes, cost-benefit analyses, and various management "myths" have been...

Toward an horizon in design ethics.

PubMed

d'Anjou, Philippe

2010-06-01

This paper suggests that design ethics can be enriched by considering ethics beyond the traditional approaches of deontology, teleology, and virtue ethics. Design practice and design ethics literature tend to frame ethics in design according to these approaches. The paper argues that a fundamental and concrete ethical understanding of design ethics can also be found in Sartrean Existentialism, a philosophy centered on the individual and his/her absolute freedom. Through the analysis of four core concepts of Sartrean Existentialism that define a specific ethics, the paper illustrates why such philosophical approach is relevant to design ethics. The paper also shows how Sartrean Existentialism and its ethics apply to critical issues of professional practice in design such as professional engagement and design decision-making. The paper finally argues that Sartre's philosophy and ethics is a perspective that offers the designer in design practice a solid ground to engage his/her ethical dilemma.

17 CFR 200.21 - The General Counsel.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND ETHICS; AND INFORMATION AND REQUESTS Organization and Program Management General Organization... Administrative and Personnel Management) for administering the Commission's Ethics Program, and (with the Ethics... Commission and its staff with regard to ethical and conflicts of interest questions and acts as the...

Higher Education and Ethical Value

ERIC Educational Resources Information Center

Lee, Jeong-Kyu

2017-01-01

The purpose of this study is to explore the importance of ethical value in higher education as well as the relevance between ethical value and higher education. In order to examine the study logically, three research questions are addressed: First, what is value, ethical value, and Asiatic ethical value? Second, for whom and what is higher…

77 FR 34046 - Advisory Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)-Ethics...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-08

... Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)--Ethics Subcommittee (ES... ACD, CDC, regarding a broad range of public health ethics questions and issues arising from programs... ethics standards to the accreditation process for public health departments; ethical considerations...

Learning for Oneself: A Confucian-Inspired Case for Moral Formation in Ethics Pedagogy

ERIC Educational Resources Information Center

Duperon, Matthew

2018-01-01

This article explores the disconnection between ethical theory and ethical practice in ethics courses at secular U.S. colleges and universities. In such contexts academic ethics focuses almost exclusively on "ethical reasoning" and leaves the business of practical moral formation of students in the realm of "student life." I…

Behavioral Ethics in Practice: Integrating Service Learning into a Graduate Business Ethics Course

ERIC Educational Resources Information Center

O'Brien, Kevin; Wittmer, Dennis; Ebrahimi, Bahman Paul

2017-01-01

Adopting a broad definition that distinguishes behavioral ethics as science and behavioral ethics in practice, we describe how service learning can be a meaningful component of a four-credit, one-quarter graduate business ethics course by blending both normative/prescriptive and behavioral/descriptive ethics. We provide a conceptual and…

What is good medical ethics? A clinician's perspective.

PubMed

Kong, Wing May

2015-01-01

Speaking from the perspective of a clinician and teacher, good medical ethics needs to make medicine better. Over the past 50 years medical ethics has helped shape the culture in medicine and medical practice for the better. However, recent healthcare scandals in the UK suggest more needs to be done to translate ethical reasoning into ethical practice. Focusing on clinical practice and individual patient care, I will argue that, to be good, medical ethics needs to become integral to the activities of health professionals and healthcare organisations. Ethics is like a language which brings a way of thinking and responding to the world. For ethics to become embedded in clinical practice, health professionals need to progress from classroom learners to fluent social speakers through ethical dialogue, ethical reflection and ethical actions. I will end by discussing three areas that need to be addressed to enable medical ethics to flourish and bring about change in everyday clinical care. 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.

Public health equity in refugee situations

PubMed Central

2011-01-01

Addressing increasing concerns about public health equity in the context of violent conflict and the consequent forced displacement of populations is complex. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. Priorities of service delivery, the allocation choices, and the processes by which they are arrived at are now coming under renewed scrutiny in the light of the estimated two million refugees who fled from Iraq since 2003. Operational questions that need to be addressed include health as a relative priority, allocations between and within different populations, and transition and exit strategies. Public health equity issues faced by the humanitarian community can be framed as issues of resource allocation and issues of decision-making. The ethical approach to resource allocation in health requires taking adequate steps to reduce suffering and promote wellbeing, with the upper bound being to avoid harming those at the lower end of the welfare continuum. Deliberations in the realm of international justice have not provided a legal or implementation platform for reducing health disparities across the world, although norms and expectations, including within the humanitarian community, may be moving in that direction. Despite the limitations of applying ethical theory in the fluid, complex and highly political environment of refugee settings, this article explores how this theory could be used in these contexts and provides practical examples. The intent is to encourage professionals in the field, such as aid workers, health care providers, policy makers, and academics, to consider these ethical principles when making decisions. PMID:21575218

Molecular genetics research in ADHD: ethical considerations concerning patients' benefit and resource allocation.

PubMed

Rothenberger, Lillian Geza

2012-12-01

Immense resource allocations have led to great data output in genetic research. Concerning ADHD resources spent on genetic research are less than those spent on clinical research. But there are successful efforts made to increase support for molecular genetics research in ADHD. Concerning genetics no evidence based conclusive results have significant impact on prevention, diagnosis or treatment yet. With regard to ethical aspects like the patients' benefit and limited resources the question arises if it is indicated to think about a new balance of resource allocation between molecular genetics and non-genetics research in ADHD. An ethical reflection was performed focusing on recent genetic studies and reviews based on a selective literature search. There are plausible reasons why genetic research results in ADHD are somehow disappointing for clinical practice so far. Researchers try to overcome these gaps systematically, without knowing what the potential future benefits for the patients might be. Non-genetic diagnostic/therapeutic research may lead to clinically relevant findings within a shorter period of time. On the other hand, non-genetic research in ADHD may be nurtured by genetic approaches. But, with the latter there exist significant risks of harm like stigmatization and concerns regarding data protection. Isolated speeding up resources of genetic research in ADHD seems questionable from an ethical point of view. There is a need to find a new balance of resource allocation between genetic and non-genetic research in ADHD, probably by integrating genetics more systematically into clinical research. A transdisciplinary debate is recommended. Copyright © 2012 Wiley Periodicals, Inc.

Public health equity in refugee situations.

PubMed

Leaning, Jennifer; Spiegel, Paul; Crisp, Jeff

2011-05-16

Addressing increasing concerns about public health equity in the context of violent conflict and the consequent forced displacement of populations is complex. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. Priorities of service delivery, the allocation choices, and the processes by which they are arrived at are now coming under renewed scrutiny in the light of the estimated two million refugees who fled from Iraq since 2003.Operational questions that need to be addressed include health as a relative priority, allocations between and within different populations, and transition and exit strategies. Public health equity issues faced by the humanitarian community can be framed as issues of resource allocation and issues of decision-making. The ethical approach to resource allocation in health requires taking adequate steps to reduce suffering and promote wellbeing, with the upper bound being to avoid harming those at the lower end of the welfare continuum. Deliberations in the realm of international justice have not provided a legal or implementation platform for reducing health disparities across the world, although norms and expectations, including within the humanitarian community, may be moving in that direction.Despite the limitations of applying ethical theory in the fluid, complex and highly political environment of refugee settings, this article explores how this theory could be used in these contexts and provides practical examples. The intent is to encourage professionals in the field, such as aid workers, health care providers, policy makers, and academics, to consider these ethical principles when making decisions.