Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa.

PubMed

Mamotte, Nicole; Wassenaar, Douglas; Koen, Jennifer; Essack, Zaynab

2010-03-09

Africa continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges. In order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009. Key cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing. The consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields.

Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa

PubMed Central

2010-01-01

Background Africa continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges. Methods In order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009. Results Key cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing. Conclusion The consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields. PMID:20211030

Understanding doctors' ethical challenges as role virtue conflicts.

PubMed

McDougall, Rosalind

2013-01-01

This paper argues that doctors' ethical challenges can be usefully conceptualised as role virtue conflicts. The hospital environment requires doctors to be simultaneously good doctors, good team members, good learners and good employees. I articulate a possible set of role virtues for each of these four roles, as a basis for a virtue ethics approach to analysing doctors' ethical challenges. Using one junior doctor's story, I argue that understanding doctors' ethical challenges as role virtue conflicts enables recognition of important moral considerations that are overlooked by other approaches to ethical analysis. © 2011 Blackwell Publishing Ltd.

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.

77 FR 6625 - Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-08

... DEPARTMENT OF VETERANS AFFAIRS Meeting the Challenge of Pandemic Influenza: Ethical Guidance for... its National Center for Ethics in Health Care (NCEHC) invites interested parties to comment on a guidance document entitled ``Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and...

Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology

PubMed Central

Magalhães-Sant'Ana, M.; More, S. J.; Morton, D. B.; Hanlon, A.

2016-01-01

Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. PMID:27613779

Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology.

PubMed

Magalhães-Sant'Ana, M; More, S J; Morton, D B; Hanlon, A

2016-10-29

Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. British Veterinary Association.

Beyond integrating social sciences: Reflecting on the place of life sciences in empirical bioethics methodologies.

PubMed

Mertz, Marcel; Schildmann, Jan

2018-06-01

Empirical bioethics is commonly understood as integrating empirical research with normative-ethical research in order to address an ethical issue. Methodological analyses in empirical bioethics mainly focus on the integration of socio-empirical sciences (e.g. sociology or psychology) and normative ethics. But while there are numerous multidisciplinary research projects combining life sciences and normative ethics, there is few explicit methodological reflection on how to integrate both fields, or about the goals and rationales of such interdisciplinary cooperation. In this paper we will review some drivers for the tendency of empirical bioethics methodologies to focus on the collaboration of normative ethics with particularly social sciences. Subsequently, we argue that the ends of empirical bioethics, not the empirical methods, are decisive for the question of which empirical disciplines can contribute to empirical bioethics in a meaningful way. Using already existing types of research integration as a springboard, five possible types of research which encompass life sciences and normative analysis will illustrate how such cooperation can be conceptualized from a methodological perspective within empirical bioethics. We will conclude with a reflection on the limitations and challenges of empirical bioethics research that integrates life sciences.

The business of ethics: gender, medicine, and the professional codification of the American Physiotherapy Association, 1918-1935.

PubMed

Linker, Beth

2005-07-01

The history of codes of ethics in health care has almost exclusively been told as a story of how medical doctors developed their own professional principles of conduct. Yet telling the history of medical ethics solely from the physicians' perspective neglects not only the numerous allied health care workers who developed their own codes of ethics in tandem with the medical profession, but also the role that gender played in the writing of such professional creeds. By focusing on the predominantly female organization of the American Physiotherapy Association (APA) and its 1935 "Code of Ethics and Discipline," I demonstrate how these women used their creed to at once curry favor from and challenge the authority of the medical profession. Through their Code, APA therapists engaged in a dynamic dialogue with the male physicians of the American Medical Association (AMA) in the name of professional survival. I conclude that, contrary to historians and philosophers who contend that professional women have historically operated under a gender-specific ethic of care, the physiotherapists avoided rhetoric construed as feminine and instead created a "business-like" creed in which they spoke solely about their relationship with physicians and remained silent on the matter of patient care.

Epistemological and Pedagogical Challenges of Teaching International Business Ethics Courses

ERIC Educational Resources Information Center

Dion, Michel

2015-01-01

International business ethics courses imply four basic epistemological and pedagogical challenges: (a) understanding various perceptions of ethics and values/virtues; (b) identifying ethical maxims among religious/spiritual traditions; (c) designing international business ethics courses as dialogical experiences; and (d) deepening our personal…

Management of ethical issues related to care of seriously ill dialysis patients in free-standing facilities.

PubMed

Song, Mi-Kyung; Hanson, Laura C; Gilet, Constance A; Jo, Minjeong; Reed, Teresa J; Hladik, Gerald A

2014-09-01

There are few data on the frequency and current management of clinical ethical issues related to care of seriously ill dialysis patients in free-standing dialysis facilities. To examine the extent of clinical ethical challenges experienced by care providers in free-standing facilities and their perceptions about how those issues are managed. A total of 183 care providers recruited from 15 facilities in North Carolina completed a survey regarding the occurrence and management of ethical issues in the past year. Care plan meetings were observed at four of the facilities for three consecutive months. Also, current policies and procedures at each of the facilities were reviewed. The two most frequently experienced challenges involved dialyzing frail patients with multiple comorbidities and caring for disruptive/difficult patients. The most common ways of managing ethical issues were discussions in care plan meetings (n = 47) or discussions with the clinic manager (n = 47). Although policies were in place to guide management of some of the challenges, respondents were often not aware of those policies. Also, although participants reported that ethical issues related to dialyzing undocumented immigrants were fairly common, no facility had a policy for managing this challenge. Participants suggested that all staff obtain training in clinical ethics and communication skills, facilities develop ethics teams, and there be clear policies to guide management of ethical challenges. The scope of ethical challenges was extensive, how these challenges were managed varied widely, and there were limited resources for assistance. Multifaceted efforts, encompassing endeavors at the individual, facility, organization, and national levels, are needed to support staff in improving the management of ethical challenges in dialysis facilities. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Ethical Challenges in Biomarker-Driven Drug Development.

PubMed

Hey, Spencer Phillips

2018-01-01

The increasing importance of biomarkers-as drivers of research and drug development activity, surrogate outcomes in clinical trials, and the centerpiece of precision medicine-raises many new ethical challenges. In what follows, I briefly review some of the major ethical challenges and debates already identified in the literature, and then describe a new ethical challenge that arises from the abstract nature of biomarker hypotheses. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review.

PubMed

Hurlimann, Thierry; Peña-Rosas, Juan Pablo; Saxena, Abha; Zamora, Gerardo; Godard, Béatrice

2017-01-01

The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. The goal of this scoping review is to delineate and "map" the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O'Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions. General ethical frameworks or recommendations-although useful-cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.

Six Challenges for Ethical Conduct in Science.

PubMed

Niemi, Petteri

2016-08-01

The realities of human agency and decision making pose serious challenges for research ethics. This article explores six major challenges that require more attention in the ethics education of students and scientists and in the research on ethical conduct in science. The first of them is the routinization of action, which makes the detection of ethical issues difficult. The social governance of action creates ethical problems related to power. The heuristic nature of human decision making implies the risk of ethical bias. The moral disengagement mechanisms represent a human tendency to evade personal responsibility. The greatest challenge of all might be the situational variation in people's ethical behaviour. Even minor situational factors have a surprisingly strong influence on our actions. Furthermore, finally, the nature of ethics itself also causes problems: instead of clear answers, we receive a multitude of theories and intuitions that may sometimes be contradictory. All these features of action and ethics represent significant risks for ethical conduct in science. I claim that they have to be managed within the everyday practices of science and addressed explicitly in research ethics education. I analyse them and suggest some ways in which their risks can be alleviated.

Ethical challenges in nursing homes--staff's opinions and experiences with systematic ethics meetings with participation of residents' relatives.

PubMed

Bollig, Georg; Schmidt, Gerda; Rosland, Jan Henrik; Heller, Andreas

2015-12-01

Many ethical problems exist in nursing homes. These include, for example, decision-making in end-of-life care, use of restraints and a lack of resources. The aim of the present study was to investigate nursing home staffs' opinions and experiences with ethical challenges and to find out which types of ethical challenges and dilemmas occur and are being discussed in nursing homes. The study used a two-tiered approach, using a questionnaire on ethical challenges and systematic ethics work, given to all employees of a Norwegian nursing home including nonmedical personnel, and a registration of systematic ethics discussions from an Austrian model of good clinical practice. Ninety-one per cent of the nursing home staff described ethical problems as a burden. Ninety per cent experienced ethical problems in their daily work. The top three ethical challenges reported by the nursing home staff were as follows: lack of resources (79%), end-of-life issues (39%) and coercion (33%). To improve systematic ethics work, most employees suggested ethics education (86%) and time for ethics discussion (82%). Of 33 documented ethics meetings from Austria during a 1-year period, 29 were prospective resident ethics meetings where decisions for a resident had to be made. Agreement about a solution was reached in all 29 cases, and this consensus was put into practice in all cases. Residents did not participate in the meetings, while relatives participated in a majority of case discussions. In many cases, the main topic was end-of-life care and life-prolonging treatment. Lack of resources, end-of-life issues and coercion were ethical challenges most often reported by nursing home staff. The staff would appreciate systematic ethics work to aid decision-making. Resident ethics meetings can help to reach consensus in decision-making for nursing home patients. In the future, residents' participation should be encouraged whenever possible. © 2015 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

Conducting a paediatric multi-centre RCT with an industry partner: challenges and lessons learned.

PubMed

Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy

2012-11-01

There are many benefits of multi-centred research including large sample sizes, statistical power, timely recruitment and generalisability of results. However, there are numerous considerations when planning and implementing a multi-centred study. This article reviews the challenges and successes of planning and implementing a multi-centred prospective randomised control trial involving an industry partner. The research investigated the impact on psychosocial functioning of a cosmetic camouflage product for children and adolescents with burn scarring. Multi-centred studies commonly have many stakeholders. Within this study, six Australian and New Zealand paediatric burn units as well as an industry partner were involved. The inclusion of an industry partner added complexities as they brought different priorities and expectations to the research. Further, multifaceted ethical and institutional approval processes needed to be negotiated. The challenges, successes, lessons learned and recommendations from this study regarding Australian and New Zealand ethics and research governance approval processes, collaboration with industry partners and the management of differing expectations will be outlined. Recommendations for future multi-centred research with industry partners include provision of regular written reports for the industry partner; continual monitoring and prompt resolution of concerns; basic research practices education for industry partners; minimisation of industry partner contact with participants; clear roles and responsibilities of all stakeholders and utilisation of single ethical review if available. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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.

School Psychologists and Ethical Challenges

ERIC Educational Resources Information Center

Kapoulitsas, Maryanne; Corcoran, Tim

2017-01-01

This research explored how psychologists working in the Victorian secondary state school system construct meaning around ethical practice. The specific aims of the research were to examine psychologists understanding of ethics in practice within schools and to explore challenges they faced regarding professional ethics when working in the…

Introducing the Medical Ethics Bowl.

PubMed

Merrick, Allison; Green, Rochelle; Cunningham, Thomas V; Eisenberg, Leah R; Hester, D Micah

2016-01-01

Although ethics is an essential component of undergraduate medical education, research suggests that current medical ethics curricula face considerable challenges in improving students' ethical reasoning. This article discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised: the Medical Ethics Bowl (MEB). Finally, we suggest the pedagogical advantages of the MEB when compared to other ethics curricula.

Improving the Curriculum with Ethics: Gaps between Perceived Ethical Challenges of Practitioners and Educators

ERIC Educational Resources Information Center

Dolezel, Diane M.; Morrison, Eileen E.

2017-01-01

Health information management (HIM) professionals must address ethical challenges in their role as guardians of patients' personal information and organizations' proprietary information. Because of this need, HIM educators strive prepare their students to address these challenges. Unfortunately, little evidence exists about specific areas of…

Ethical Challenges in the Teaching of Multicultural Course Work

ERIC Educational Resources Information Center

Fier, Elizabeth Boyer; Ramsey, MaryLou

2005-01-01

The authors explore the ethical issues and challenges frequently encountered by counselor educators of multicultural course work. Existing ethics codes are examined, and the need for greater specificity with regard to teaching courses of multicultural content is addressed. Options for revising existing codes to better address the challenges of…

Ethics in global surgery.

PubMed

Wall, Anji E

2014-07-01

Global surgery, while historically a small niche, is becoming a larger part of the global health enterprise. This article discusses the burden of global surgery, emphasizing the importance of addressing surgical needs in low- and middle-income countries. It describes the barriers to surgical care in the developing world, the ethical challenges that these barriers create, and strategies to overcome these barriers. It emphasizes the crucial role of preparation for global surgical interventions as a way to maximize benefits as well as minimize harms and ethical challenges. It ends with the cautionary statement that preparation does not eliminate ethical problems, so surgical volunteers must be prepared not only for the technical challenges of global surgery but also for the ethical challenges.

A spoonful of care ethics: The challenges of enriching medical education.

PubMed

van Reenen, Eva; van Nistelrooij, Inge

2017-01-01

Nursing Ethics has featured several discussions on what good care comprises and how to achieve good care practices. We should "nurse" ethics by continuously reflecting on the way we "do" ethics, which is what care ethicists have been doing over the past few decades and continue to do so. Ethics is not limited to nursing but extends to all caring professions. In 2011, Elin Martinsen argued in this journal that care should be included as a core concept in medical ethical terminology because of "the harm to which patients may be exposed owing to a lack of care in the clinical encounter," specifically between doctors and patients. However, Martinsen leaves the didactical challenges arising from such a venture open for further enquiry. In this article, we explore the challenges arising from implementing care-ethical insights into medical education. Medical education in the Netherlands is investigated through a "care-ethical lens". This means exploring the possibility of enriching medical education with care-ethical insights, while at the same time discovering possible challenges emerging from such an undertaking. Participants and research context: This paper has been written from the academic context of a master in care ethics and policy. Ethical considerations: We have tried to be fair and respectful to the authors discussed and take a neutral stance towards the findings portrayed. Several challenges are identified, which we narrow down to two types: didactical and non-didactical. In order to overcome these challenges, we must not underestimate the possible resistance to a paradigm shift. Our efforts should mainly target the learning that takes place in the clinical phases of medical training and should be accompanied by the creation of awareness in healthcare practice.

77 FR 2556 - Ethical and Regulatory Challenges in the Development of Pediatric Medical Countermeasures; Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-18

...] Ethical and Regulatory Challenges in the Development of Pediatric Medical Countermeasures; Public Workshop... Administration (FDA), Office of Pediatric Therapeutics, is announcing a public workshop entitled ``Ethical and... provide a forum for careful consideration of scientific, ethical, and regulatory issues confronting FDA...

Information Ethics Education for a Multicultural World

ERIC Educational Resources Information Center

Fleischmann, Kenneth R.; Robbins, Russell W.; Wallace, William A.

2011-01-01

How can we prepare information systems students to face the ethical challenges of a globalized world? This paper describes a three-step approach for addressing these challenges. First, we have designed undergraduate and graduate information ethics courses that expand the range of learning of ethical theories beyond the traditional Western canon to…

Ethical challenges in surgery as narrated by practicing surgeons

PubMed Central

Torjuul, Kirsti; Nordam, Ann; Sørlie, Venke

2005-01-01

Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity. PMID:15737235

Ethical challenges in neonatal intensive care nursing.

PubMed

Strandås, Maria; Fredriksen, Sven-Tore D

2015-12-01

Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data. Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. © The Author(s) 2014.

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.

Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care.

PubMed

Hem, Marit Helene; Molewijk, Bert; Pedersen, Reidar

2014-12-04

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work? We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a 'bricolage' approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals' administrations and all health care professionals who participated in the focus group interviews. Health care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated "moral enterprise". The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital. A systematic focus on ethical challenges when dealing with coercion is an important step forward in order to improve health care in the mental health field.

Ethical challenges for accountable care organizations: a structured review.

PubMed

DeCamp, Matthew; Farber, Neil J; Torke, Alexia M; George, Maura; Berger, Zackary; Keirns, Carla C; Kaldjian, Lauris C

2014-10-01

Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges. No framework exists to assist key ACO stakeholders in identifying or managing these challenges. We conducted a structured review of the medical ACO literature using qualitative content analysis to inform identification of ethical challenges for ACOs. Our analysis found infrequent discussion of ethics as an explicit concern for ACOs. Nonetheless, we identified nine critical ethical challenges, often described in other terms, for ACO stakeholders. Leaders could face challenges regarding fair resource allocation (e.g., about fairly using ACOs' shared savings), protection of professionals' ethical obligations (especially related to the design of financial incentives), and development of fair decision processes (e.g., ensuring that beneficiary representatives on the ACO board truly represent the ACO's patients). Clinicians could perceive threats to their professional autonomy (e.g., through cost control measures), a sense of dual or conflicted responsibility to their patients and the ACO, or competition with other clinicians. For patients, critical ethical challenges will include protecting their autonomy, ensuring privacy and confidentiality, and effectively engaging them with the ACO. ACOs are not inherently more or less "ethical" than other health care payment models, such as fee-for-service or pure capitation. ACOs' nascent development and flexibility in design, however, present a time-sensitive opportunity to ensure their ethical operation, promote their success, and refine their design and implementation by identifying, managing, and conducting research into the ethical issues they might face.

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…

Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review

PubMed Central

Peña-Rosas, Juan Pablo; Saxena, Abha; Zamora, Gerardo

2017-01-01

Background The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. Aim The goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. Methods A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. Results The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. Discussion The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions. Conclusion General ethical frameworks or recommendations–although useful–cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks. PMID:29073186

Ethics challenges and guidance related to research involving adolescent post-abortion care: a scoping review.

PubMed

Zulu, Joseph M; Ali, Joseph; Hallez, Kristina; Kass, Nancy; Michelo, Charles; Hyder, Adnan A

2018-05-02

An increase in post abortion care (PAC) research with adolescents, particularly in low- and middle-income countries, has brought to attention several associated research ethics challenges. In order to better understand the ethics context of PAC research with adolescents, we conducted a scoping review of published literature. Following a systematic search of PubMed, HINARI, and Google Scholar, we analysed articles meeting inclusion criteria to determine common themes across both the ethical challenges related to PAC research with adolescents and any available guidance on the identified challenges. The literature search identified an initial 3321 records of which 14 were included in analysis following screening. Several ethical challenges stem from abortion being a controversial, sensitive, and stigmatized topic in many settings. Ethical dilemmas experienced by researchers conducting adolescent PAC research included: difficulties in convincing local health providers to permit PAC research; challenges in recruiting and seeking consent due to sensitivity of the subject; effectively protecting confidentiality; managing negative effects of interventions; creating a non-prejudicial atmosphere for research; managing emotional issues among adolescents; and dealing with uncertainty regarding the role of researchers when observing unethical health care practices. Suggested strategies for addressing some of these challenges include: using several sources to recruit study participants, using research to facilitate dialogue on abortion, briefing health workers on any observed unethical practices after data collection, fostering a comprehensive understanding of contextual norms and values, selecting staff with experience working with study populations, and avoiding collection of personal identifiers. Addressing ethical challenges that researchers face when conducting PAC research with adolescents requires guidance at the individual, institutional, community, and international levels. Overall, despite the documentation of challenges in the published literature, guidance on handling several of these ethics challenges is sparse. We encourage further research to clarify the identified challenges and support the development of formal guidance in this area.

Qualitative research ethics on the spot: Not only on the desktop.

PubMed

Øye, Christine; Sørensen, Nelli Øvre; Glasdam, Stinne

2016-06-01

The increase in medical ethical regulations and bureaucracy handled by institutional review boards and healthcare institutions puts the researchers using qualitative methods in a challenging position. Based on three different cases from three different research studies, the article explores and discusses research ethical dilemmas. First, and especially, the article addresses the challenges for gatekeepers who influence the informant's decisions to participate in research. Second, the article addresses the challenges in following research ethical guidelines related to informed consent and doing no harm. Third, the article argues for the importance of having research ethical guidelines and review boards to question and discuss the possible ethical dilemmas that occur in qualitative research. Research ethics must be understood in qualitative research as relational, situational, and emerging. That is, that focus on ethical issues and dilemmas has to be paid attention on the spot and not only at the desktop. © The Author(s) 2015.

A qualitative description of service providers' experiences of ethical issues in HIV care.

PubMed

Sabone, Motshedisi B; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther I; Corless, Inge B; Cuca, Yvette P; Holzemer, William L; Dawson-Rose, Carol; Baez, Solymar S Soliz; Rivero-Mendz, Marta; Webel, Allison R; Eller, Lucille Sanzero; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice K; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen

2018-01-01

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Workplace Stress and Ethical Challenges Experienced by Nursing Staff in a Nursing Home

ERIC Educational Resources Information Center

Vondras, Dean D.; Flittner, Diane; Malcore, Sylvia A.; Pouliot, Gregory

2009-01-01

This research explores the workplace stress and ethical challenges reported by healthcare staff in a nursing home. A brief self-report survey was administered to 44 members of the nursing staff in a not-for-profit nursing home. The survey included items that elicited identification of specific workplace stressors and ethical challenges and global…

The Top 10 Ethical Challenges in Dental Practice in Indian Scenario: Dentist Perspective

PubMed Central

Kemparaj, Vanishree M.; Panchmal, Ganesh Shenoy; Kadalur, Umashankar Gangadaraiah

2018-01-01

Aim: This exploratory qualitative research is an attempt to assess the health care ethical challenges in dental practice in an Indian scenario. Methodology: Qualitative indepth interview was conducted on 20 dental professionals to assess the ethical challenges prevailing in dental practice in Indian scenario. After obtaining the responses the verbatims were categorized into categories and finally 36 themes emerged. Later from two group of 6 panellists each after conducting focus group discussion the themes of ethical issues occurring in dental practice were ranked based on order of significance impact on the practice, patient and society using Delphi method. Result: The top ten ethical challenges listed by the panellists are inadequate sterilization and waste management in dental clinics, poor knowledge and attitude towards ethics among our dental practitioners, in competence among dental professional, increase in cost of oral health service, poor informed consent process, requirement of consensus about the treatment procedures among dentists, Conflict in Advertising, clustering of dental clinics in urban areas, disagreement with treatment modalities among dentist and patient, poor medical record maintenance among our dental practitioners. Conclusion: The study attempts to bring the prevailing ethical challenges in oral health care practice in Indian scenario. PMID:29599593

Ethical issues in sports medicine: a review and justification for ethical decision making and reasoning.

PubMed

Greenfield, Bruce H; West, Charles Robert

2012-11-01

Ethical issues present a challenge for health care professionals working with athletes of sports teams. Health care professionals-including the team physician, the physical therapist, and the athletic trainer-are faced with the challenge of returning an athlete to competition as quickly as possible but as safely as possible. Conflicts of interest arise due to conflicting obligations of the team physician to the athlete and other members of the sports organization, including coaches and the team owner. The multiple stakeholders involved in sports teams challenge the traditional notion of confidentiality and autonomy. The aims of this article are to explicate the ethics of sports medicine, highlight the ethical issues, and provide some strategies and suggestions for ethical decision making.

Ethics in a time of contagion: a relational perspective.

PubMed

Austin, Wendy

2008-12-01

In times of contagion, the key role of nurses brings fears, dangers, and unique demands. The ethics of such challenges need to be explored and understood. Using Callahan's framework for thinking ethically and Taylor's "worries" of modern life, the author elucidates some of the challenges and then argues that the current approach to pandemic ethics, with its reliance on moral reasoning, is insufficient to guide nurses' ethical actions. Relational ethics, which explicitly situates ethics within relationships and our commitment to one another, and which recognizes that context matters in ethical decision-making, is offered as a viable alternative for nurses in considering how to respond.

Improving skill development: an exploratory study comparing a philosophical and an applied ethical analysis technique

NASA Astrophysics Data System (ADS)

Al-Saggaf, Yeslam; Burmeister, Oliver K.

2012-09-01

This exploratory study compares and contrasts two types of critical thinking techniques; one is a philosophical and the other an applied ethical analysis technique. The two techniques analyse an ethically challenging situation involving ICT that a recent media article raised to demonstrate their ability to develop the ethical analysis skills of ICT students and professionals. In particular the skill development focused on includes: being able to recognise ethical challenges and formulate coherent responses; distancing oneself from subjective judgements; developing ethical literacy; identifying stakeholders; and communicating ethical decisions made, to name a few.

Sankofan socio-ethical reflections: the Tuskegee University National Bioethics Center's decade of operation, 1999-2009.

PubMed

Earl, Riggins R

2010-08-01

Primarily, this is a Sankofan socio-ethical analysis of the moral foundation of the Tuskegee University National Bioethics Center's decade of operation. The first section of the study will do the following: a) a Sankofan socio-ethical analysis of the Center's raison d'être; and b) definitions of ethical terms and the social world of the infamous syphilis study. The second section, as a result of the analysis, will address the Center's following challenges: c) the Center's challenge of theory and practice; d) the Center's challenge of moral heritage; and e) the Center's challenge of the future.

The Ethical, Legal, and Social Issues Impacted by Modern Assisted Reproductive Technologies

PubMed Central

Brezina, Paul R.; Zhao, Yulian

2012-01-01

Background. While assisted reproductive technology (ART), including in vitro fertilization has given hope to millions of couples suffering from infertility, it has also introduced countless ethical, legal, and social challenges. The objective of this paper is to identify the aspects of ART that are most relevant to present-day society and discuss the multiple ethical, legal, and social challenges inherent to this technology. Scope of Review. This paper evaluates some of the most visible and challenging topics in the field of ART and outlines the ethical, legal, and social challenges they introduce. Major Conclusions. ART has resulted in a tectonic shift in the way physicians and the general population perceive infertility and ethics. In the coming years, advancing technology is likely to exacerbate ethical, legal, and social concerns associated with ART. ART is directly challenging society to reevaluate the way in which human life, social justice and equality, and claims to genetic offspring are viewed. Furthermore, these issues will force legal systems to modify existing laws to accommodate the unique challenges created by ART. Society has a responsibility to ensure that the advances achieved through ART are implemented in a socially responsible manner. PMID:22272208

Practising virtue: a challenge to the view that a virtue centred approach to ethics lacks practical content.

PubMed

Begley, Ann Marie

2005-11-01

A virtue centred approach to ethics has been criticized for being vague owing to the nature of its central concept, the paradigm person. From the perspective of the practitioner the most damaging charge is that virtue ethics fails to be action guiding and, in addition to this, it does not offer any means of act appraisal. These criticisms leave virtue ethics in a weak position vis-à-vis traditional approaches to ethics. The criticism is, however, challenged by Hursthouse in her analysis of the accounts of right action offered by deontology, utilitarianism and virtue ethics. It is possible to defend the action guiding nature of virtue ethics: there are virtue rules and exemplars to guide action. Insights from Aristotle's practical approach to ethics are considered alongside Hursthouse's analysis and it is suggested that virtue ethics is also capable of facilitating action appraisal. It is at the same time acknowledged that approaches to virtue ethics vary widely and that the challenges offered here would be rejected by those who embrace a radical replacement virtue approach.

Ethical challenges for using human cells in clinical cell therapy.

PubMed

Hermerén, Göran

2012-01-01

In this chapter, different challenges for using human cells in clinical cell therapy are identified and discussed. Several types of challenges are defined and described, with particular attention to the relation between ethical and scientific challenges. Some challenges are cell and disease specific: they are raised by research on special types of cells with certain methods in order to pave the way for cell therapies of particular diseases. But since scientific work is carried out in a societal and value-loaded context, the relations between scientific, ethical, and regulatory challenges are complex. Three theses are first discussed: there is not one fixed list of ethical challenges, some challenges are disease and cell type specific; there are challenges at all stages of the translation from bench to bedside, and the challenges are related to the various stages of translation. Moreover, experimental and ethical research needs to be integrated. Finally, a fourth thesis is suggested: if a constructive and well-argued position is desired, it is necessary to be specific not only about the scientific details but also about the value premises. Everybody is for justice, integrity, and respect for persons. But what precisely does this mean when it is applied to the choices scientists and regulators have to face in their daily work? Copyright © 2012 Elsevier B.V. All rights reserved.

Ethical and Safety Issues of Stem Cell-Based Therapy.

PubMed

Volarevic, Vladislav; Markovic, Bojana Simovic; Gazdic, Marina; Volarevic, Ana; Jovicic, Nemanja; Arsenijevic, Nebojsa; Armstrong, Lyle; Djonov, Valentin; Lako, Majlinda; Stojkovic, Miodrag

2018-01-01

Results obtained from completed and on-going clinical studies indicate huge therapeutic potential of stem cell-based therapy in the treatment of degenerative, autoimmune and genetic disorders. However, clinical application of stem cells raises numerous ethical and safety concerns. In this review, we provide an overview of the most important ethical issues in stem cell therapy, as a contribution to the controversial debate about their clinical usage in regenerative and transplantation medicine. We describe ethical challenges regarding human embryonic stem cell (hESC) research, emphasizing that ethical dilemma involving the destruction of a human embryo is a major factor that may have limited the development of hESC-based clinical therapies. With previous derivation of induced pluripotent stem cells (iPSCs) this problem has been overcome, however current perspectives regarding clinical translation of iPSCs still remain. Unlimited differentiation potential of iPSCs which can be used in human reproductive cloning, as a risk for generation of genetically engineered human embryos and human-animal chimeras, is major ethical issue, while undesired differentiation and malignant transformation are major safety issues. Although clinical application of mesenchymal stem cells (MSCs) has shown beneficial effects in the therapy of autoimmune and chronic inflammatory diseases, the ability to promote tumor growth and metastasis and overestimated therapeutic potential of MSCs still provide concerns for the field of regenerative medicine. This review offers stem cell scientists, clinicians and patient's useful information and could be used as a starting point for more in-depth analysis of ethical and safety issues related to clinical application of stem cells.

Ethical and Safety Issues of Stem Cell-Based Therapy

PubMed Central

Volarevic, Vladislav; Markovic, Bojana Simovic; Gazdic, Marina; Volarevic, Ana; Jovicic, Nemanja; Arsenijevic, Nebojsa; Armstrong, Lyle; Djonov, Valentin; Lako, Majlinda; Stojkovic, Miodrag

2018-01-01

Results obtained from completed and on-going clinical studies indicate huge therapeutic potential of stem cell-based therapy in the treatment of degenerative, autoimmune and genetic disorders. However, clinical application of stem cells raises numerous ethical and safety concerns. In this review, we provide an overview of the most important ethical issues in stem cell therapy, as a contribution to the controversial debate about their clinical usage in regenerative and transplantation medicine. We describe ethical challenges regarding human embryonic stem cell (hESC) research, emphasizing that ethical dilemma involving the destruction of a human embryo is a major factor that may have limited the development of hESC-based clinical therapies. With previous derivation of induced pluripotent stem cells (iPSCs) this problem has been overcome, however current perspectives regarding clinical translation of iPSCs still remain. Unlimited differentiation potential of iPSCs which can be used in human reproductive cloning, as a risk for generation of genetically engineered human embryos and human-animal chimeras, is major ethical issue, while undesired differentiation and malignant transformation are major safety issues. Although clinical application of mesenchymal stem cells (MSCs) has shown beneficial effects in the therapy of autoimmune and chronic inflammatory diseases, the ability to promote tumor growth and metastasis and overestimated therapeutic potential of MSCs still provide concerns for the field of regenerative medicine. This review offers stem cell scientists, clinicians and patient's useful information and could be used as a starting point for more in-depth analysis of ethical and safety issues related to clinical application of stem cells. PMID:29333086

Teaching about genetic testing issues in the undergraduate classroom: a case study.

PubMed

Rogers, Jill Cellars; Taylor, Ann T S

2011-06-01

Educating undergraduates about current genetic testing and genomics can involve novel and creative teaching practices. The higher education literature describes numerous pedagogical approaches in the laboratory designed to engage science and liberal arts students. Often these experiences involve students analyzing their own genes for various polymorphisms, some of which are associated with disease states such as an increased risk for developing cancer. While the literature acknowledges possible ethical ramifications of such laboratory exercises, authors do not present recommendations or rubrics for evaluating whether or not the testing is, in fact, ethical. In response, we developed a laboratory investigation and discussion which allowed undergraduate science students to explore current DNA manipulation techniques to isolate their p53 gene, followed by a dialogue probing the ethical implications of examining their sample for various polymorphisms. Students never conducted genotyping on their samples because of ethical concerns, so the discussion served to replace actual genetic testing in the class. A basic scientist led the laboratory portion of the assignment. A genetic counselor facilitated the discussion, which centered around existing ethical guidelines for clinical genetic testing and possible challenges of human genotyping outside the medical setting. In their final papers, students demonstrated an understanding of the practice guidelines established by the genetics community and acknowledged the ethical considerations inherent in p53 genotyping. Given the burgeoning market for personalized medicine, teaching undergraduates about the psychosocial and ethical dimensions of human gene testing seems important and timely, and introduces an additional role genetic counselors can play in educating consumers about genomics.

Ethical Challenges

ERIC Educational Resources Information Center

Morris, Michael

2004-01-01

All evaluators face the challenge of striving to adhere to the highest possible standards of ethical conduct. Translating the AEA's Guiding Principles and the Joint Committee's Program Evaluation Standards into everyday practice, however, can be a complex, uncertain, and frustrating endeavor. Moreover, acting in an ethical fashion can require…

Evaluation Team Dynamics: Intragroup Ethical Challenges

ERIC Educational Resources Information Center

Urias, David

2009-01-01

Ethical challenges associated with the relationships among members of an evaluative team/organization receive less attention. Examples of the kinds of ethical dilemmas that could occur within an evaluation team include an individual taking undeserved credit, transferring blame, making false promises, withholding information, breaching…

Ethical Issues in Sports Medicine

PubMed Central

Greenfield, Bruce H.; West, Charles Robert

2012-01-01

Ethical issues present a challenge for health care professionals working with athletes of sports teams. Health care professionals—including the team physician, the physical therapist, and the athletic trainer—are faced with the challenge of returning an athlete to competition as quickly as possible but as safely as possible. Conflicts of interest arise due to conflicting obligations of the team physician to the athlete and other members of the sports organization, including coaches and the team owner. The multiple stakeholders involved in sports teams challenge the traditional notion of confidentiality and autonomy. The aims of this article are to explicate the ethics of sports medicine, highlight the ethical issues, and provide some strategies and suggestions for ethical decision making. PMID:24179585

Twenty-first Century ethics of medical research involving human subjects: achievements and challenges.

PubMed

Tzamaloukas, Antonios H; Konstantinov, Konstantin N; Agaba, Emmanuel I; Raj, Dominic S C; Murata, Glen H; Glew, Robert H

2008-01-01

The field of ethics in medical research has seen important developments in the last three decades, but it also faces great challenges in the new century. The purposes of this report are to examine the current status of ethics of medical research involving human subjects and the nature of the ethical challenges facing this research, to identify the weakness of the current system of safeguards for ethical research, and to stress the importance of the ethical character of the researcher, which is the safeguard that has the greatest potential for protecting the research subjects. Researchers appreciate the risks of human medical research that create ethical dilemmas and the need for an ethical compromise in order to proceed with the research. The main elements of the compromise, formulated primarily from experiences in the Second World War, include: (1) the dominant position of the ethical principle of autonomy; (2) the demand for a signed informed consent; (3) the likelihood of improving health with the research protocol, which must be approved by a duly appointed supervising committee; and (4) an acceptable risk/benefit ratio. The main weakness of this set of safeguards is the difficulty with obtaining a truly informed consent. The new challenges to ethical medical research stem from certain types of research, such as genetic and stem cell research, and from the increasing involvement of the industry in planning and funding the research studies. Developing medical researchers with an ethical character and knowledge about ethics in medicine may be the most effective safeguard in protecting participants of medical research experiments.

Ethics and Research with Undergraduates

ERIC Educational Resources Information Center

Richman, Kenneth A.; Alexander, Leslie B.

2006-01-01

Ethicists, researchers and policy makers have paid increasing attention to the ethical conduct of research, especially research involving human beings. Research performed with and by undergraduates poses a specific set of ethical challenges. These challenges are often overlooked by the research community because it is assumed that undergraduate…

Educational Leadership: Key Challenges and Ethical Tensions

ERIC Educational Resources Information Center

Duignan, Patrick

2007-01-01

"Educational Leadership" is a major research book on contemporary leadership challenges for educational leaders. In this groundbreaking new work, educational leaders in schools, including teachers, are provided with ways of analysing and resolving common but complex leadership challenges. Ethical tensions inherent in these challenges are…

Using Challenge Course Activities to Teach Organizational Ethics

ERIC Educational Resources Information Center

Goltz, Sonia M.; Hietapelto, Amy B.

2006-01-01

Few learning experiences give students immediate feedback on ethical and unethical behaviors and provide opportunities to repeatedly practice effective behaviors. This article describes how the authors have used challenge course activities to stimulate students to observe their own and others' ethical and unethical behaviors. Specifically, these…

Ethical Issues for Control-Arm Patients After Revelation of Benefits of Experimental Therapy: A Framework Modeled in Neuroblastoma

PubMed Central

Unguru, Yoram; Joffe, Steven; Fernandez, Conrad V.; Yu, Alice L.

2013-01-01

In 2009, the Children's Oncology Group (COG) phase III randomized controlled trial, ANBL0032, found that adding immunotherapy (Ch14.18) to standard therapy significantly improved outcomes in patients with high-risk neuroblastoma when administered within 110 days after autologous stem-cell transplantation (SCT). After careful deliberation and consultation, the COG Neuroblastoma Committee decided to offer Ch14.18 to prior trial participants who had been randomly assigned to the control arm (no immunotherapy), regardless of the time that had elapsed since SCT. This decision occurred in the context of a limited supply of Ch14.18 and no data regarding its role when administered beyond 110 days. In this article, we analyze the numerous ethical challenges highlighted by the ANBL0032 trial, including the limits of researchers' reciprocity-based obligations to study participants, post-trial access to beneficial therapies, and the balance between scientific knowledge and parental hope. These deliberations may be useful to other researchers when considering their ethical obligations to control-arm participants in the wake of a positive randomized trial. PMID:23295797

Deep brain stimulation and ethics: perspectives from a multisite qualitative study of Canadian neurosurgical centers.

PubMed

Bell, Emily; Maxwell, Bruce; McAndrews, Mary Pat; Sadikot, Abbas; Racine, Eric

2011-12-01

Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted. Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care. This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation. Copyright © 2011 Elsevier Inc. All rights reserved.

Ethical Challenges Scenario: Youth Involvement in Evaluation

ERIC Educational Resources Information Center

Cooksy, Leslie J.

2007-01-01

All evaluators face the challenge of striving to adhere to the highest possible standards of ethical conduct. Translating the AEA's Guiding Principles and the Joint Committee's Program Evaluation Standards into everyday practice, however, can be a complex, uncertain, and frustrating endeavor. Moreover, acting in an ethical fashion can require…

An Ethics Challenge for School Counselors

ERIC Educational Resources Information Center

Froeschle, Janet G.; Crews, Charles

2010-01-01

Ethical issues arise more often for school counselors than for those who work in other settings (Remley, 2002). The challenge of working not only with minors but also with other stakeholders including parents, teachers, school administrators, and community members sets the stage for potential legal and ethical dilemmas. Awareness and adherence to…

Technology in Art Therapy: Ethical Challenges

ERIC Educational Resources Information Center

Alders, Amanda; Beck, Liz; Allen, Pat B.; Mosinski, Barbara

2011-01-01

As technology advances, art therapy practices are adapting to the demands of a new cultural climate. Art therapists face a number of ethical challenges as they interact with increasingly diverse populations and employ new media. This article addresses some of the ethical and professional issues related to the use of technology in clinical…

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.

PubMed

Norvoll, Reidun; Hem, Marit Helene; Pedersen, Reidar

2017-03-01

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals' descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.

Teachers' Ethical Dilemmas: What Would You Do?

ERIC Educational Resources Information Center

Bucholz, Jessica L.; Keller, Cassandra L.; Brady, Michael P.

2007-01-01

Educators will face a variety of ethical and moral dilemmas throughout their teaching careers; however, they do not have a common board that governs its members' ethical behavior. Instead, there are numerous educational organizations that have written their own specific codes for ethical behavior. The Council for Exceptional Children (CEC) has…

A Contingency Model for Ethical Decision-Making by Educational Leaders

ERIC Educational Resources Information Center

Green, James; Walker, Keith

2009-01-01

While numerous philosophical essays offer speculative explanations of how persons should make ethical decisions, empirical investigations of the phenomenon of ethical decision-making are limited to just a few studies in the discipline of business management. This investigation focused on the ethical dilemmas confronted by educators, with emphasis…

The ethics of research using electronic mail discussion groups.

PubMed

Kralik, Debbie; Warren, Jim; Price, Kay; Koch, Tina; Pignone, Gino

2005-12-01

The aim of this paper is to identify and discuss the ethical considerations that have confronted and challenged the research team when researchers facilitate conversations using private electronic mail discussion lists. The use of electronic mail group conversations, as a collaborative data generation method, remains underdeveloped in nursing. Ethical challenges associated with this approach to data generation have only begun to be considered. As receipt of ethics approval for a study titled; 'Describing transition with people who live with chronic illness' we have been challenged by many ethical dilemmas, hence we believe it is timely to share the issues that have confronted the research team. These discussions are essential so we can understand the possibilities for research interaction, communication, and collaboration made possible by advanced information technologies. Our experiences in this study have increased our awareness for ongoing ethical discussions about privacy, confidentiality, consent, accountability and openness underpinning research with human participants when generating data using an electronic mail discussion group. We describe how we work at upholding these ethical principles focusing on informed consent, participant confidentiality and privacy, the participants as threats to themselves and one another, public-private confusion, employees with access, hackers and threats from the researchers. A variety of complex issues arise during cyberspace research that can make the application of traditional ethical standards troublesome. Communication in cyberspace alters the temporal, spatial and sensory components of human interaction, thereby challenging traditional ethical definitions and calling to question some basic assumptions about identity and ones right to keep aspects of it confidential. Nurse researchers are bound by human research ethics protocols; however, the nature of research by electronic mail generates moral issues as well as ethical concerns. Vigilance by researchers is required to ensure that data are viewed within the scope of the enabling ethics approval.

Business Ethics 101 for the biotech industry.

PubMed

MacDonald, Chris

2004-01-01

Biotechnology companies face ethical challenges of two distinct types: bioethical challenges faced on account of the nature of work in the life sciences, and corporate ethical challenges on account of their nature as commercial entities. The latter set of challenges has received almost no attention at all in the academic literature or media. This paper begins to remedy that lacuna, examining ethical issues that arise specifically on account of the status of biotech companies as commercial entities. The focus here is on three representative issues: product safety, corporate social responsibility, and corporate governance. It is argued that each of these issues poses particular ethical challenges for companies in the biotech sector. In the area of product safety, it is noted that biotech companies face particular challenges in determining what counts as a "safe" product, given the contentious nature of what might count as a "harm" in the biotech field. In the area of corporate social responsibility, the adoption of a "stakeholder approach" and an attempt to manage the social consequences of products pose special challenges for biotech companies. This is due to the enormous range of groups and individuals claiming to have a stake in the doings of such companies, and the trenchant controversies over just what the social consequences of various biotechnologies might be. In the area of corporate governance, biotech companies need to seek out and follow best practices regarding the ways in which information, authority, and influence flow between a company's shareholders, managers, and Board of Directors, if they are to avoid duplicating the ethical and financial scandal that brought down ImClone. An important meta-issue, here--one that renders each of these corporate ethical challenges more vexing--is the difficulty of finding the appropriate benchmarks for ethical corporate behavior in a field as controversial, and as rapidly evolving, as biotechnology. Three programmatic suggestions can be made: Firstly, scholars and others interested in the ethical performance of the biotech sector must seek out and build opportunities for richer interdisciplinary collaboration. Secondly, companies within the biotech sector must seek out expertise and build capacity and competency in dealing with the corporate ethical issues that arise in their sector. Finally, companies in the biotech sector should explore the opportunities for collective problem solving afforded by the existence of local, national, and international industry associations such as the Biotechnology Industry Organization, BIOTECanada, and EuropaBio.

Genetic testing in congenital heart disease: ethical considerations.

PubMed

Lin, Kimberly Y; D'Alessandro, Lisa C A; Goldmuntz, Elizabeth

2013-01-01

On March 16, 2012, the Ethics of the Heart 2012: Ethical and Policy Challenges in Pediatric and Adult Congenital Heart Disease Conference took place in Philadelphia, Pennsylvania. The first session focused on the ethics surrounding genetic testing in patients with congenital heart disease. Summarized here is the introductory presentation given by Dr Elizabeth Goldmuntz entitled "The Role of Genetic Testing in Congenital Heart Disease," followed by a case presentation given by Dr Lisa D'Alessandro. The case and the panel discussion that ensued highlight several ethical principles and challenges in this unique patient population.

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

Ethical Challenges in Psychiatric Administration and Leadership.

PubMed

Moffic, H Steven; Saeed, Sy Atezaz; Silver, Stuart; Koh, Steve

2015-09-01

As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority.

Herbal medicine research and global health: an ethical analysis.

PubMed

Tilburt, Jon C; Kaptchuk, Ted J

2008-08-01

Governments, international agencies and corporations are increasingly investing in traditional herbal medicine research. Yet little literature addresses ethical challenges in this research. In this paper, we apply concepts in a comprehensive ethical framework for clinical research to international traditional herbal medicine research. We examine in detail three key, underappreciated dimensions of the ethical framework in which particularly difficult questions arise for international herbal medicine research: social value, scientific validity and favourable risk-benefit ratio. Significant challenges exist in determining shared concepts of social value, scientific validity and favourable risk-benefit ratio across international research collaborations. However, we argue that collaborative partnership, including democratic deliberation, offers the context and process by which many of the ethical challenges in international herbal medicine research can, and should be, resolved. By "cross-training" investigators, and investing in safety-monitoring infrastructure, the issues identified by this comprehensive framework can promote ethically sound international herbal medicine research that contributes to global health.

Anticipating issues related to increasing preimplantation genetic diagnosis use: a research agenda.

PubMed

Klitzman, Robert; Appelbaum, Paul S; Chung, Wendy; Sauer, Mark

2008-01-01

Increasing use of preimplantation genetic diagnosis (PGD) poses numerous clinical, social, psychological, ethical, legal and policy dilemmas, many of which have received little attention. Patients and providers are now considering and using PGD for a widening array of genetic disorders, and patients may increasingly seek 'designer babies.' In the USA, although governmental oversight policies have been discussed, few specific guidelines exist. Hence, increasingly, patients and providers will face challenging ethical and policy questions of when and for whom to use PGD, and how it should be financed. These issues should be better clarified and addressed through collection of data concerning the current use of PGD in the USA, including factors involved in decision making about PGD use, as well as the education of the various communities that are, and should be, involved in its implementation. Improved understanding of these issues will ultimately enhance the development and implementation of future clinical guidelines and policies.

Foundation Officers, Evaluation, and Ethical Problems: A Pilot Investigation

ERIC Educational Resources Information Center

Morris, Michael

2007-01-01

Ethical problems encountered by foundation officers in their evaluation-related work were identified via an email survey of a sample of Council on Foundations member organizations. Of the respondents who had worked with evaluators, one-third indicated that they had faced ethical challenges. Most challenges fell into one of four categories:…

Ethical practice under fire: deployed physicians in the global war on terrorism.

PubMed

Sessums, Laura L; Collen, Jacob F; O'Malley, Patrick G; Jackson, Jeffery L; Roy, Michael J

2009-05-01

The Global War on Terrorism brings significant ethical challenges for military physicians. From Abu Ghraib to Guantanamo Bay, the actions of health care providers have come under considerable scrutiny. Military providers have dual roles as military officers and medical professionals, which have the potential to come into conflict. Often they are inadequately prepared to manage this conflict. We review pertinent historical precedents, applicable laws, ethical guidelines, and military regulations. We also present examples of ethical challenges deployed clinicians have faced and their ethical solution. Finally, we propose a practical strategy to educate physicians on how to manage complex ethical dilemmas in war time settings.

Engineering Ethics Education : Its Necessity, Objectives, Methods, Current State, and Challenges

NASA Astrophysics Data System (ADS)

Fudano, Jun

The importance of engineering ethics education has become widely recognized in the industrialized countries including Japan. This paper examines the background against which engineering ethics education is required, and reviews its objectives, methods, and challenges, as well as its current state. In pointing out important issues associated with the apparent acceptance and quantitative development of ethics education, especially after the establishment of the Japan Accreditation Board for Engineering Education in 1999, the author stresses that the most serious problem is the lack of common understanding on the objectives of engineering ethics education. As a strategy to improve the situation, the so-called “Ethics-across-the-Curriculum” approach is introduced. The author also claims that business/organization ethics which is consistent with engineering ethics should be promoted in Japan.

From subject to participant: ethics and the evolving role of community in health research.

PubMed

Bromley, Elizabeth; Mikesell, Lisa; Jones, Felica; Khodyakov, Dmitry

2015-05-01

Belmont Report principles focus on the well-being of the research subject, yet community-engaged investigators often eschew the role of subject for that of participant. We conducted semistructured interviews with 29 community and academic investigators working on 10 community-engaged studies. Interviews elicited perspectives on ethical priorities and ethical challenges. Interviewees drew on the Belmont Report to describe 4 key principles of ethical community-engaged research (embodying ethical action, respecting participants, generalizing beneficence, and negotiating justice). However, novel aspects of the participant role were the source of most ethical challenges. We theorize that the shift in ethical focus from subject to participant will pose new ethical dilemmas for community-engaged investigators and for other constituents interested in increasing community involvement in health research.

From Subject to Participant: Ethics and the Evolving Role of Community in Health Research

PubMed Central

Mikesell, Lisa; Jones, Felica; Khodyakov, Dmitry

2015-01-01

Belmont Report principles focus on the well-being of the research subject, yet community-engaged investigators often eschew the role of subject for that of participant. We conducted semistructured interviews with 29 community and academic investigators working on 10 community-engaged studies. Interviews elicited perspectives on ethical priorities and ethical challenges. Interviewees drew on the Belmont Report to describe 4 key principles of ethical community-engaged research (embodying ethical action, respecting participants, generalizing beneficence, and negotiating justice). However, novel aspects of the participant role were the source of most ethical challenges. We theorize that the shift in ethical focus from subject to participant will pose new ethical dilemmas for community-engaged investigators and for other constituents interested in increasing community involvement in health research. PMID:25790380

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

What is the role of clinical ethics support in the era of e-medicine?

PubMed

Parker, M; Gray, J A

2001-04-01

The internet is becoming increasingly important in health care practice. The number of health-related web sites is rising exponentially as people seek health-related information and services to supplement traditional sources, such as their local doctor, friends, or family. The development of e-medicine poses important ethical challenges, both for health professionals and for those who provide clinical ethics support for them. This paper describes some of these challenges and explores some of the ways in which those who provide clinical ethics support might respond creatively to them. By offering ways of responding to such challenges, both electronically and face-to-face, the providers of clinical ethics support can show themselves to be an indispensable part of good quality health care provision.

Evidence-Based Ethics for Neurology and Psychiatry Research

PubMed Central

Kim, Scott Y. H.

2004-01-01

Summary: American bioethics, historically arising out of theology and philosophy, has been dominated by the method of normative analysis. Ethics as policy, however, requires in addition a solid evidence base. This paper discusses the background conditions that make neurotherapeutics research particularly challenging. Three key ethical issues are discussed within an evidence-based ethics framework: the ethical challenges arising from changes in the financial incentive structures for academic researchers and their institutions, the challenges of risk-benefit analysis for neurotherapeutics protocols testing innovative interventions, and the evolving issues surrounding impaired decision-making capacity and surrogate consent for research. For each of these issues, selected empirical data are reviewed, areas for further inquiry are noted, and the need for development of novel methods for bioethics policy research is discussed. PMID:15717040

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.

Advancing HIV research with pregnant women: navigating challenges and opportunities.

PubMed

Krubiner, Carleigh B; Faden, Ruth R; Cadigan, R Jean; Gilbert, Sappho Z; Henry, Leslie M; Little, Margaret O; Mastroianni, Anna C; Namey, Emily E; Sullivan, Kristen A; Lyerly, Anne D

2016-09-24

Concerns about including pregnant women in research have led to a dearth of evidence to guide safe and effective treatment and prevention of HIV in pregnancy. To better understand why these evidence gaps persist and inform guidance for responsible inclusion of pregnant women in the HIV research agenda, we aimed to learn what HIV experts perceive as barriers and constraints to conducting this research. We conducted a series of group and one-on-one consultations with 62 HIV investigators and clinicians to elicit their views and experiences conducting HIV research involving pregnant women. Thematic analysis was used to identify priorities and perceived barriers to HIV research with pregnant women. Experts discussed a breadth of needed research, including safety, efficacy, and appropriate dosing of: newer antiretrovirals for pregnant women, emerging preventive strategies, and treatment for coinfections. Challenges to conducting research on pregnancy and HIV included ethical concerns, such as how to weigh risks and benefits in pregnancy; legal concerns, such as restrictive interpretations of current regulations and liability issues; financial and professional disincentives, including misaligned funder priorities and fear of reputational damage; and analytical and logistical complexities, such as challenges recruiting and retaining pregnant women to sufficiently power analyses. Investigators face numerous challenges to conducting needed HIV research with pregnant women. Advancing such research will require clearer guidance regarding ethical and legal uncertainties; incentives that encourage rather than discourage investigators to undertake such research; and a commitment to earlier development of safety and efficacy data through creative trial designs.

Enhancing Research Ethics Capacity in the Middle East: Experience and Challenges of a Fogarty-Sponsored Training Program

PubMed Central

Silverman, Henry; Edwards, Hillary; Shamoo, Adil; Matar, Amal

2014-01-01

we describe the research ethics capacity needs of the countries from the Middle East region. Against this background, we relate the experience of an international training program focused on providing long-term training in research ethics to individuals from low- and middle-income countries in the Middle East area. We describe our pedagogical approach to training, program changes to address challenges faced, and accomplishments of trainees. Many former trainees developed research ethics curricula in their home institutions, established or enhanced their institutions’ research ethics committees, provided leadership to national research ethics systems, and conducted research in research ethics. Based on our analysis, we make recommendations for how trainees can further address current regional research ethics needs in the Middle East and conduct future research. This paper is part of a collection of papers analyzing the Fogarty International Center’s International Research Ethics Education and Curriculum Development program. PMID:24384515

The Medical Ethics Curriculum in Medical Schools: Present and Future.

PubMed

Giubilini, Alberto; Milnes, Sharyn; Savulescu, Julian

2016-01-01

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Integrating Ethics into International Business Teaching: Challenges and Methodologies in the Greater China Context

ERIC Educational Resources Information Center

Whitla, Paul

2011-01-01

This paper examines the process of integrating ethics into the teaching of international business within the Greater China region. An example of how ethics is integrated into a required undergraduate international business course at a Hong Kong based university is presented. The contextual challenges of developing a course for use in the Greater…

Work Ethic and Employment Status: A Study of Jobseekers

ERIC Educational Resources Information Center

Hill, Roger B.; Fouts, Susan

2005-01-01

Although there have been numerous changes within the workplace during the past century, employers continue to search for employees with a strong work ethic. Employers often cite a strong work ethic as the most desired characteristic in a new employee. Work ethic can be described as a set of characteristics and attitudes in which an individual…

Ethical Issues in Providing Online Psychotherapeutic Interventions

PubMed Central

2000-01-01

The Internet offers psychotherapists a new communication medium through which they can deliver psychotherapeutic interventions that are appropriate to the medium. Yet online psychotherapy also offers new ethical challenges for therapists interested in providing online psychotherapeutic services. The differences between interactive text-based communication and in-person verbal communication create new ethical challenges not previously encountered in face-to-face therapy. This article will examine the Internet's potential for providing online psychotherapeutic interventions and will review the ethical issues involved with providing interactive text-based psychotherapy. PMID:11720924

The historical context of business ethics: implications for choices and challenges in wound care.

PubMed

Gallagher, S M

1999-08-01

Wound care clinicians are regularly asked to make decisions of an ethical nature within their work settings. Business and business practices are influenced by a number of factors, such as history, culture, and individual choices. This article describes business practices and ultimately business ethics from an historical context, the meaning of business culture within the dominant culture, and the debate over business ethics as it relates to choices and challenges for wound care clinicians.

Transplant ethics under scrutiny – responsibilities of all medical professionals

PubMed Central

Trey, Torsten; Caplan, Arthur L.; Lavee, Jacob

2013-01-01

In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices. PMID:23444249

Transplant ethics under scrutiny - responsibilities of all medical professionals.

PubMed

Trey, Torsten; Caplan, Arthur L; Lavee, Jacob

2013-02-01

In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices.

Moral experience and ethical challenges in an emergency department in Pakistan: emergency physicians' perspectives.

PubMed

Zafar, Waleed

2015-04-01

Emergency departments (ED) are often stressful environments posing unique ethical challenges-issues that primarily raise moral rather than clinical concerns-in patient care. Despite this, there are very few reports of what emergency physicians find ethically challenging in their everyday work. Emergency medicine (EM) is a relatively young but rapidly growing specialty that is gaining acceptance worldwide. The aim of this study was to explore the perspectives of EM residents and physicians regarding the common ethical challenges they face during patient care in one of only two academic EM departments in Pakistan. These challenges could then be addressed in residents' training and departmental practice guidelines. A qualitative research design was employed and in-depth interviews were conducted with ED physicians. Participants were encouraged to think of specific examples from their work, to highlight the particular ethical concerns raised and to describe in detail the process by which those concerns were addressed or left unresolved. Transcripts were analysed using grounded theory methods. Thirteen participants were interviewed and they described four key challenges: how to provide highest quality care with limited resources; how to be truthful to patients; what to do when it is not possible to provide or continue treatment to patients; and when (and when not) to offer life-sustaining treatments. Participants' accounts provided important insights into how physicians tried to resolve these challenges in the 'local moral world' of an ED in Pakistan. The study highlights the need for developing systematic and contextually appropriate mechanisms for resolving common ethical challenges in the EDs and for training residents in moral problem solving. 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.

The Ethics Liaison Program: building a moral community.

PubMed

Bates, Sarah R; McHugh, Wendy J; Carbo, Alexander R; O'Neill, Stephen F; Forrow, Lachlan

2017-09-01

Ethicists often struggle to maintain institution-wide awareness of and commitment to medical ethics. At Beth Israel Deaconess Medical Center (BIDMC), we created the Ethics Liaison Program to address that challenge by making ethics part of the moral culture of the institution. Liaisons represent clinical and non-clinical areas throughout the medical centre. The liaison has a four-part role: to spread awareness and understanding of Ethics Programs among their coworkers; share information regarding ethical dilemmas in their work area with the members of the Ethics Support Service; review ethics activities and needs within their area; and undertake ethics-related projects. This paper lists the notable attributes of the Ethics Liaison Program, and describes the purpose and structure of the programme, its advantages and the challenges to implementing it. The Ethics Liaison Program has helped to make ethics part of the everyday culture at BIDMC, and other medical centres might benefit from the establishment of similar programmes. 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/.

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.

The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.

PubMed

Hem, Marit Helene; Molewijk, Bert; Gjerberg, Elisabeth; Lillemoen, Lillian; Pedersen, Reidar

2018-06-05

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of 'bricolage' which means our approach was inductive. Most participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices.

Research Ethics Education in the STEM Disciplines: The Promises and Challenges of a Gaming Approach.

PubMed

Briggle, Adam; Holbrook, J Britt; Oppong, Joseph; Hoffmann, Joesph; Larsen, Elizabeth K; Pluscht, Patrick

2016-02-01

While education in ethics and the responsible conduct of research (RCR) is widely acknowledged as an essential component of graduate education, particularly in the STEM disciplines (science, technology, engineering, and math), little consensus exists on how best to accomplish this goal. Recent years have witnessed a turn toward the use of games in this context. Drawing from two NSF-funded grants (one completed and one on-going), this paper takes a critical look at the use of games in ethics and RCR education. It does so by: (a) setting the development of research and engineering ethics games in wider historical and theoretical contexts, which highlights their promise to solve important pedagogical problems; (b) reporting on some initial results from our own efforts to develop a game; and (c) reflecting on the challenges that arise in using games for ethics education. In our discussion of the challenges, we draw out lessons to improve this nascent approach to ethics education in the STEM disciplines .

Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey.

PubMed

Byrd, Gary D; Devine, Patricia J; Corcoran, Kate E

2014-10-01

The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. THE TASK FORCE AND MLA STAFF CRAFTED A SURVEY TO DETERMINE: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians.

Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey

PubMed Central

Byrd, Gary D.; Devine, Patricia J.; Corcoran, Kate E.

2014-01-01

Objective: The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. Methods: The task force and MLA staff crafted a survey to determine: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Results: Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Implications: Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians. PMID:25349544

Research Ethics 2.0: New Perspectives on Norms, Values, and Integrity in Genomic Research in Times of Even Scarcer Resources

PubMed Central

Brall, Caroline; Maeckelberghe, Els; Porz, Rouven; Makhoul, Jihad; Schröder-Bäck, Peter

2017-01-01

Research ethics anew gained importance due to the changing scientific landscape and increasing demands and competition in the academic field. These changes are further exaggerated because of scarce(r) resources in some countries on the one hand and advances in genomics on the other. In this paper, we will highlight the current challenges thereof to scientific integrity. To mark key developments in research ethics, we will distinguish between what we call research ethics 1.0 and research ethics 2.0. Whereas research ethics 1.0 focuses on individual integrity and informed consent, research ethics 2.0 entails social scientific integrity within a broader perspective of a research network. This research network can be regarded as a network of responsibilities in which every stakeholder involved has to jointly meet the ethical challenges posed to research. PMID:28288472

Research Ethics 2.0: New Perspectives on Norms, Values, and Integrity in Genomic Research in Times of Even Scarcer Resources.

PubMed

Brall, Caroline; Maeckelberghe, Els; Porz, Rouven; Makhoul, Jihad; Schröder-Bäck, Peter

2017-01-01

Research ethics anew gained importance due to the changing scientific landscape and increasing demands and competition in the academic field. These changes are further exaggerated because of scarce(r) resources in some countries on the one hand and advances in genomics on the other. In this paper, we will highlight the current challenges thereof to scientific integrity. To mark key developments in research ethics, we will distinguish between what we call research ethics 1.0 and research ethics 2.0. Whereas research ethics 1.0 focuses on individual integrity and informed consent, research ethics 2.0 entails social scientific integrity within a broader perspective of a research network. This research network can be regarded as a network of responsibilities in which every stakeholder involved has to jointly meet the ethical challenges posed to research. © 2017 S. Karger AG, Basel.

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.

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

PubMed

Sánchez, Veralia Gabriela; Taylor, Ingrid; Bing-Jonsson, Pia Cecilie

2017-01-01

The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. This article reviews reported ethical challenges to implementing smart houses for older adults. A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

Students' Responses to Ethical Dilemmas in an Academic Setting and in the Work Place

ERIC Educational Resources Information Center

Teer, Faye P.; Kruck, S. E.

2012-01-01

It is important for students to be prepared to act ethically when they face real world situations that test their ethical leadership. The purpose of this study was to examine university students' responses to ethical dilemmas. One hundred and sixty two students in numerous majors and both undergraduate and graduate classifications responded to a…

Surgical ethics and the challenge of surgical innovation.

PubMed

Angelos, Peter

2014-12-01

Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages. Copyright © 2014 Elsevier Inc. All rights reserved.

Ethics Education: Using Inductive Reasoning to Develop Individual, Group, Organizational, and Global Perspectives

ERIC Educational Resources Information Center

Taft, Susan H.; White, Judith

2007-01-01

Ethics education that prepares students to address ethical challenges at work is a multifaceted and long-term endeavor. In this article, the authors propose an inductive ethics pedagogy that begins the process of ethics education by grounding students in their own individual ethical principles. The approach centers on developing students' ethical…

A New Ethical Challenge for Institutional Review Boards (IRBs)/Ethics Committees (ECs) in the Assessment of Pediatric Clinical Trials.

PubMed

Rose, Klaus; Kummer, Hans

2015-05-28

Both the US and EU have introduced pediatric pharmaceutical legislation to facilitate clinical trials in children and development of better medicines for children. The first concerns were published in 2014 that the European Medicines Agency (EMA)'s Pediatric Committee (PDCO) may be over-enthusiastic and has compelled questionable pediatric clinical trials from pharmaceutical companies. Numerous clinical trials are mandated in rare conditions for which not enough patients exist for even one trial. Furthermore, where these trials are mandated in adolescent patients, the legal age limit of the 18th birthday is confused with a medical age limit and can result in separate clinical trials in adolescent patients that neither make medical nor scientific sense nor will ever recruit enough patients for a meaningful outcome. To confirm our concerns we searched the registry clinicaltrials.gov and found examples for PDCO-triggered unethical trials. We conclude that such trials should not be accepted by institutional review boards (IRBs)/ethics committees (ECs) and that clinical trials resulting from negotiations with EMA's PDCO need extra careful scrutiny by IRBs/ECs in order to prevent unethical studies and damage to pediatric research and unnecessary risks to pediatric patients.

Geoethical implications for geoarchaeology. The Laacher See and AD 536 case studies

NASA Astrophysics Data System (ADS)

Riede, Felix; Price, Neil; Andersen, Per

2017-04-01

Environmental catastrophes represent profound challenges faced by societies today. Numerous scholars in the climate sciences as well as the Humanities have argued for a greater ethical engagement with these pressing issues. At the same time, several disciplines concerned with hazards are moving towards formalized ethical codes or promises that guide not only the dissemination of data but oblige scientists to relate to fundamentally political issues. With its starting point in the recently proposed geoethical promise, this paper reports on two case studies of how past natural hazards have affected vulnerable societies in Europe's past. We ask whether cases of past calamities and their societal effects should not play a greater role in public debates and whether geo-archaeologists working with past environmental hazards should be more outspoken in their ethical considerations. We offer no firm answers, but suggest that geo-archaeologists engage with debates of human-environment relations at this interface between politics, public affairs and science. We argue for greater communication between the human and natural sciences and further suggest that outreach institutions such as museums - both natural and cultural - could and perhaps should play a key role in staging such engagements.

Too much information: visual research ethics in the age of wearable cameras.

PubMed

Mok, Tze Ming; Cornish, Flora; Tarr, Jen

2015-06-01

When everything you see is data, what ethical principles apply? This paper argues that first-person digital recording technologies challenge traditional institutional approaches to research ethics, but that this makes ethics governance more important, not less so. We review evolving ethical concerns across four fields: Visual ethics; ubiquitous computing; mobile health; and grey literature from applied or market research. Collectively, these bodies of literature identify new challenges to traditional notions of informed consent, anonymity, confidentiality, privacy, beneficence and maleficence. Challenges come from the ever-increasing power, breadth and multi-functional integration of recording technologies, and the ubiquity and normalization of their use by participants. Some authors argue that these evolving relationships mean that institutional ethics governance procedures are irrelevant or no longer apply. By contrast, we argue that the fundamental principles of research ethics frameworks have become even more important for the protection of research participants, and that institutional frameworks need to adapt to keep pace with the ever-increasing power of recording technologies and the consequent risks to privacy. We conclude with four recommendations for efforts to ensure that contemporary visual recording research is held appropriately accountable to ethical standards: (i) minimizing the detail, scope, integration and retention of captured data, and limiting its accessibility; (ii) formulating an approach to ethics that takes in both the 'common rule' approaches privileging anonymity and confidentiality together with principles of contextual judgement and consent as an ongoing process; (iii) developing stronger ethical regulation of research outside academia; (iv) engaging the public and research participants in the development of ethical guidelines.

MEDICAL ETHICS EDUCATION IN TURKEY; STATE OF PLAY AND CHALLENGES.

PubMed

Ekmekçi, Perihan Elif

Medical ethics can be traced back to Hippocratic Oath in antiquity. Last decade witnessed improvements in science and technology which attracted attention to the ethical impacts of the innovations in medicine. The need to combine medical innovations with a preservation of human values and to cultivate ethical competencies required by professionalism conceived medical ethics education in various levels in medical schools. Despite the diversities regarding teaching hours, methodology and content of the courses, medical ethics became a fundamental part of medical education around the world. In Turkey medical ethics education is given both in undergraduate and postgraduate levels. The high increase in the number of medical schools and shortfall of instructors who have medical ethics as their primary academic focus creates a big challenge in medical ethics education in both levels. Currently there are 89 medical schools in Turkey and only six medical schools are giving postgraduate medical ethics education. In 2010 only 33 of all medical schools could establish a separate department dedicated to medical ethics. There are no medical ethics courses embedded in residency programs. The quality and standardization of undergraduate medical ethics education has started but there are no initiatives to do so in postgraduate level.

Teaching the Ethics of Biology.

ERIC Educational Resources Information Center

Johansen, Carol K.; Harris, David E.

2000-01-01

Points out the challenges of educating students about bioethics and the limited training of many biologists on ethics. Discusses the basic principles of ethics and ethical decision making as applied to biology. Explains the models of ethical decision making that are often difficult for students to determine where to begin analyzing. (Contains 28…

Encompassing multiple moral paradigms: a challenge for nursing educators.

PubMed

Caldwell, Elizabeth Shirin; Lu, Hongyan; Harding, Thomas

2010-03-01

Providing ethically competent care requires nurses to reflect not only on nursing ethics, but also on their own ethical traditions. New challenges for nurse educators over the last decade have been the increasing globalization of the nursing workforce and the internationalization of nursing education. In New Zealand, there has been a large increase in numbers of Chinese students, both international and immigrant, already acculturated with ethical and cultural values derived from Chinese Confucian moral traditions. Recently, several incidents involving Chinese nursing students in morally conflicting situations have led to one nursing faculty reflecting upon how moral philosophy is taught to non-European students and the support given to Chinese students in integrating the taught curriculum into real-life clinical practice settings. This article uses a case study involving a Chinese student to reflect on the challenges for both faculty members and students when encountering situations that present ethical dilemmas.

The Ethical Practice of Podiatric Medicine.

ERIC Educational Resources Information Center

McCarthy, Daniel J.

1978-01-01

A close examination of the Hippocratic Oath and the Code of Ethics of the American Podiatry Association is proposed as a outline for the parameters of ethical professional conduct. Ethical challenges facing the medical community, such as euthanasia, are discussed. (LBH)

The Development of a Code of Ethics: An Online Classroom Approach to Making Connections between Ethical Foundations and the Challenges Presented by Information Technology

ERIC Educational Resources Information Center

Brooks, Rochelle

2010-01-01

In today's organizations, ethical challenges relate to areas like fraud, right to privacy for consumers, social responsibility, and trade restrictions. For Information Technology (IT) specifically, these can translate to considerations on how technology is used to violate people's privacy, how automation leads to job reductions, or how management…

Ethics creep or governance creep? Challenges for Australian Human Research Ethics Committees (HRECS).

PubMed

Gorman, Susanna M

2011-09-01

Australian Human Research Ethics Committees (HRECs) have to contend with ever-increasing workloads and responsibilities which go well beyond questions of mere ethics. In this article, I shall examine how the roles of HRECs have changed, and show how this is reflected in the iterations of the National Statement on Ethical Conduct in Human Research 2007 (NS). In particular I suggest that the focus of the National Statement has shifted to concentrate on matters of research governance at the expense of research ethics, compounded by its linkage to the Australian Code for the Responsible Conduct of Research (2007) in its most recent iteration. I shall explore some of the challenges this poses for HRECs and institutions and the risks it poses to ensuring that Australian researchers receive clear ethical guidance and review.

Challenges of Postmodern Thought in Christian Higher Education Institutions: Implications for Ethical Leadership

ERIC Educational Resources Information Center

Darroux, Dean A.

2013-01-01

The study investigated the question: What is the process that Christian higher education administrators and faculty members used when understanding the challenges of postmodern thought at the institutions, and what are the challenges for ethical leadership? Utilizing a grounded theory methodology, the researcher sought to develop a theory that…

Hitting the Moving Target: Challenges of Creating a Dynamic Curriculum Addressing the Ethical Dimensions of Geospatial Data

ERIC Educational Resources Information Center

Carr, John; Vallor, Shannon; Freundschuh, Scott; Gannon, William L.; Zandbergen, Paul

2014-01-01

While established ethical norms and core legal principles concerning the protection of privacy may be easily identified, applying these standards to rapidly evolving digital information technologies, markets for digital information and convulsive changes in social understandings of privacy is increasingly challenging. This challenge has been…

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.

Research ethics consultation: ethical and professional practice challenges and recommendations.

PubMed

Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

2015-05-01

The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.

Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

PubMed Central

Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

2015-01-01

The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

Ethics issues in scientific data and service provision: evidence and challenges for the European Plate Observing System (EPOS)

NASA Astrophysics Data System (ADS)

Cocco, Massimo; Freda, Carmela; Haslinger, Florian; Consortium, Epos

2016-04-01

Addressing Ethics issues is nowadays a relevant challenge for any initiative, program or project dealing with scientific data and products provision, access to services for scientific purposes and communication with different stakeholders, including society. This is corroborated by the evidence that Ethics has very high priority in EU funded research. Indeed, all the activities carried out under Horizon 2020 must comply with ethical principles and national, Union and international legislation. This implies that "For all activities funded by the European Union, Ethics is an integral part of research from beginning to end, and ethical compliance is seen as pivotal to achieve real research excellence." Here, we present the experience of EPOS, a public pan-European research infrastructure. EPOS aims at integrating data, data products, services and software (DDSS) for solid Earth science generated and provided by monitoring networks, observing systems and facilities belonging to European countries. EPOS fosters the integrated use of multidisciplinary solid Earth data to improve the understanding of physical and chemical processes controlling earthquakes, volcanic eruptions, tsunamis as well as those driving tectonics and surface dynamics. The EPOS integration plan will make significant contributions to understanding and mitigating geo-hazards, yielding data for hazard assessment, data products for engaging different stakeholders, and services for training, education and communication to society. Numerous national research infrastructures engaged in EPOS are deployed for the monitoring of areas prone to geo-hazards and for the surveillance of the national territory including areas used for exploiting geo-resources. The EPOS community is therefore already trained to provide services to public (civil defence agencies, local and national authorities) and private (petroleum industry, mining industry, geothermal companies, aviation security) stakeholders. Our ability to monitor planet Earth is rapidly evolving through the development of new sensor technology and we can deliver this information with increasing rapidity, integrate it, provide solutions to scientific challenges and furnish essential information for decision makers. EPOS is aware that the research promoted by its data and service provision can have a profound influence on the environment, human health and wellbeing, economic development, national security, and other facets of human societies. For these reasons EPOS must address Ethics issues associated with the exploitation of its achievements involving security issues, use and misuse of data, environmental protection and risk communication. The EPOS community feels the obligation to adopt a responsible conduct, both within the scientific community and in the broader society, exploring the implications of open provisioning of data and services, up to imposing justified constraints. This requires that contributing to the DDSS provision cannot be simply limited to activities fostering the capacity (i.e., ability) to access scientific products, but must promote the creation of capabilities (i.e., conscious use of data) and the functioning (i.e., activities constitutive of a scientist's being) to access and use scientific products in an ethically consistent way. We will present and discuss Ethics issues envisaged in EPOS, focusing on the most relevant for its implementation phase: protection of personal data, misuse of data, communication, and societal impact.

Clinical ethics revisited

PubMed Central

Singer, Peter A; Pellegrino, Edmund D; Siegler, Mark

2001-01-01

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems. PMID:11346456

Ethics for pandemics beyond influenza: Ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response.

PubMed

Smith, Maxwell J; Silva, Diego S

2015-01-01

The unprecedented outbreak of Ebola virus disease (EVD) in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: (1) different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, (2) clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and (3) current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics.

The Toolkit and the Carpenter: Teaching the Critical Distinction between Business Ethics and Personal Morals

ERIC Educational Resources Information Center

Lovett, Steven L.; Woolard, Nathan A.

2016-01-01

Business ethics' curricula frequently presents and discusses ethical paradigms through the lens of personal values and morality. Ethics professors often have challenges with evaluating students' ability to successfully address many business dilemmas because the way business ethics are taught may only prepare students to choose between the binary…

From Theory to Practice: Facing Ethical Challenges as a Clinical Intern

ERIC Educational Resources Information Center

Hambrick, James P.; Pimentel, Sandra; Albano, Anne Marie

2009-01-01

Although formal ethics classes provide a basic foundation in managing ethical dilemmas, professionals often point to their experiences on internship as an important training ground for consolidation of their ethical development. Clinical interns face many personal and professional transitions that can lead to a number of ethical dilemmas.…

Leadership in Meeting Ethical Challenges.

ERIC Educational Resources Information Center

Jonsen, Albert R.

1987-01-01

The ethical challenge to academic medical centers is to find a balance between education and research, addressing such issues as serving the unsponsored patient, the cost of new technology, and balancing acute and primary care as well as educating future physicians. (MSE)

Ethical Challenges in Evaluation with Communities: A Manager's Perspective.

ERIC Educational Resources Information Center

Nee, David; Mojica, Maria I.

1999-01-01

Senior staff members at a family foundation share their perspectives, as managers and practitioners, on the ethical challenges and opportunities facing professionals engaged in the evaluation of comprehensive, community-based initiatives and other nontraditional program strategies. (Author/SLD)

[Perception of ethical aspects in psychiatric patient care: a pilot study].

PubMed

Rabenschlag, Franziska; Steinauer, Regine; Heimann, Regine; Reiter-Theil, Stella

2014-10-01

Research on staff perception of ethical aspects of psychiatric patient care are scarce; little is known about systematic supplies of ethics support in psychiatric institutions. The goal of this pilot study is to inform the implementation of Clinical Ethics Support Services in psychiatric institutions by assessing which topics of psychiatric practice are considered ethically challenging by the staff. Explorative survey as pilot study by questionnaire with clinical staff, quantitative (descriptive) and qualitative (coding) data-analysis. Involuntary treatment, the relationship between healthcare professionals and patients, staff shortage and the collaboration between the professions as well as dealing with patient relatives came up as ethical challenges. Clinical Ethics Support in psychiatric patient care should not only cover aspects that are specific for psychiatry, but also structural topics such as short resources, interprofessional collaboration and communication with relatives. © Georg Thieme Verlag KG Stuttgart · New York.

Are Students Blind to Their Ethical Blind Spots? An Exploration of Why Ethics Education Should Focus on Self-Perception Biases

ERIC Educational Resources Information Center

Tomlin, Kathleen A.; Metzger, Matthew L.; Bradley-Geist, Jill; Gonzalez-Padron, Tracy

2017-01-01

Ethics blind spots, which have become a keystone of the emerging behavioral ethics literature, are essentially biases, heuristics, and psychological traps. Though students typically recognize that ethical challenges exist in the world at large, they often fail to see when they are personally prone to ethics blind spots. This creates an obstacle…

Emergency department triage: an ethical analysis

PubMed Central

2011-01-01

Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach. PMID:21982119

Cluster randomization and political philosophy.

PubMed

Chwang, Eric

2012-11-01

In this paper, I will argue that, while the ethical issues raised by cluster randomization can be challenging, they are not new. My thesis divides neatly into two parts. In the first, easier part I argue that many of the ethical challenges posed by cluster randomized human subjects research are clearly present in other types of human subjects research, and so are not novel. In the second, more difficult part I discuss the thorniest ethical challenge for cluster randomized research--cases where consent is genuinely impractical to obtain. I argue that once again these cases require no new analytic insight; instead, we should look to political philosophy for guidance. In other words, the most serious ethical problem that arises in cluster randomized research also arises in political philosophy. © 2011 Blackwell Publishing Ltd.

Making Ethics Come Alive

ERIC Educational Resources Information Center

McQueeney, Edward

2006-01-01

Making ethics relevant to students in a business communications course continues to be a challenge. Classroom practitioners have long noted the difficulties in surmounting the contradictions students sense in business ethics instruction. Furthermore, students often perceive ethics to be largely irrelevant to the skills necessary for success in…

Feasibility of rapid ethical assessment for the Ethiopian health research ethics review system.

PubMed

Addissie, Adamu; Davey, Gail; Newport, Melanie; Farsides, Bobbie; Feleke, Yeweyenhareg

2015-01-01

One of the challenges in the process of ethical medical research in developing countries, including Ethiopia, is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate, relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community, with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system.

Ethics Leadership in Research, Healthcare and Organizational Systems: Commentary and Critical Reflections

ERIC Educational Resources Information Center

Gabriele, Edward F.

2011-01-01

In the last decades there has arisen a greater awareness of the ever present need for critical academic reflection on the nature of ethics leadership and committees in research, healthcare, and organizational systems. Yet what is meant by ethics itself? How is ethics understood as a historical phenomenon? What challenges must ethics leaders face…

Ethics, Ricoeur And Philosophy: Ethical Teacher Workshops

ERIC Educational Resources Information Center

Scott-Baumann, Alison

2006-01-01

This work is about the ethics of education, and about philosophy as a discipline that can help us to help children look at ethics afresh. The study and practice of ethics is about morals and uncertainties and, as such, poses problems for the research community. The philosopher Ricoeur challenges research as only one way to find meaning in the…

Virtue ethics - an old answer to a new dilemma? Part 1. Problems with contemporary medical ethics.

PubMed

Misselbrook, David

2015-02-01

The commonest practical model used in contemporary medical ethics is Principlism. Yet, while Principlism is a widely accepted consensus statement for ethics, the moral theory that underpins it faces serious challenges in its attempt to provide a coherent and accepted system of moral analysis. This inevitably challenges the stability of such a consensus statement and makes it vulnerable to attack by competitors such as preference consequentialism. This two-part paper proposes an inclusive version of virtue theory as a more grounded system of moral analysis. © The Royal Society of Medicine.

Virtue ethics – an old answer to a new dilemma? Part 1. Problems with contemporary medical ethics

PubMed Central

2015-01-01

The commonest practical model used in contemporary medical ethics is Principlism. Yet, while Principlism is a widely accepted consensus statement for ethics, the moral theory that underpins it faces serious challenges in its attempt to provide a coherent and accepted system of moral analysis. This inevitably challenges the stability of such a consensus statement and makes it vulnerable to attack by competitors such as preference consequentialism. This two-part paper proposes an inclusive version of virtue theory as a more grounded system of moral analysis. PMID:25721113

ACED IT: A Tool for Improved Ethical and Moral Decision-Making

ERIC Educational Resources Information Center

Kreitler, Crystal Mata; Stenmark, Cheryl K.; Rodarte, Allen M.; Piñón DuMond, Rebecca

2014-01-01

Numerous examples of unethical organizational decision-making highlighted in the media have led many to question the general moral perception and ethical judgments of individuals. The present study examined two forms of a straightforward ethical decision-making (EDM) tool (ACED IT cognitive map) that could be a relatively simple instrument for…

An Ethical Analysis of Reagan's Rhetoric Justifying the Invasion of Grenada.

ERIC Educational Resources Information Center

Dowling, Ralph E.

A study examined the Ronald Reagan Administration's rhetoric about the invasion of Grenada to determine its ethical quality and whether the American public could make a fair judgment about the incident based on this rhetoric. Examination of President Reagan's rhetorical efforts revealed numerous violations of democratic ethical standards.…

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 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.

Ethics issues for HIV/AIDS researchers in international settings - perspectives from the Canadian experience.

PubMed

Gahagan, Jacqueline; Sweeney, Ellen; Worthington, Catherine; Perry, Darryl; Satzinger, Franziska; Rogers, Erin

2008-11-01

In recognition of the level of international HIV/AIDS research being conducted by Canadians, the Canadian Association for HIV Research (CAHR), along with its partners, has developed a resource document to assist researchers in identifying and preparing for the unique ethics issues and challenges that may arise during international HIV/AIDS research. Between 2004 and 2007, face-to-face consultations were undertaken with community and government stakeholders, and interviews were conducted with eight prominent HIV/AIDS researchers with international experience to identify key research ethics challenges and structural, cultural, political, social, and economic factors that may impact HIV/AIDS research ethics in resource-limited settings. These challenges and factors served as the basis for the hypothetical ethics issues case scenarios developed for each of the four research tracks. Ethics issues were identified at every stage of the research process. Key contextual issues included: (1) stigma and culturally-embedded conceptualizations of HIV; (2) local and global politics and economics; (3) gender inequities, power dynamics, and sexual roles; and (4) allocation and availability of resources for research and health services. The final document resulting from the consultation process provides a framework for open dialogue on the complex and interconnected ethics issues researchers may experience in the field of international HIV/AIDS research, and contributes to the HIV/AIDS research field by reinforcing the need for high quality and ethically sound research. This document can be found at http://ethics.cahr-acrv.ca/.

Controlled human infection models for vaccine development: Zika virus debate.

PubMed

Gopichandran, Vijayaprasad

2018-01-01

An ethics panel, convened by the National Institute of Health and other research bodies in the USA, disallowed researchers from the Johns Hopkins University and University of Vermont from performing controlled human infection of healthy volunteers to develop a vaccine against Zika virus infection. The members published their ethical analysis and recommendations in February 2017. They have elaborated on the risks posed by human challenge with Zika virus to the volunteers and other uninvolved third parties and have systematically analysed the social value of such a human challenge experiment. They have also posited some mandatory ethical requirements which should be met before allowing the infection of healthy volunteers with the Zika virus. This commentary elaborates on the debate on the ethics of the human challenge model for the development of a Zika virus vaccine and the role of systematic ethical analysis in protecting the interests of research participants. It further analyses the importance of this debate to the development of a Zika vaccine in India.

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.

Ethical challenges in pain management post-surgery.

PubMed

Rejeh, Nahid; Ahmadi, Fazlollah; Mohamadi, Eesa; Anoosheh, Moniereh; Kazemnejad, Anooshirvan

2009-03-01

This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with believing patients' complaints regarding pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice.

Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation

PubMed Central

2013-01-01

Millions of people undergo displacement in the world. Internally displaced people (IDP) are especially vulnerable as they are not protected by special legislation in contrast to other migrants. Research conducted among IDPs must be correspondingly sensitive in dealing with ethical issues that may arise. Muslim IDPs in Puttalam district in the North-Western province of Sri Lanka were initially displaced from Northern Sri Lanka due to the conflict in 1991. In the backdrop of a study exploring the prevalence of common mental disorders among the IDPs, researchers encountered various ethical challenges. These included inter-related issues of autonomy, non-maleficence, beneficence, confidentiality and informed consent, and how these were tailored in a culture-specific way to a population that has increased vulnerability. This paper analyses how these ethical issues were perceived, detected and managed by the researchers, and the role of ethics review committees in mental health research concerning IDPs. The relevance of guidelines and methodologies in the context of an atypical study population and the benefit versus risk potential of research for IDPs are also discussed. The limitations that were encountered while dealing with ethical challenges during the study are discussed. The concept of post-research ethical conduct audit is suggested to be considered as a potential step to minimize the exploitation of vulnerable populations such as IDPs in mental health research. PMID:23497333

Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation.

PubMed

Siriwardhana, Chesmal; Adikari, Anushka; Jayaweera, Kaushalya; Sumathipala, Athula

2013-03-12

Millions of people undergo displacement in the world. Internally displaced people (IDP) are especially vulnerable as they are not protected by special legislation in contrast to other migrants. Research conducted among IDPs must be correspondingly sensitive in dealing with ethical issues that may arise. Muslim IDPs in Puttalam district in the North-Western province of Sri Lanka were initially displaced from Northern Sri Lanka due to the conflict in 1991. In the backdrop of a study exploring the prevalence of common mental disorders among the IDPs, researchers encountered various ethical challenges. These included inter-related issues of autonomy, non-maleficence, beneficence, confidentiality and informed consent, and how these were tailored in a culture-specific way to a population that has increased vulnerability. This paper analyses how these ethical issues were perceived, detected and managed by the researchers, and the role of ethics review committees in mental health research concerning IDPs. The relevance of guidelines and methodologies in the context of an atypical study population and the benefit versus risk potential of research for IDPs are also discussed. The limitations that were encountered while dealing with ethical challenges during the study are discussed. The concept of post-research ethical conduct audit is suggested to be considered as a potential step to minimize the exploitation of vulnerable populations such as IDPs in mental health research.

From Banking to International Governance: Fostering Innovation in Stem Cell Research

PubMed Central

Isasi, Rosario; Knoppers, Bartha M.

2011-01-01

Stem cell banks are increasingly recognized as an essential resource of biological materials for both basic and translational stem cell research. By providing transnational access to quality controlled and ethically sourced stem cell lines, stem cell banks seek to foster international collaboration and innovation. However, given that national stem cell banks operate under different policy, regulatory and commercial frameworks, the transnational sharing of stem cell materials and data can be complicating. This paper will provide an overview of the most pressing challenges regarding the governance of stem cell banks, and the difficulties in designing regulatory and commercial frameworks that foster stem cell research. Moreover, the paper will shed light on the numerous international initiatives that have arisen to help harmonize and standardize stem cell banking and research processes to overcome such challenges. PMID:21904557

Ethical Considerations of Community-based Participatory Research: Contextual Underpinnings for Developing Countries

PubMed Central

Jamshidi, Ensiyeh; Morasae, Esmaeil Khedmati; Shahandeh, Khandan; Majdzadeh, Reza; Seydali, Elham; Aramesh, Kiarash; Abknar, Nina Loori

2014-01-01

Background: The nature of community-based participatory research (CBPR) poses distinctive ethical challenges. In the absence of organized guidelines, a remarkable amount of researchers’ time and energy will be spent tackling these ethical challenges. The study aimed to explore ethical issues and principles potentially arising when conducting CBPR. Methods: This qualitative study conducted in CBPR Center of Tehran University of Medical Sciences. Required data were gathered through systematic literature review and semi-structured interviews. Representatives of community, academia, and nongovernmental organizations (NGOs) participated in our study. Ten interviews with representatives of partner organizations, four group interviews with academic staff, and four with representatives of community were conducted. Repeated thematic analysis was used to elicit ethics-related overarching themes from transcribed interviews. As recommendations, these themes were then organized into a set of CBPR-related ethical issues and principles. Results: Four CBPR ethical guidelines (including 173 articles) were selected from a systematic review. Overarching themes relating to ethical principles which emerged from interviews were as follows: Trust, transparency and accountability, equity and inclusion, power imbalance, tolerance and conflict management, and attention to cultural sensitivity. Practical principles that emerged included: Consensus rather than informed consent, ownership of data and research achievements, and sustainability and maintenance of relationships. According to findings and in comparison to international guidelines, the present study put more emphasis on cultural sensitivity and sustainability as CBPR ethical tangles. Conclusions: Community-based participatory research ethical challenges are of the same kind in most parts of the world. However, some discrepancies exist that calls for local scrutiny. Future use and critic of current explored ethical issues and principles are highly encouraged. PMID:25400893

Developing a Family-Based HIV Prevention Intervention in Rural Kenya: Challenges in Conducting Community-Based Participatory Research

PubMed Central

Puffer, Eve S.; Pian, Jessica; Sikkema, Kathleen J.; Ogwang-Odhiambo, Rose A.; Broverman, Sherryl A.

2013-01-01

Community-based participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. We describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerged related to: negotiating power imbalances between APs and the CAC; CAC members’ shifting roles as part of the CAC and wider community; and anticipated challenges in decision making about sustainability. Factors contributing to ethical dilemmas included low access to education, scarcity of financial resources, and the shortage of HIV-related services despite high prevalence. PMID:23651936

Ethical concerns in early 21st century organ transplantation

PubMed Central

Waness, Abdelkarim

2011-01-01

Medical ethics is an indispensible and challenging aspect of clinical practice. This is particularly prominent in the field of organ transplantation. In this paper, initially, a clinical case with brain death that ended up as an organ donor will be presented. Following the presentation, important moral challenges which initially formed medical ethics and some highlights of it in organ transplantation will be discussed in detail. The impact of complex modern influential factors that might interfere with the practice of medical ethics in this field such as patients’ vulnerability, financial temptations, and legal regulations will be also dealt with. Finally, we shall propose practical guidelines aiming at improving the practice of medical ethics in the emerging issue of organ transplantation. PMID:23908752

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

Ethical challenges related to elder care. High level decision-makers' experiences

PubMed Central

Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke

2007-01-01

Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet. PMID:17419880

Ethical challenges related to elder care. High level decision-makers' experiences.

PubMed

Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke

2007-04-10

Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet.

Ethical Challenges

ERIC Educational Resources Information Center

Morris, Michael

2005-01-01

The Ethical Challenges scenario in the June 2004 issue of the American Journal of Evaluation focused on an evaluator-client disagreement concerning the wisdom of having consumer representation on a steering committee that would help plan and oversee an evaluation in an agency providing community-based residential services to the chronically…

It Is a Small World after All: Teaching Business Ethics in a Global Environment

ERIC Educational Resources Information Center

Budden, Connie B.; Budden, Michael C.

2011-01-01

Increasingly, managers and employees are facing ethical issues when conducting business in the global marketplace. Business educators attempting to teach appropriate ethical behavior and develop skills for dealing with complex ethical situations need to incorporate realistic case scenarios to challenge students. Such cases should appropriately…

School Counselor Advocacy: When Law and Ethics May Collide

ERIC Educational Resources Information Center

Stone, Carolyn B.; Zirkel, Perry A.

2010-01-01

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

Ethical Dilemmas as Perceived by Healthcare Students with Teaching Implications

ERIC Educational Resources Information Center

Buelow, Janet R.; Mahan, Pamela L.; Garrity, April W.

2010-01-01

Ethical dilemmas are experienced by all individuals, but are especially prevalent among healthcare professionals. Universities and colleges preparing students to work and provide care in this arena are currently addressing this challenge through traditional ethics courses and lectures. However, student perspectives of the major ethical dilemmas in…

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)

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.

Stakeholder perspectives on ethical challenges in HIV vaccine trials in South Africa.

PubMed

Essack, Zaynab; Koen, Jennifer; Barsdorf, Nicola; Slack, Catherine; Quayle, Michael; Milford, Cedilia; Lindegger, Graham; Ranchod, Chitra; Mukuka, Richard

2010-04-01

There is little published literature on the ethical concerns of stakeholders in HIV vaccine trials. This study explored the ethical challenges identified by various stakeholders, through an open-ended, in-depth approach. While the few previous studies have been largely quantitative, respondents in this study had the opportunity to spontaneously identify the issues that they perceived to be of priority concern in the South African context. Stakeholders spontaneously identified the following as ethical priorities: informed consent, social harms, collaborative relationships between research stakeholders, the participation of children and adolescents, access to treatment for participants who become infected with HIV, physical harms, fair participant and community selection, confidentiality, benefits, and payment. While there is some speculation that research in developing countries poses special ethical challenges, overall no issues were identified that have not been anticipated in international guidance, literature and popular frameworks. However, the South African context affords a distinctive gloss to these expected issues; for example, respondents were concerned that the predominant selection of black participants may perpetuate racist practices of apartheid. Stakeholders should be aware of contextual factors impacting on the implementation of ethical principles. We make a series of recommendations for South African trials, including amendments to the ethical-legal framework and research policies, and, for further research.

The ethical leadership challenge for effective resolution of patient and family complaints and grievances: proven methods and models.

PubMed

Piper, Llewellyn E; Tallman, Erin

2015-01-01

Health care leaders and managers face the ethical leadership challenge in ensuring effective resolution of patient and family complaints and grievances. In today's society of increasing discontent about safety, quality, cost, and satisfaction, patient complaints and grievances are becoming more prevalent. Under the mandates of the Patient Protection and Affordable Care Act for transparency of quality and patient satisfaction scores and to be compliant with the standards from the Centers for Medicare & Medicaid Services and The Joint Commission, it is imperative that leadership ensure an ethical culture for effective resolution of patient and family complaints and grievances. This article addresses this ethical leadership challenge by providing a systematic approach with proven methods and models for effective resolution of complaints and grievances and thereby improving satisfaction, quality, safety, and cost.

Ethical challenges in resuscitation.

PubMed

Mentzelopoulos, Spyros D; Slowther, Anne-Marie; Fritz, Zoe; Sandroni, Claudio; Xanthos, Theodoros; Callaway, Clifton; Perkins, Gavin D; Newgard, Craig; Ischaki, Eleni; Greif, Robert; Kompanje, Erwin; Bossaert, Leo

2018-06-01

A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation. Following agreement on the article's outline, subgroups of 2-3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered. Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals' education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased. Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research.

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

PubMed

Gaidry, Alicia D; Hoehner, Paul J

2016-08-01

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

Challenges in the research ethics review of cluster randomized trials: international survey of investigators.

PubMed

Chaudhry, Shazia H; Brehaut, Jamie C; Grimshaw, Jeremy M; Weijer, Charles; Boruch, Robert; Donner, Allan; Eccles, Martin P; McRae, Andrew D; Saginur, Raphael; Skea, Zoë C; Zwarenstein, Merrick; Taljaard, Monica

2013-04-01

Cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines for several reasons. For one, the units of allocation, intervention, and observation often may differ within a single trial. In the absence of tailored and internationally accepted ethics guidelines for CRTs, researchers and research ethics committees have no common standard by which to judge ethically appropriate practices in CRTs. Moreover, lack of familiarity with and consideration of the unique features of the CRT design by research ethics committees may cause difficulties in the research ethics review process, and amplify problems such as variability in the requirements and decisions reached by different research ethics committees. We aimed to characterize research ethics review of CRTs, examine investigator experiences with the ethics review process, and assess the need for ethics guidelines for CRTs. An electronic search strategy implemented in MEDLINE was used to identify and randomly sample 300 CRTs published in English language journals from 2000 to 2008. A web-based survey with closed- and open-ended questions was administered to corresponding authors in a series of six contacts. The survey response rate was 64%. Among 182 of 285 eligible respondents, 91% indicated that they had sought research ethics approval for the identified CRT, although only 70% respondents reported research ethics approval in the published article. Nearly one-third (31%) indicated that they have had to meet with ethics committees to explain aspects of their trials, nearly half (46%) experienced variability in the ethics review process in multijurisdictional trials, and 38% experienced negative impacts of the ethics review process on their trials, including delays in trial initiation (28%), increased costs (10%), compromised ability to recruit participants (16%), and compromised methodological quality (9%). Most respondents (74%; 95% confidence interval (CI): 67%-80%) agreed or strongly agreed that there is a need to develop ethics guidelines for CRTs, and (70%; 95% CI: 63%-77%) that ethics committees could be better informed about distinct ethical issues surrounding CRTs. Thirty-six percent of authors did not respond to the survey. Due to the absence of comparable results from a representative sample of authors of individually randomized trials, it is unclear to what extent the reported challenges result from the CRT design. CRT investigators are experiencing challenges in the research ethics review of their trials, including excessive delays, variability in process and outcome, and imposed requirements that can have negative consequences for study conduct. Investigators identified a clear need for ethics guidelines for CRTs and education of research ethics committees about distinct ethical issues in CRTs.

Ethical Challenges Regarding Globalization of Higher Education

ERIC Educational Resources Information Center

Olivier, Bert

2011-01-01

This paper places the question of ethical challenges in relation to the process of globalization concerning international education and the mobility of international students worldwide. It focuses on five areas of justice, namely, social and political justice, administrative justice, distributive justice, cultural justice and ecological justice.…

Sex Work Research: Methodological and Ethical Challenges

ERIC Educational Resources Information Center

Shaver, Frances M.

2005-01-01

The challenges involved in the design of ethical, nonexploitative research projects with sex workers or any other marginalized population are significant. First, the size and boundaries of the population are unknown, making it extremely difficult to get a representative sample. Second, because membership in hidden populations often involves…

Methodological and ethical challenges in studying patients' perceptions of coercion: a systematic mixed studies review.

PubMed

Soininen, Päivi; Putkonen, Hanna; Joffe, Grigori; Korkeila, Jyrki; Välimäki, Maritta

2014-06-04

Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients' perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay. Systematic mixed studies review was the study method. Studies reporting patients' perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out. Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient's refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22). The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants' informed consent and respecting ethical procedures.

Humanlike Robots - Synthetically Mimicking Humans

NASA Technical Reports Server (NTRS)

Bar-Cohen, Yoseph

2012-01-01

Nature inspired many inventions and the field of technology that is based on the mimicking or inspiration of nature is widely known as Biomimetics and it is increasingly leading to many new capabilities. There are numerous examples of biomimetic successes including the copying of fins for swimming, and the inspiration of the insects and birds flight. More and more commercial implementations of biomimetics are appearing and behaving lifelike and applications are emerging that are important to our daily life. Making humanlike robots is the ultimate challenge to biomimetics and, for many years, it was considered science fiction, but such robots are becoming an engineering reality. Advances in producing such robot are allowing them to perform impressive functions and tasks. The development of such robots involves addressing many challenges and is raising concerns that are related to fear of their application implications and potential ethical issues. In this paper, the state-of-the-art of humanlike robots, potential applications and challenges will be reviewed.

Ethical challenges embedded in qualitative research interviews with close relatives.

PubMed

Haahr, Anita; Norlyk, Annelise; Hall, Elisabeth Oc

2014-02-01

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers' premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers' ethical preparation and to continually address and discuss cases from their own interviews.

Ethics of clinical trials in Nigeria.

PubMed

Okonta, Patrick I

2014-05-01

The conduct of clinical trials for the development and licensing of drugs is a very important aspect of healthcare. Drug research, development and promotion have grown to a multi-billion dollar global business. Like all areas of human endeavour involving generation and control of huge financial resources, it could be subject to deviant behaviour, sharp business practices and unethical practices. The main objective of this review is to highlight potential ethical challenges in the conduct of clinical trials in Nigeria and outline ways in which these can be avoided. Current international and national regulatory and ethical guidelines are reviewed to illustrate the requirements for ethical conduct of clinical trials. Past experiences of unethical conduct of clinical trials especially in developing countries along with the increasing globalisation of research makes it imperative that all players should be aware of the ethical challenges in clinical trials and the benchmarks for ethical conduct of clinical research in Nigeria.

Ethics of clinical trials in Nigeria

PubMed Central

Okonta, Patrick I.

2014-01-01

The conduct of clinical trials for the development and licensing of drugs is a very important aspect of healthcare. Drug research, development and promotion have grown to a multi-billion dollar global business. Like all areas of human endeavour involving generation and control of huge financial resources, it could be subject to deviant behaviour, sharp business practices and unethical practices. The main objective of this review is to highlight potential ethical challenges in the conduct of clinical trials in Nigeria and outline ways in which these can be avoided. Current international and national regulatory and ethical guidelines are reviewed to illustrate the requirements for ethical conduct of clinical trials. Past experiences of unethical conduct of clinical trials especially in developing countries along with the increasing globalisation of research makes it imperative that all players should be aware of the ethical challenges in clinical trials and the benchmarks for ethical conduct of clinical research in Nigeria. PMID:25013247

A quick guide to ethical theory in healthcare: solving ethical dilemmas in nutrition support situations.

PubMed

Ferrie, Suzie

2006-04-01

Ethical dilemmas can be challenging for the nutrition support clinician who is accustomed to evidence-based practice. The emotional and personal nature of ethical decision making can present difficulties, and conflict can arise when people have different ethical perspectives. An understanding of ethical terms and ethical theories can be helpful in clarifying the source of this conflict. These may include prominent ethical theories such as moral relativism, utilitarianism, Kantian absolutism, Aristotle's virtue ethics and ethics of care, as well as the key ethical principles in healthcare (autonomy, beneficence, nonmaleficence, and justice). Adopting a step-by-step approach can simplify the process of resolving ethical problems.

New Strategies of Control: Academic Freedom and Research Ethics Boards

ERIC Educational Resources Information Center

Lewis, Magda

2008-01-01

This article, detailing the implications of "ethics drift" for critical work in the academy, reports on an ethics challenge to a non-research-based scholarly text. It analyzes how General Research Ethics Boards (GREBs) can threaten academic freedom when they lack a clear definition of "human subject" research, fail to…

A New Model for Teaching Ethical Behavior

ERIC Educational Resources Information Center

Sternberg, Robert J.

2009-01-01

One can scarcely open the newspaper without finding examples of smart, well-educated people who have behaved in ethically challenged ways. What is frightening about ethical lapses is not that they happen to the ethically outrageous but that they can sneak up on just about everyone. An informal classroom "experiment" recently performed by this…

77 FR 2549 - Advisory Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)-Ethics...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-18

... Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)--Ethics Subcommittee (ES... will provide counsel to the ACD, CDC, regarding a broad range of public health ethics questions and... territorial health departments in their efforts to address public health ethics challenges, approaches for...

A New Ethical Challenge for Institutional Review Boards (IRBs)/Ethics Committees (ECs) in the Assessment of Pediatric Clinical Trials

PubMed Central

Rose, Klaus; Kummer, Hans

2015-01-01

Both the US and EU have introduced pediatric pharmaceutical legislation to facilitate clinical trials in children and development of better medicines for children. The first concerns were published in 2014 that the European Medicines Agency (EMA)’s Pediatric Committee (PDCO) may be over-enthusiastic and has compelled questionable pediatric clinical trials from pharmaceutical companies. Numerous clinical trials are mandated in rare conditions for which not enough patients exist for even one trial. Furthermore, where these trials are mandated in adolescent patients, the legal age limit of the 18th birthday is confused with a medical age limit and can result in separate clinical trials in adolescent patients that neither make medical nor scientific sense nor will ever recruit enough patients for a meaningful outcome. To confirm our concerns we searched the registry clinicaltrials.gov and found examples for PDCO-triggered unethical trials. We conclude that such trials should not be accepted by institutional review boards (IRBs)/ethics committees (ECs) and that clinical trials resulting from negotiations with EMA’s PDCO need extra careful scrutiny by IRBs/ECs in order to prevent unethical studies and damage to pediatric research and unnecessary risks to pediatric patients. PMID:27417359

Twenty-first Century Ethical Challenges for Psychology

ERIC Educational Resources Information Center

Koocher, Gerald P.

2007-01-01

Foreseeable social and technological changes will force us to reevaluate our thinking about ethically appropriate ways to fulfill our mission of using psychology to advance human health and welfare in the twenty-first century. Three categories of challenge related to societal and technological changes have become particularly evident. First,…

Ethics in sports medicine.

PubMed

Dunn, Warren R; George, Michael S; Churchill, Larry; Spindler, Kurt P

2007-05-01

Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

Professional Ethics for Digital Age Psychiatry: Boundaries, Privacy, and Communication.

PubMed

Sabin, James E; Harland, Jonathan Clark

2017-09-01

Internet and social media use continue to expand rapidly. Many patients and psychiatrists are bringing digital technologies into the treatment process, but relatively little attention has been paid to the ethical challenges in doing this. This review presents ethical guidelines for psychiatry in the digital age. Surveys demonstrate that patients are eager to make digital technologies part of their treatment. Substantial numbers search for professional and personal information about their therapists. Attitudes among psychiatrists about using digital technologies with patients range from dread to enthusiastic adoption. Digital technologies create four major ethical challenges for psychiatry: managing clinical boundaries; maintaining privacy and confidentiality; establishing realistic expectations regarding digital communications; and upholding professional ideals. Traditional ethical expectations are valid for the evolving digital arena, but guidance must be adapted for actual application in practice.

Preparing students for the ethical challenges on international health electives: A systematic review of the literature on educational interventions.

PubMed

Rahim, Anika; Knights Née Jones, Felicity; Fyfe, Molly; Alagarajah, Janagan; Baraitser, Paula

2016-09-01

International health electives pose specific ethical challenges for students travelling from to low and middle income countries. We undertook a systematic review of the literature on interventions to prepare students to identify ethical issues addressed, educational approaches and to collate evidence on the effectiveness of different strategies. We searched nine electronic databases of peer-reviewed literature and identified grey literature through key word searches; supplemented through citation mapping and expert consultation. Articles that described ethical training conducted by universities or professional bodies were included for review. We reviewed forty-four full text articles. Ten sources of published literature and seven sources of grey literature met our inclusion criteria. We identified thirteen ethical situations that students should be prepared to manage and eight generic skills to support this process. Most interventions were delivered before the elective, used case studies or guidelines. Some suggested ethical principles or a framework for analysis of ethical issues. Only two papers evaluated the intervention described. Our paper collates a small but growing body of work on education to prepare students to manage ethical issues. Ethical training should have elements that are delivered before, during and after the elective. Interventions should include case studies covering thirteen ethical issues identified here, linked to ethical principles and a process for responding to ethical issues. We suggest that evaluations of interventions are an important area for future research.

Ethical reasoning through simulation: a phenomenological analysis of student experience.

PubMed

Lewis, Gareth; McCullough, Melissa; Maxwell, Alexander P; Gormley, Gerard J

2016-01-01

Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students' lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment. This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data. Four main themes emerged from the analysis: (1) 'Authentic on all levels?', (2)'Letting the emotions flow', (3) 'Ethical alarm bells' and (4) 'Voices of children and ghosts'. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences. This study provided deep insights into medical students' immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

Beyond Compliance Checking: A Situated Approach to Visual Research Ethics.

PubMed

Lenette, Caroline; Botfield, Jessica R; Boydell, Katherine; Haire, Bridget; Newman, Christy E; Zwi, Anthony B

2018-03-19

Visual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse knowledge on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a negotiated, flexible approach, given that ethical issues usually emerge in relation to the specific contexts of individual research projects. Drawing on available literature and two case studies, we identify and reflect on nuanced ethical implications in visual research, like tensions between aesthetics and research validity. The case studies highlight strategies developed in-situ to address the challenges two researchers encountered when using visual research methods, illustrating that some practice implications are not necessarily addressed using established ethical clearance procedures. A situated approach can ensure that visual research remains ethical, engaging, and rigorous.

The challenges facing midwifery educators in sustaining a future education workforce.

PubMed

Albarran, John W; Rosser, Elizabeth A

2014-08-01

national and international trends have identified concerns over the ability of health and social care workforces in meeting the needs of service users. Attention has increasingly been drawn to problems of recruiting and retaining professionals within higher education; however data in relation to the midwifery profession is scant. to examine the perceptions and experiences of midwifery educators, in south-west England, about the challenges facing them sustaining the education workforce of the future. a mixed methodology approach was adopted involving heads of midwifery education and midwife educators. midwifery participants were recruited from three higher education institutions in south west England. Data collection comprised of self-administered questionnaires plus individual qualitative interviews with heads of midwifery education (n=3), and tape recorded focus groups with midwife academics (n=19). Numerical data were analysed using descriptive statistics. Textual data were analysed for themes that represented the experiences and perspectives of participants. Ethics approval was granted by one University Ethics committee. demographic data suggests that within south-west England, there is a clear ageing population and few in possession of a doctorate within midwifery. The six identified sub-themes represented in the data describe challenges and tensions that midwifery academics experienced in their efforts to attract new recruits and retain those in post in a highly changing educational environment which demands more from a contracting workforce. there remain some serious challenges facing midwifery educators in sustaining the future education workforce, which if unresolved may jeopardise standards of education and quality of care women receive. Active succession planning and more radical approaches that embrace flexible careers will enable educational workforce to be sustained and by a clinically credible and scholarly orientated midwifery workforce. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ethical challenges in fetal surgery.

PubMed

Smajdor, Anna

2011-02-01

Fetal surgery has been practised for some decades now. However, it remains a highly complex area, both medically and ethically. This paper shows how the routine use of ultrasound has been a catalyst for fetal surgery, in creating new needs and new incentives for intervention. Some of the needs met by fetal surgery are those of parents and clinicians who experience stress while waiting for the birth of a fetus with known anomalies. The paper suggests that the role of technology and visualisation techniques in creating and meeting such new needs is ethically problematic. It then addresses the idea that fetal surgery should be restricted to interventions that are life-saving for the fetus, arguing that this restriction is unduly paternalistic. Fetal surgery poses challenges for an autonomy-based system of ethics. However, it is risky to circumvent these challenges by restricting the choices open to pregnant women, even when these choices appear excessively altruistic.

Review of national research ethics regulations and guidelines in Middle Eastern Arab countries

PubMed Central

2012-01-01

Background Research ethics guidelines are essential for conducting medical research. Recently, numerous attempts have been made to establish national clinical research documents in the countries of the Middle East. This article analyzes these documents. Methods Thirteen Arab countries in the Middle East were explored for available national codes, regulations, and guidelines concerning research ethics, and 10 documents from eight countries were found. We studied these documents, considering the ethical principles stated in the Declaration of Helsinki, the Council for International Organizations of Medical Sciences (CIOMS) guidelines, and the International Conference of Harmonization - Guidelines for Good Clinical Practice (ICH-GCP). Our paper comprises a complete list of protections, such as confidentiality, informed consent, ethics committees, and others. Results This study found different levels and kinds of research ethics regulations and guidelines in the countries examined. Two groups can be distinguished: the countries in the first group have one or more research ethics regulations or guidelines, while the countries in the second group have not yet established any. Most of the documents showed various degrees of deficiencies in regard to ethical protection. The majority of the documents that were examined refer to one or more international documents on biomedical research ethics. Conclusions Recently, a lot of efforts have been made in many countries in the Middle East. However, compared with international documents, most of the research ethics documents in use in this region demonstrate numerous deficiencies. As it relates to these documents, extensive differences could be observed in regard to development, structure, content, and reference to international guidelines. PMID:23234422

Ethically sustainable governance in the biobanking of eggs and embryos for research.

PubMed

Stroud, Karla; O'Doherty, Kieran C

2015-12-01

Biobanking of human tissues is associated with a range of ethical, legal, and social (ELS) challenges. These include difficulties in operationalising informed consent protocols, protecting donors' privacy, managing the return of incidental findings, conceptualising ownership of tissues, and benefit sharing. Though largely unresolved, these challenges are well documented and debated in academic literature. One common response to the ELS challenges of biobanks is a call for strong and independent governance of biobanks. Theorists who argue along these lines suggest that since fully informed consent to a single research project is often not feasible, research participants should be given the additional protection of being allowed to consent to the governance framework of the biobank. Such governance therefore needs to be transparent and ethically sustainable. In this paper we review the governance challenges of establishing and maintaining human tissue biobanks. We then discuss how the creation of a biobank for eggs and embryos, in particular, may introduce additional or unique challenges beyond those presented by the biobanking of other human tissues. Following previous work on biobank governance, we argue that ethically sustainable governance needs to be participatory, adaptive, and trustworthy.

Cautionary Tales: Ethics and Case Studies in Science

PubMed Central

Herreid, Clyde Freeman

2014-01-01

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

Privacy and Ethics in Pediatric Environmental Health Research—Part I: Genetic and Prenatal Testing

PubMed Central

Fisher, Celia B.

2006-01-01

The pressing need for empirically informed public policies aimed at understanding and promoting children’s health has challenged environmental scientists to modify traditional research paradigms and reevaluate their roles and obligations toward research participants. Methodologic approaches to children’s environmental health research raise ethical challenges for which federal regulations may provide insufficient guidance. In this article I begin with a general discussion of privacy concerns and informed consent within pediatric environmental health research contexts. I then turn to specific ethical challenges associated with research on genetic determinants of environmental risk, prenatal studies and maternal privacy, and data causing inflicted insight or affecting the informational rights of third parties. PMID:17035153

Privacy and ethics in pediatric environmental health research-part I: genetic and prenatal testing.

PubMed

Fisher, Celia B

2006-10-01

The pressing need for empirically informed public policies aimed at understanding and promoting children's health has challenged environmental scientists to modify traditional research paradigms and reevaluate their roles and obligations toward research participants. Methodologic approaches to children's environmental health research raise ethical challenges for which federal regulations may provide insufficient guidance. In this article I begin with a general discussion of privacy concerns and informed consent within pediatric environmental health research contexts. I then turn to specific ethical challenges associated with research on genetic determinants of environmental risk, prenatal studies and maternal privacy, and data causing inflicted insight or affecting the informational rights of third parties.

Ethical Issues and Practical Challenges in Suicide Research.

PubMed

Hom, Melanie A; Podlogar, Matthew C; Stanley, Ian H; Joiner, Thomas E

2017-03-01

Research with human subjects represents a critical avenue for suicide prevention efforts; however, such research is not without its ethical and practical challenges. Specifically, given the nature of research with individuals at elevated risk for suicide (e.g., increased concerns regarding participant safety, adverse events, liability, difficulties often arise during the institutional review board (IRB) evaluation and approval process. This paper aims to discuss IRB-related issues associated with suicide prevention research, including researcher and IRB panel member responsibilities, suicide risk assessment and management ethics and procedures, informed consent considerations, preparation of study protocols, and education and training. Points to consider and components to potentially include in an IRB application for suicide-related research are additionally provided. Literature relevant to ethics in suicide research and suicide risk assessment and management was reviewed and synthesized. Suicide research can be conducted in accordance with ethical principles while also furthering the science of suicide prevention. Despite the challenging nature of suicide prevention research, empirically informed solutions exist to address difficulties that may emerge in interfacing with IRBs. There remain areas for improvement in the IRB approval process that warrant further investigation and work.

Maintaining professionalism in today's business environment: ethical challenges for the pain medicine specialist.

PubMed

Lebovits, Allen

2012-09-01

There are many external influences in today's market force that impair the relationship between the pain medicine specialist and the patient, and ultimately prevent optimal quality of care. This article explores the ethical challenges facing the pain medicine specialist in today's increasingly "business" environment and will offer solutions for maintaining the professionalism of pain medicine. Four commonly encountered bioethical principles in the practice of pain medicine are reviewed: beneficence, nonmaleficence, justice, and autonomy. The following ethical challenges of the pain medicine specialist are reviewed: practicing outside ones specialty area, practice characteristics, the consultant role, the economic lure of aggressive intervention, not evaluating for and treating comorbid psychopathology, reimbursement pressures, workers' compensation, and use of unproven methods. Solutions offered include collegial associations, social responsibility, legislative initiatives, pain education, interdisciplinary evaluation and treatment, improved relationships with third-party payers, reduced racial disparities, and ethics education. Ethics is the "roadmap" that enables the pain medicine specialist to navigate the increasingly murky waters of practicing pain management today by maintaining the professionalism necessary to combat today's "business" pressures. Wiley Periodicals, Inc.

Informed consent in psychiatry clinical research: A conceptual review of issues, challenges, and recommendations

PubMed Central

Gupta, Umesh Chandra; Kharawala, Saifuddin

2012-01-01

Obtaining informed consent in psychiatry clinical research involving subjects with diminished mental abilities and impaired consent capacity has been a challenge for researchers, posing many ethical concerns and procedural hurdles due to participants’ cognitive deficits and impaired ability to judge reality. Regulations seem inadequate and provide limited guidance, not sufficient to address all the ethical issues inherent in different situations related to obtaining consent from decisionally impaired persons. Researchers are struggling to find a balance between risk-benefit ratio, research advancement, and autonomy of study subjects. Inspired to improve the consent process in psychiatry clinical research, many studies have been conducted focusing on various informed consent-related ethical concerns, with the aim of developing appropriate strategies and optimizing the informed consent procedure in psychiatry clinical research, overcoming the ethical concerns. This article critically reviews the various ethical issues and consent challenges, their underlying reasons, and investigates the appropriate strategies and practices needed to be adopted while obtaining informed consent from subjects with impaired consent capacity, participating in psychiatry clinical research. PMID:22347696

The Need for Social Ethics in Interdisciplinary Environmental Science Graduate Programs: Results from a Nation-Wide Survey in the United States.

PubMed

Hall, Troy E; Engebretson, Jesse; O'Rourke, Michael; Piso, Zach; Whyte, Kyle; Valles, Sean

2017-04-01

Professionals in environmental fields engage with complex problems that involve stakeholders with different values, different forms of knowledge, and contentious decisions. There is increasing recognition of the need to train graduate students in interdisciplinary environmental science programs (IESPs) in these issues, which we refer to as "social ethics." A literature review revealed topics and skills that should be included in such training, as well as potential challenges and barriers. From this review, we developed an online survey, which we administered to faculty from 81 United States colleges and universities offering IESPs (480 surveys were completed). Respondents overwhelmingly agreed that IESPs should address values in applying science to policy and management decisions. They also agreed that programs should engage students with issues related to norms of scientific practice. Agreement was slightly less strong that IESPs should train students in skills related to managing value conflicts among different stakeholders. The primary challenges to incorporating social ethics into the curriculum were related to the lack of materials and expertise for delivery, though challenges such as ethics being marginalized in relation to environmental science content were also prominent. Challenges related to students' interest in ethics were considered less problematic. Respondents believed that social ethics are most effectively delivered when incorporated into existing courses, and they preferred case studies or problem-based learning for delivery. Student competence is generally not assessed, and respondents recognized a need for both curricular materials and assessment tools.

Using Gaming Technology to Teach Ethical Decision-Making

ERIC Educational Resources Information Center

Sloane, Sharon; Holmes, Elizabeth

2009-01-01

The authors describe the steps in the ethical decision-making process and show how employers and educators are addressing ethical gray areas using innovative simulations in order to better prepare employees and other personnel to face ethical challenges head-on. The model outlined in this article can be used as a teaching and training tool to…

Improving Skill Development: An Exploratory Study Comparing a Philosophical and an Applied Ethical Analysis Technique

ERIC Educational Resources Information Center

Al-Saggaf, Yeslam; Burmeister, Oliver K.

2012-01-01

This exploratory study compares and contrasts two types of critical thinking techniques; one is a philosophical and the other an applied ethical analysis technique. The two techniques analyse an ethically challenging situation involving ICT that a recent media article raised to demonstrate their ability to develop the ethical analysis skills of…

Ethics and the Early Childhood Teacher Educator: A Proposed Addendum to the NAEYC Code of Ethical Conduct.

ERIC Educational Resources Information Center

Freeman, Nancy; Feeney, Stephanie; Moravcik, Eva

2003-01-01

Proposes an addendum to the National Association for the Education of Young Children's Code of Ethical Conduct concerning the unique ethical challenges facing teacher educators. Presents a conception of professional responsibility in six areas: children and families, adult students, programs hosting practicum students and programs' staffs and…

76 FR 55678 - Advisory Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)-Ethics...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)--Ethics Subcommittee (ES... provide counsel to the ACD, CDC, regarding a broad range of public health ethics questions and issues... in their efforts to address public health ethics challenges. The agenda is subject to change as...

Lifelong Learning in Ethical Practice: A Challenge for Continuing Medical Education.

ERIC Educational Resources Information Center

Kenny, Nuala; Sargeant, Joan; Allen, Michael

2001-01-01

Questionnaires and small-group discussions with a physician-ethicist revealed that physicians had very little formal ethics training in medical school. They did not feel they needed a very high level of confidence regarding ethical issues in practice, but lacked a systematic approach to identification and analysis of ethical issues. (Contains 24…

Emotions, narratives, and ethical mindfulness.

PubMed

Guillemin, Marilys; Gillam, Lynn

2015-06-01

Clinical care is laden with emotions, from the perspectives of both clinicians and patients. It is important that emotions are addressed in health professions curricula to ensure that clinicians are humane healers as well as technical experts. Emotions have a valuable and generative role in health professional ethics education.The authors have previously described a narrative ethics pedagogy, the aim of which is to develop ethical mindfulness. Ethical mindfulness is a state of being that acknowledges everyday ethics and ethically important moments as significant in clinical care, with the aim of enabling ethical clinical practice. Using a sample narrative, the authors extend this concept to examine five features of ethical mindfulness as they relate to emotions: (1) being sensitized to emotions in everyday practice, (2) acknowledging and understanding the ways in which emotions are significant in practice, (3) being able to articulate the emotions at play during ethically important moments, (4) being reflexive and acknowledging both the generative aspects and the limitations of emotions, and (5) being courageous.The process of writing and engaging with narratives can lead to ethical mindfulness, including the capacity to understand and work with emotions. Strategies for productively incorporating emotions in narrative ethics teaching are described. This can be a challenging domain within medical education for both educators and health care students and thus needs to be addressed sensitively and responsibly. The potential benefit of educating health professionals in a way which addresses emotionality in an ethical framework makes the challenges worthwhile.

Evaluating clinical ethics support in mental healthcare: a systematic literature review.

PubMed

Hem, Marit Helene; Pedersen, Reidar; Norvoll, Reidun; Molewijk, Bert

2015-06-01

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded 'grey zone articles', in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients' and caregivers' views on ethical challenges, is presented. © The Author(s) 2014.

The ethical junior: a typology of ethical problems faced by house officers

PubMed Central

McDougall, Rosalind; Sokol, Daniel K

2008-01-01

Although many studies have explored the experiences of doctors in their first postgraduate year, few have focused on the ethical issues encountered by this group. Based on an extensive literature review of research involving house officers, we argue that these doctors encounter a broad range of ‘everyday’ ethical challenges, from truth-telling to working in non-ideal conditions. We propose a typology of house officers' ethical issues and advocate prioritizing these issues in undergraduate medical ethics and law curricula. PMID:18299625

Four Roles of Ethical Theory in Clinical Ethics Consultation.

PubMed

Magelssen, Morten; Pedersen, Reidar; Førde, Reidun

2016-09-01

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout.

Professionalism: challenges for dentistry in the future.

PubMed

Ozar, D T

2012-11-30

While countries varies significantly in the financing of dental care, they are much more alike in the delivery of dentistry. Dental care is principally provided in dental offices and clinics that are independent business entities whose business leaders are most often the dentists themselves. However society expects from dentists a level of professionalism (i.e. habitually acting ethically, both in terms of competence and conduct) in contrast to the methods and motivations of the marketplace. This is why the single most important challenge of dental professional ethics continues to be giving proper priority to patients' well being and building ethically correct decision-making relationships with patients while, at the same time, trying to maintain a successful business operation. If we look into dentistry's future, the centrality of this aspect of professional ethics is not likely to change, although the ways in which dentists might violate this trust will probably multiple as funding mechanisms become increasingly complex. It is important that dentists reflect with fresh eyes on their ethical commitments. One challenge is the increased availability of oral health information to the public and the fact that so many people are uncritical of the accuracy of information in the media and on the web. A second is the increase in the amount of health care advertising in many societies. A third is the growth of aesthetic dentistry that differs from standard oral health care in important and ethically significant ways. The fourth is insurance that frequently complicates the explanation of a patient's treatment alternatives and often brings a third party into the treatment decision relationship. The ethical challenges of each of these factors will be considered and ultimately tying it to the central theme of dental professionalism.

Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education.

PubMed

Gorkey, Sefik; Guven, Tolga; Sert, Gurkan

2012-01-01

Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topics such as informed consent and patient rights can be considered to be of equal importance in both fields, a number of ethical issues in dental practice are only remotely-if at all-relevant for medical practice. Therefore, any sound approach to education in dental ethics has to recognise the unique aspects of dental practice in order to meet the needs of dental students and prepare them for the ethical challenges they may face during their professional practice. With this goal in mind, this paper examines the approach of the authors to dental ethics education and proposes a system to organise the topics of biomedical ethics for dental education. While the authors' perspective is based on their experience in Turkey, the proposed system of classification is not a rigid one; it is open to interpretation in other contexts with different social, cultural and professional expectations. Therefore, the paper also aims to inspire discussion on the development of an ideal dental ethics curriculum at an international level.

[Ethics, medical ethics, and occupational medicine: is their dialogue possible?].

PubMed

Buzzi, Elisa

2016-01-20

Today's medicine faces some critical moral challenges, yet the medical class suffers from an increasingly evident malaise: a growing dissatisfaction with an ethical demand often perceived as a cumbersome burden of rules and prohibitions, which risk to erode the fiduciary relations with patients. Such a negative appraisal is partly due to a narrow interpretation of the meaning of ethics, a misconception whose roots are in the positivistic stance that permeates our culture, and in its almost exclusively technological bent. This radical orientation of our culture shows itself in the vanishing of the idea of an intrinsic ethical dimension of medicine and consequent eclipse of traditional medical ethics, currently all but assimilated by bioethics. Maintaining a clear distinction between medical ethics and bioethics is a fundamental condition for guaranteeing an original ethical reflection in medicine, thereby fostering a constructive dialogue between philosophical and medical ethics. In this sense, occupational medicine holds a very propitious position, at the cross-roads to some of the most important dimensions in human life and society: health, work, environment. In a milieu which is too often inclined to efface the living human being and the deepest needs of humanity, the moral commitment of medical profession to the care of the integral reality of the embodied human person is one of the most important ethical challenges facing occupational medicine and a most valuable contribution to the current ethical debate.

Qualitative research with small connected communities: generating new knowledge while upholding research ethics.

PubMed

Damianakis, Thecla; Woodford, Michael R

2012-05-01

Qualitative researchers have a dual mission: to generate knowledge through rigorous research and to uphold ethical standards and principles. Qualitative researchers often conduct studies with small connected communities in which relationships exist among community members. When engaging such communities, researchers might face ethical issues in upholding confidentiality standards while they work to achieve their dual mandate. Qualitative scholars have paid little attention to the ethical challenges that might arise in this context. Drawing on our experiences conducting studies with such communities, we expand the dialogue concerning qualitative research ethics by making explicit conceptual and practical tensions that emerge at various stages of the research process; articulating our respective reflective processes; and exploring issues associated with strategies for upholding confidentiality. We conclude with lessons learned to guide researchers who might face similar challenges.

Pharmaceutical ethics and physician liability in Side Effects.

PubMed

Dhiman, Gaurav J; Amber, Kyle T

2013-12-01

We review Side Effects, a 2013 film involving bioethics, pharmaceuticals, and financial conspiracies. After the main character Emily unsuccessfully attempts suicide, she begins receiving care from a psychiatrist, Dr. Banks. Following numerous events, she is placed on a fictional antidepressant, Ablixa, which leads her to suffer from sleepwalking. During an episode of sleepwalking she commits a serious crime. The film poses an interesting dilemma: How responsible would the physician be in this instance? We analyze this question by applying numerous ethical principles.

How to succeed with ethics reflection groups in community healthcare? Professionals' perceptions.

PubMed

Karlsen, Heidi; Lillemoen, Lillian; Magelssen, Morten; Førde, Reidun; Pedersen, Reidar; Gjerberg, Elisabeth

2018-01-01

Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection. To examine what the staff experience as promoters or as barriers to successful ethics reflection. The study has a qualitative design, where 56 participants in municipal healthcare participated in 10 different focus-group interviews. Ethical considerations: The data collection was based on the participants' informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data. The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator's role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection. The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group. Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities' instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups.

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.

The Impact of Perception of Performance Appraisal and Distributive Justice Fairness on Employees' Ethical Decision Making in Paternalist Organizational Culture

ERIC Educational Resources Information Center

Goksoy, Asli; Alayoglu, Nihat

2013-01-01

Ethics in decision making has been an issue for academics, practitioners, and governmental regulators for decades. In the last decade, numerous scandals and consequently many corporate crises in the global business world have added credence to the criticisms of business ethics. Therefore, it is vital to understand the factors affecting employees'…

Beyond human subjects: risk, ethics, and clinical development of nanomedicines.

PubMed

Kimmelman, Jonathan

2012-01-01

Clinical testing of nanomedicines presents two challenges to prevailing, human subject-centered frameworks governing research ethics. First, some nanomedical applications may present risk to persons other than research subjects. Second, pressures encountered in testing nanomedicines may present threats to the kinds of collaborations and collective activities needed for supporting clinical translation and redeeming research risk. In this article, I describe how similar challenges were encountered and addressed in gene transfer, and sketch policy options that might be explored in the nanomedicine translation arena. © 2012 American Society of Law, Medicine & Ethics, Inc.

How Cuba's Latin American School of Medicine challenges the ethics of physician migration.

PubMed

Huish, Robert

2009-08-01

This paper demonstrates a working alternative to the accepted ethics of physician migration. A dominant cosmopolitan ethics encourages upward mobility of physicians in a globalized labour force, and this ultimately advances the position of individuals rather than improving public health-care service for vulnerable communities in the global South. Cuba's Escuela Latinoamericana de Medicina (ELAM) challenges this trend as its institutional ethics furnishes graduates with appropriate skills, knowledge and service ethics to deliver quality care in marginalized areas. This paper provides an analysis of how ELAM trains physicians in community-oriented service for marginalized areas in the global South. The principle finding of this analysis is that ELAM exhibits a working alternative to the accepted ethics of physician migration, as it encourages graduates to practice in marginalized communities rather than feed the migration pipeline into the North. Arguably, ELAM serves as an important case study in how a medical school's ethics can work to bring graduates closer to the communities that are in desperate need of their skills and of their compassion.

Instructional Vignettes in Publication and Journalism Ethics in Radiology Research: Assessment via a Survey of Radiology Trainees.

PubMed

Rosenkrantz, Andrew B; Ginocchio, Luke A

2016-07-01

The aim of the present study was to assess the potential usefulness of written instructional vignettes relating to publication and journalism ethics in radiology via a survey of radiology trainees. A literature review was conducted to guide the development of vignettes, each describing a scenario relating to an ethical issue in research and publication, with subsequent commentary on the underlying ethical issue and potential approaches to its handling. Radiology trainees at a single institution were surveyed regarding the vignettes' perceived usefulness. A total of 21 vignettes were prepared, addressing institutional review board and human subjects protection, authorship issues, usage of previous work, manuscript review, and other miscellaneous topics. Of the solicited trainees, 24.7% (16/65) completed the survey. On average among the vignettes, 94.0% of the participants found the vignette helpful; 19.9 received prior formal instruction on the issue during medical training; 40.0% received prior informal guidance from a research mentor; and 42.0% indicated that the issue had arisen in their own or a peer's prior research experience. The most common previously experienced specific issue was authorship order (93.8%). Free-text responses were largely favorable regarding the value of the vignettes, although also indicated numerous challenges in properly handling the ethical issues: impact of hierarchy, pressure to publish, internal politics, reluctance to conduct sensitive conversations with colleagues, and variability in journal and professional society policies. Radiology trainees overall found the vignettes helpful, addressing commonly encountered topics for which formal and informal guidance were otherwise lacking. The vignettes are publicly available through the Association of University Radiologists (AUR) website and may foster greater insights by investigators into ethical aspects of the publication and journalism process, thus contributing to higher quality radiology research. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

The Global Ethics Corner: Foundations, Beliefs, and the Teaching of Biomedical and Scientific Ethics around the World

ERIC Educational Resources Information Center

Jakubowski, Henry; Xie, Jianping; Kumar Mitra, Arup; Ghooi, Ravindra; Hosseinkhani, Saman; Alipour, Mohsen; Hajipour, Behnam; Obiero, George

2017-01-01

The profound advances in the biomolecular sciences over the last decades have enabled similar advances in biomedicine. These advances have increasingly challenged our abilities to deploy them in an equitable and ethically acceptable manner. As such, it has become necessary and important to teach biomedical and scientific ethics to our students who…

Collaborating with the Disability Rights Community: Co-Writing a Code of Ethics as a Vehicle for Ethics Education

ERIC Educational Resources Information Center

Tarvydas, Vilia; Hartley, Michael; Jang, Yoo Jin; Johnston, Sara; Moore-Grant, Nykeisha; Walker, Quiteya; O'Hanlon, Chris; Whalen, James

2012-01-01

An ethics project is described that challenged students to collaborate with disability rights authorities to co-write a code of ethics for a Center of Independent Living. Experiential and reflective assignments analyzed how the construction of knowledge and language is never value-neutral, and people with disabilities need to have a voice in…

Moral Competence for the Joint Warfighter: The Missing Element in Defense Transformation

DTIC Science & Technology

2006-06-01

warriors. Further, it argues that through a combination of benign neglect and intentional acquiescence, the Services have undermined their own ethical ...initiate a Joint Ethical Transformation Campaign to improve moral competence and ethical cultures within all of the Services...21 Demand for Moral Skill Joint Values in Joint Warfare Challenging Ethical Environment Special Trust Avoiding the Worst Possible Outcome

Addressing Ethics and Technology in Business: Preparing Today's Students for the Ethical Challenges Presented by Technology in the Workplace

ERIC Educational Resources Information Center

Brooks, Rochelle

2008-01-01

The ethical development of information systems is but one of those sensitive scenarios associated with computer technology that has a tremendous impact on individuals and social life. The significance of these issues of concern cannot be overstated. However, since computer ethics is meant to be everybody's responsibility, the result can often be…

Towards an ethics safe harbor for global biomedical research

PubMed Central

Dove, Edward S.; Knoppers, Bartha M.; Zawati, Ma'n H.

2014-01-01

Although increasingly global, data-driven genomics and other ‘omics’-focused research hold great promise for health discoveries, current research ethics review systems around the world challenge potential improvements in human health from such research. To overcome this challenge, we propose a ‘Safe Harbor Framework for International Ethics Equivalency’ that facilitates the harmonization of ethics review of specific types of data-driven international research projects while respecting globally transposable research ethics norms and principles. The Safe Harbor would consist in part of an agency supporting an International Federation for Ethics Review (IFER), formed by a voluntary compact among countries, granting agencies, philanthropies, institutions, and healthcare, patient advocacy, and research organizations. IFER would be both a central ethics review body, and also a forum for review and follow-up of policies concerning ethics norms for international research projects. It would be built on five principle elements: (1) registration, (2) compliance review, (3) recognition, (4) monitoring and enforcement, and (5) public participation. The Safe Harbor would create many benefits for researchers, countries, and the general public, and may eventually have application beyond (gen)omics to other areas of biomedical research that increasingly engage in secondary use of data and present only negligible risks. PMID:27774154

Representation or reason: consulting the public on the ethics of health policy.

PubMed

Mullen, Caroline

2008-12-01

Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate. The question then is whether there are forms of consultation which have the potential to realise more defensible decisions in either of these senses. Problems of adequately accounting for the views of those affected by policy decisions casts doubt on the plausibility of using consultation as a means of determining the opinions of the public. Consultation can have a role by bringing new ideas and challenges to debate, although it is uncertain whether this will increase the defensibility of any decision on ethics.

Just a Collection of Recollections: Clinical Ethics Consultation and the Interplay of Evaluating Voices.

PubMed

Bartlett, Virginia L; Bliton, Mark J; Finder, Stuart G

2016-12-01

Despite increased attention to the question of how best to evaluate clinical ethics consultations and emphasis on external evaluation (Hastings Center Report, ASBH Quality Attestation Process), there has been little sustained focus on how we, as clinicians, make sense of and learn from our own experiences in the midst of any one consultation. Questions of how we evaluate the request for, unfolding of, and conclusion of any specific ethics consultation are often overlooked, along with the underlying question of whether it is possible to give an accurate account of clinical ethics consultants' experience as experienced by ethics consultants. Before the challenge of submitting one's accounts or case reports for review and evaluation from others (at one's local institution or in the broader field), there is an underlying challenge of understanding and evaluating our own accounts. To highlight this crucial and deeply challenging dimension of actual clinical ethics practice, we present an account of a complex consultation, explicitly constructed to engage the reader in the unfolding experience of the consultant by emphasizing the multiple perspectives unfolding within the consultant's experience. Written in script format, the three perspectives presented-prototypical clinically descriptive account; didactically reflective and self-evidentiary account often seen in journal presentations; highly self-critical reflective account emphasizing uncertainties inherent to clinical ethics practice-reflect different manners for responding to the ways actual clinical involvement in ethics consultation practice accentuates and refocuses the question of how to understand and evaluate our own work, as well as that of our colleagues.

Interviewing with or without the partner present?--an underexposed dilemma between ethics and methodology in nursing research.

PubMed

Norlyk, Annelise; Haahr, Anita; Hall, Elisabeth

2016-04-01

To discuss ethical and methodological challenges related to in-depth interviews with patients and partners when interviewed together or separately. Increased interest in exploring illness phenomena from both patients' and partners' perspectives has emerged. The decision about how to collect data is challenging. Patients and partners can be interviewed separately or together; in both scenarios researchers face complex questions of methodology and ethics. This paper contributes to the ongoing debate on individual or joint interviewing and the effect of absence/presence of the partner on data collection. Discussion paper that draws on data from three phenomenological studies. Referring to three cases from our phenomenological studies, we discuss the different types of ethical and methodological dilemmas faced when undertaking joint and separate interviews with couples. Furthermore, we discuss how the unexpected presence of the partner potentially influences the data gathered from the patient. The cases demonstrate the interrelatedness of ethics and methodology in studies based on in-depth interviews with couples. Nurse researchers may be caught up in a dilemma between ethical concerns and methodological considerations. We argue that the presence of the partner during an interview session might influence the data and favour expressions of shared rather than individual experiences of the phenomenon studied. Furthermore, we argue that ethical concerns must be given higher priority than methodology when interviewing couples. An increased awareness of the tension between ethical and methodological challenges in joint or individual interviewing with patients and partners is necessary, as this issue is underexposed. © 2015 John Wiley & Sons Ltd.

Ethical challenges faced by healthcare professionals who care for suicidal patients: a scoping review.

PubMed

Saigle, Victoria; Racine, Eric

2018-04-17

For each one of the approximately 800,000 people who die from suicide every year, an additional twenty people attempt suicide. Many of these attempts result in hospitalization or in contact with other healthcare services. However, many personal, educational, and institutional barriers make it difficult for healthcare professionals to care for suicidal individuals. We reviewed literature that discusses suicidal patients in healthcare settings in order to highlight common ethical issues and to identify knowledge gaps. A sample was generated via PubMed using keywords "[(ethics OR *ethic*) AND suicid*] AND [English (Language) OR French (Language)]" (final N = 52), ethics content was extracted according to scoping review methodology, and categorized thematically. We identified three main areas posing ethical challenges for health professionals caring for suicidal individuals and their families. These were: (1) making clinical decisions for patients in acute care or when presented with specific circumstances; (2) issues arising from therapeutic relationships in chronic care, and (3) organizational factors. There is considerable uncertainty about how to resolve ethical issues when caring for someone who is suicidal. The stigma associated with suicide and mental illness, problems associated with risk-benefit assessments, and the fear of being held liable for malpractice should a patient die by suicide were overarching themes present across these three categories. Caring for suicidal patients is clinically and ethically challenging. The current literature highlights the complexity and range of decisions that need to be made. More attention should be paid to the difficulties faced by healthcare professionals and the development of solutions.

Collecting behavioural data using the world wide web: considerations for researchers

PubMed Central

Rhodes, S; Bowie, D; Hergenrather, K

2003-01-01

Objective: To identify and describe advantages, challenges, and ethical considerations of web based behavioural data collection. Methods: This discussion is based on the authors' experiences in survey development and study design, respondent recruitment, and internet research, and on the experiences of others as found in the literature. Results: The advantages of using the world wide web to collect behavioural data include rapid access to numerous potential respondents and previously hidden populations, respondent openness and full participation, opportunities for student research, and reduced research costs. Challenges identified include issues related to sampling and sample representativeness, competition for the attention of respondents, and potential limitations resulting from the much cited "digital divide", literacy, and disability. Ethical considerations include anonymity and privacy, providing and substantiating informed consent, and potential risks of malfeasance. Conclusions: Computer mediated communications, including electronic mail, the world wide web, and interactive programs will play an ever increasing part in the future of behavioural science research. Justifiable concerns regarding the use of the world wide web in research exist, but as access to, and use of, the internet becomes more widely and representatively distributed globally, the world wide web will become more applicable. In fact, the world wide web may be the only research tool able to reach some previously hidden population subgroups. Furthermore, many of the criticisms of online data collection are common to other survey research methodologies. PMID:12490652

Collecting behavioural data using the world wide web: considerations for researchers.

PubMed

Rhodes, S D; Bowie, D A; Hergenrather, K C

2003-01-01

To identify and describe advantages, challenges, and ethical considerations of web based behavioural data collection. This discussion is based on the authors' experiences in survey development and study design, respondent recruitment, and internet research, and on the experiences of others as found in the literature. The advantages of using the world wide web to collect behavioural data include rapid access to numerous potential respondents and previously hidden populations, respondent openness and full participation, opportunities for student research, and reduced research costs. Challenges identified include issues related to sampling and sample representativeness, competition for the attention of respondents, and potential limitations resulting from the much cited "digital divide", literacy, and disability. Ethical considerations include anonymity and privacy, providing and substantiating informed consent, and potential risks of malfeasance. Computer mediated communications, including electronic mail, the world wide web, and interactive programs will play an ever increasing part in the future of behavioural science research. Justifiable concerns regarding the use of the world wide web in research exist, but as access to, and use of, the internet becomes more widely and representatively distributed globally, the world wide web will become more applicable. In fact, the world wide web may be the only research tool able to reach some previously hidden population subgroups. Furthermore, many of the criticisms of online data collection are common to other survey research methodologies.

Getting comfortable with "comfort feeding": An exploration of legal and ethical aspects of the Australian speech-language pathologist's role in palliative dysphagia care.

PubMed

Kelly, Katherine; Cumming, Steven; Kenny, Belinda; Smith-Merry, Jennifer; Bogaardt, Hans

2018-06-01

With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area. This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context. Relevant legal and ethical considerations in palliative and end-of-life care are described. SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.

Reflections on Teaching Research Ethics in Education for International Postgraduate Students in the UK

ERIC Educational Resources Information Center

Smith, Jan

2016-01-01

Research ethics in education is a challenging topic to teach and to learn. As the staff and student body in UK higher education and elsewhere diversifies, the challenges increase as shared reference points diminish. My teaching reflections focus on a key tension explored in this article: how the imperative of internationalising the curriculum…

Effects of the Protestant Work Ethic and Perceived Challenge on Time Allocated to an Experimental Task.

ERIC Educational Resources Information Center

Tang, Thomas Li-Ping

Goal-setting literature has suggested that specific, difficult goals will produce higher performance levels than easy goals. A difficult task or one with negative performance feedback may increase an individual's perceived challenge of the task which may in turn enhance his motivation. Effects of the Protestant work ethic and perceived challenge…

Ethical Challenges in Participant Observation: A Reflection on Ethnographic Fieldwork

ERIC Educational Resources Information Center

Li, Jun

2008-01-01

In this essay I reflect on the ethical challenges of ethnographic fieldwork I personally experienced in a female gambling study. By assuming a covert research role, I was able to observe natural occurrences of female gambling activities but unable to make peace with disturbing feelings of my research concealment. By making my study overt, I was…

Battlefield ethics training: integrating ethical scenarios in high-intensity military field exercises.

PubMed

Thompson, Megan M; Jetly, Rakesh

2014-01-01

There is growing evidence that modern missions have added stresses and ethical complexities not seen in previous military operations and that there are links between battlefield stressors and ethical lapses. Military ethicists have concluded that the ethical challenges of modern missions are not well addressed by current military ethics educational programs. Integrating the extant research in the area, we propose that scenario-based operational ethics training in high-intensity military field training settings may be an important adjunct to traditional military ethics education and training. We make the case as to why this approach will enhance ethical operational preparation for soldiers, supporting their psychological well-being as well as mission effectiveness.

The development of computer ethics: contributions from business ethics and medical ethics.

PubMed

Wong, K; Steinke, G

2000-04-01

In this essay, we demonstrate that the field of computer ethics shares many core similarities with two other areas of applied ethics. Academicians writing and teaching in the area of computer ethics, along with practitioners, must address ethical issues that are qualitatively similar in nature to those raised in medicine and business. In addition, as academic disciplines, these three fields also share some similar concerns. For example, all face the difficult challenge of maintaining a credible dialogue with diverse constituents such as academicians of various disciplines, professionals, policymakers, and the general public. Given these similarities, the fields of bioethics and business ethics can serve as useful models for the development of computer ethics.

Battlefield ethics training: integrating ethical scenarios in high-intensity military field exercises

PubMed Central

Thompson, Megan M.; Jetly, Rakesh

2014-01-01

There is growing evidence that modern missions have added stresses and ethical complexities not seen in previous military operations and that there are links between battlefield stressors and ethical lapses. Military ethicists have concluded that the ethical challenges of modern missions are not well addressed by current military ethics educational programs. Integrating the extant research in the area, we propose that scenario-based operational ethics training in high-intensity military field training settings may be an important adjunct to traditional military ethics education and training. We make the case as to why this approach will enhance ethical operational preparation for soldiers, supporting their psychological well-being as well as mission effectiveness. PMID:25206947

Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

PubMed Central

2014-01-01

Background Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay. Methods Systematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out. Results Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22). Conclusions The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures. PMID:24894162

Impact of ethical factors on job satisfaction among Korean nurses.

PubMed

Jang, Yujin; Oh, Younjae

2017-01-01

Although numerous studies on job satisfaction among nurses have been conducted, there is a lack of research considering the ethical perspectives of leadership and organizational climate in job satisfaction. The purpose of this study was to clarify the impact of the ethical climate and ethical leadership as perceived by nurses on job satisfaction in South Korea. A descriptive and correlational study was conducted with a convenience sample of 263 nurses from four general hospitals in South Korea. Ethical considerations: This study was approved by the Institute Review Board of Hallym University before data collection. Job satisfaction was positively correlated with ethical climate and ethical leadership. The ethical climate in relationship with hospitals and people orientation leadership were influential factors in the level of job satisfaction among nurses. Organizations in the nursing environment should pay attention to improving the ethical climate with acceptable ethical norms in the workplace and nurse leaders should respect, support and genuinely care about their nurses in ethical concerns.

Electronic monitoring of offenders: an ethical review.

PubMed

Bülow, William

2014-06-01

This paper considers electronic monitoring (EM) a promising alternative to imprisonment as a criminal sanction for a series of criminal offenses. However, little has been said about EM from an ethical perspective. To evaluate EM from an ethical perspective, six initial ethical challenges are addressed and discussed. It is argued that since EM is developing as a technology and a punitive means, it is urgent to discuss its ethical implications and incorporate moral values into its design and development.

Experiences of ethical issues when caring for children with cancer.

PubMed

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

2015-01-01

The treatment for pediatric cancer is often physically, socially, and psychologically demanding and often gives rise to ethical issues. The purpose of this study was to describe healthcare professionals' experiences of ethical issues and ways to deal with these when caring for children with cancer. A study-specific questionnaire was given to healthcare professionals at a pediatric hospital in Sweden. Qualitative content analysis was used to analyze answers to open-ended questions. The data were sorted into 2 domains based on the objective of the study. In the next step, the data in each domain were inductively coded, generating categories and subcategories. The main ethical issues included concerns of (1) infringing on autonomy, (2) deciding on treatment levels, and (3) conflicting perspectives that constituted a challenge to collaboration. Professionals desired teamwork and reflection to deal with ethical concerns, and they needed resources for dealing with ethics. Interprofessional consideration needs to be improved. Forums and time for ethics reflections need to be offered to deal with ethical concerns in childhood cancer care. Experiences of ethical concerns and dealing with these in caring for children with cancer evoked strong feelings and moral perplexity among nursing staff. The study raises a challenging question: How can conflicting perspectives, lack of interprofessional consideration, and obstacles related to parents' involvement be "turned around," that is, contribute to a holistic perspective of ethics in cancer care of children?

A taste of ethical consumption at a slow food festival.

PubMed

Williams, Lauren T; Germov, John; Fuller, Sascha; Freij, Maria

2015-08-01

This paper examines the motives and experiences of attendees at a Slow Food festival to gain an understanding of how people engage with ethical consumer projects. Slow Food is a global social movement aimed at promoting food that is regionally, ethically, and sustainably produced, and convivially consumed. The movement uses culinary tourist events, such as food festivals and farmers' markets, to promote its philosophy and attract new members. There have been no empirical studies of ethical consumption using a Slow Food event as a case study. This study uses an ethnographic approach and a framework of virtue ethics to explore the views of people attending a major Slow Food festival in the city of Melbourne, Australia. Semi-structured interviews were conducted in situ with 33 participants (19 consumers and 14 stallholders) to discover their rationales for attending the festival, and their perspectives on ethical consumption. Transcripts were coded and thematically analysed, resulting in three themes reflecting varying degrees of public virtues (altruistic motivations) and private virtues (personal wellbeing): the quest for virtuous lifestyles through ethical consumption, the importance of co-production, and the challenges of putting ethical consumer projects like Slow Food into daily practice. The findings reveal the manner in which virtue ethics affects foodways and highlights the contingent and challenging nature of practising ethical eating. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

Imaging or Imagining? A Neuroethics Challenge Informed by Genetics

PubMed Central

Illes, Judy; Racine, Eric

2006-01-01

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the difficulty of carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point—even a backbone—for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge. PMID:16036688

Ethics in Higher Education Research

ERIC Educational Resources Information Center

Parsell, Mitch; Ambler, Trudy; Jacenyik-Trawoger, Christa

2014-01-01

Many educational researchers have experienced challenges in obtaining ethics approval. This article explores some of the reasons why this is the case, looking specifically at the participatory action research methodology. The authors' experience of seeking ethics approval for a project intended to introduce peer review as an enhancement process is…

The Revised 2010 Ethical Standards for School Counselors

ERIC Educational Resources Information Center

Huey, Wayne C.

2011-01-01

The American School Counselor Association (ASCA) recently revised its ethical code for professional school counselors, the "Ethical Standards for School Counselors," in 2010. Professional school counselors have a unique challenge in counseling minors in that they provide services in an educational setting. Consequently, school counselors not only…

Teaching Ethically: Challenges and Opportunities

ERIC Educational Resources Information Center

Landrum, R. Eric, Ed.; McCarthy, Maureen A., Ed.

2012-01-01

Educators work within a fluid academic and social landscape that requires frequent examination and re-examination of what constitutes ethical practice. In this book, editors R. Eric Landrum and Maureen McCarthy identify four broad areas of concern in the ethical teaching of undergraduate psychology: pedagogy, student behavior, faculty behavior…

Systems thinking and ethics in public health: a necessary and mutually beneficial partnership.

PubMed

Silva, Diego S; Smith, Maxwell J; Norman, Cameron D

2018-06-13

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders.

Twelve Years of Fogarty-Funded Bioethics Training in Latin America and the Caribbean: Achievements and Challenges

PubMed Central

Saenz, Carla; Heitman, Elizabeth; Luna, Florencia; Litewka, Sergio; Goodman, Kenneth W.; Macklin, Ruth

2017-01-01

The landscape in research ethics has changed significantly in Latin America and the Caribbean over the past two decades. Research ethics has gone from being a largely foreign concept and unfamiliar practice to an integral and growing feature of regional health research systems. Four bioethics training programs have been funded by the Fogarty International Center (FIC) in this region in the past 12 years. Overall, they have contributed significantly to changing the face of research ethics through the creation of locally relevant training materials and courses (including distance learning), academic publications, workshops, and conferences in Spanish, and strengthening ethics review committees and national systems of governance. This paper outlines their achievements and challenges, and reflects on current regional needs and what the future may hold for research ethics and bioethics training in Latin America and the Caribbean. PMID:24782074

The Council for International Organizations and Medical Sciences (CIOMS) guidelines on ethics of clinical trials.

PubMed

Macrae, Duncan J

2007-05-01

Numerous bodies from many countries, including governments, government regulatory departments, research organizations, medical professional bodies, and health care providers, have issued guidance or legislation on the ethical conduct of clinical trials. It is possible to trace the development of current guidelines back to the post-World War II Nuremburg war crimes trials, more specifically the "Doctors' Trial." From that trial emerged the Nuremburg Code, which set out basic principles to be observed when conducting research involving human subjects and which subsequently formed the basis for comprehensive international guidelines on medical research, such as the Declaration of Helsinki. Most recently, the Council for International Organizations and Medical Sciences (CIOMS) produced detailed guidelines (originally published in 1993 and updated in 2002) on the implementation of the principles outlined in the Declaration of Helsinki. The CIOMS guidelines set in an appropriate context the challenges of present-day clinical research, by addressing complex issues including HIV/AIDS research, availability of study treatments after a study ends, women as research subjects, safeguarding confidentiality, compensation for adverse events, as well guidelines on consent.

Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals.

PubMed

Sippel, Daniel; Marckmann, Georg; Ndzie Atangana, Etienne; Strech, Daniel

2015-01-01

Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding), giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information", "interpersonal, relational and behavioral issues", "psychological strain of individuals", and "scarce resources"; B) meso level: "structural issues of medical institutions", "issues with private clinics", "challenges connected to the family", and "issues of education, training and competence"; and C) macro level: "influence of society, culture, religion and superstition", "applicability of western medicine", "structural issues on the political level", and "legal issues". Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon.

Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals

PubMed Central

Sippel, Daniel; Marckmann, Georg; Ndzie Atangana, Etienne; Strech, Daniel

2015-01-01

Introduction Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. Materials and Methods In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding), giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. Results Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: “confidentiality and information”, “interpersonal, relational and behavioral issues”, “psychological strain of individuals”, and “scarce resources”; B) meso level: “structural issues of medical institutions”, “issues with private clinics”, “challenges connected to the family”, and “issues of education, training and competence”; and C) macro level: “influence of society, culture, religion and superstition”, “applicability of western medicine”, “structural issues on the political level”, and “legal issues”. Discussion Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon. PMID:26161655

An ethics of body scanners: requirements and future challenges from an ethical point of view

NASA Astrophysics Data System (ADS)

Rampp, Benjamin; Wolkenstein, Andreas F. X.; Ammicht Quinn, Regina

2011-05-01

At the moment, body scanners based on terahertz and millimeter-wave technologies are implemented at airports around the world. Thus, challenges of acceptance and acceptability become pressing. In this context, we present the results of an ethical research project on the development and implementation of body scanners. We will show which requirements concerning the system, its developers, and its users should be met in order that the scanners can be acceptable from an ethical point of view. These requirements involve, among others, questions of privacy, health, data protection, and security processes. A special ethical challenge for body scanners, however, still remains: Automatic anonymization processes are based on the assumption of "normal" bodies. Certain groups of persons with "deviant bodies" (e.g. persons with hidden disabilities, persons with aberrant sex characteristics, etc.) are affected in a special way: Their deviation from the standard (for instance their disability) is socially hidden, but eventually exposed by body scanners, even (and even more) if the produced pictures are anonymized. Here, we address the question how the possible discrimination against and exclusion of people with "deviant bodies" could be mitigated or prevented.

Evaluating Research Ethics Training in the Maryland Sea Grant REU Program

NASA Astrophysics Data System (ADS)

Allen, M. R.; Kumi, G. A.; Kumi, B. C.; Moser, F. C.

2016-02-01

The NSF's Research Experiences for Undergraduates (REU) program is an opportunity to cultivate responsible research practices in researchers at an early stage in their career. However, teaching responsible research conduct and science ethics in this program has been challenging because of a lack of consensus regarding which instructional methods are most effective for educating students about ethical concepts and establishing the process of ethical decision-making. Over the last 15 years, Maryland Sea Grant's REU ethics program has evolved by exploring different teaching models and looking for ways to effectively engage upper level undergraduates throughout their summer experience in ethical responsibility training. Since 2007, we have adopted a concerted experiential learning approach that includes an ethics seminar, role playing, case studies, and reflection. Currently, our summer long ethics training includes: 1) an interactive seminar; 2) a workshop with role playing and case studies; 3) 1-2 readings; and 4) a roundtable discussion with faculty mentors and their mentees to discuss researchers' real-world experiences with ethical dilemmas. Within the last 3 years, we have expanded our student learning outcomes assessments by administering pre- and post-program surveys to assess ethical skills students acquire through the program. Reevaluations administered three and six years after the REU experience will measure long term effectiveness of the training. Results from the first group of students reveal a greater awareness of ethical issues following our summer program. Students show a high level of competence about "black and white" issues (falsification, fabrication, plagiarism), but are more challenged by ethical "gray areas" such as data ownership and authorship. Results suggest many undergraduates come to research programs with basic ethics training, but benefit from our additional focus on complex ethical dilemmas.

An Ethics Challenge for School Counselors: Part 2

ERIC Educational Resources Information Center

Hicks, Janet G. Froeschle; Noble, Nicole; Berry, Steve; Talbert, Steve; Crews, Charles; Li, Jiaqi; Castillo, Yvette

2014-01-01

Ethical and legal issues are dealt with daily by school counselors (Bodenhorn, 2006; Moyer, Sullivan & Growcock, 2012). Despite the prevalence of these issues, few resources exist to assist these professionals when making ethical and legal decisions. In addition, a lack of supervision for school counselors and managing complexities inherent…

Structured Ethical Reflection in Practitioner Inquiry: Theory, Pedagogy, and Practice

ERIC Educational Resources Information Center

Stevens, Douglas M.; Brydon-Miller, Mary; Raider-Roth, Miriam

2016-01-01

Practitioner inquiry provides a powerful tool for improving practice and addressing critical issues in classrooms, schools, and broader communities. However, it also raises unique ethical challenges that often go unrecognized and unresolved. Structured Ethical Reflection (SER) provides teacher researchers with a process for identifying core values…

Everyday Ethics in Dementia Day Care: Narratives of Crossing the Line.

ERIC Educational Resources Information Center

Hasselkus, Betty Risteen

1997-01-01

Examines the ethical aspects of the experience of providing day care to dementia patients. Results, based on telephone interviews (N=40), indicate that ethical challenges arise in everyday incidents when participants, staff, or family members "cross the line" of acceptable behavior. Staff responses ranged from benign manipulation to…

Giving Voice to Values: A Pedagogy for Behavioral Ethics

ERIC Educational Resources Information Center

Gentile, Mary C.

2017-01-01

Management education has had a long and somewhat conflicted relationship with the integration of ethics and values-driven leadership into its curriculum. This essay presents some of the key challenges around pedagogy, curriculum design, as well as organizational and faculty concerns; and then outlines how behavioral ethics has triggered some…

Distance Supervision in Rehabilitation Counseling: Ethical and Clinical Considerations

ERIC Educational Resources Information Center

Lund, Emily M.; Schultz, Jared C.

2015-01-01

Background: The use of technology-mediated distance supervision is a rapidly growing area in rehabilitation counseling and other fields. Distance supervision has both tremendous potential and notable challenges to address, including questions of ethics and evidence. Purpose: This article examines both the ethical and nonethical principles that…

Gift Giving and Receiving in Child-Centered Play Therapy: An Ethical Response

ERIC Educational Resources Information Center

Blanco, Pedro J.; Sheely-Moore, Angela I.

2012-01-01

Child-centered play therapists are often confronted with the challenge of receiving gifts from clients. This article highlights recommended strategies when faced with gift receiving, exemplified by actual ethical dilemmas encountered by child-centered play therapists. Ethical and therapeutic considerations of therapist gift giving to child clients…

Factors Affecting Intrinsic Motivation among University Students in Taiwan.

ERIC Educational Resources Information Center

Tang, Li-Ping Thomas

1990-01-01

Studies the effects of the Protestant work ethic and performance feedback on intrinsic motivation in a sample of Taiwanese university students. Divides subjects into three groups according to work ethic measurement: high, intermediate, and low. Suggests students with a low work ethic exert more effort when challenged. (NL)

Teaching Ethics in a Business Program

ERIC Educational Resources Information Center

Grant, John H.

2008-01-01

Societies face continuing challenges in balancing the role of voluntary levels of ethical conduct against those of rules and enforcement. Undergraduate business programs around the world send hundreds of thousands of students into organizations and communities every year, each with his or her own perception of "what's ethical" and "what's legal"…

Ethical drift: when good people do bad things.

PubMed

Kleinman, Carole S

2006-01-01

There are many factors in today's healthcare environment which challenge nurses and nursing administration in adhering to ethical values. This article discusses the phenomenon of ethical drift, a gradual erosion of ethical behavior that occurs in individuals below their level of awareness. It is imperative for nurse managers and executives to be aware of the danger that workplace pressures pose in encouraging ethical drift at all levels of nursing, and to take steps to prevent this phenomena from occurring in their facilities.

Virtue ethics – an old answer to a new dilemma? Part 2. The case for inclusive virtue ethics

PubMed Central

2015-01-01

Summary While Principlism is a widely accepted consensus statement for ethics, the moral theory that underpins it faces serious challenges. This two-part paper proposes a version of virtue theory as a more grounded system of moral analysis. Part 2 examines the role of basic moral theory as the foundation to ethics and suggests how virtue theory can be used as a central framework for ethics while being inclusive of insights from deontology and consequentialism. PMID:25792615

On teaching computer ethics within a computer science department.

PubMed

Quinn, Michael J

2006-04-01

The author has surveyed a quarter of the accredited undergraduate computer science programs in the United States. More than half of these programs offer a 'social and ethical implications of computing' course taught by a computer science faculty member, and there appears to be a trend toward teaching ethics classes within computer science departments. Although the decision to create an 'in house' computer ethics course may sometimes be a pragmatic response to pressure from the accreditation agency, this paper argues that teaching ethics within a computer science department can provide students and faculty members with numerous benefits. The paper lists topics that can be covered in a computer ethics course and offers some practical suggestions for making the course successful.

Organ shortage: the greatest challenge facing transplant medicine.

PubMed

Shafran, David; Kodish, Eric; Tzakis, Andreas

2014-07-01

The success of organ transplantation as a treatment for end-stage organ disease has yielded a series of ethical quandaries originating from the issue of organ shortage. Scarcity of organs for transplantation necessitates formulation of just and fair allocation policies as well as ethically viable solutions to bridging the vast gap between organ supply and demand. The concept of "triage" provides a useful paradigm in which to contextualize the organ shortage issue. This entails subjugating the welfare of the individual patient for the benefit of the wider community as an ethically justified response to the challenge of scarcity.

Ethics of health policy and systems research: a scoping review of the literature.

PubMed

Pratt, Bridget; Paul, Amy; Hyder, Adnan A; Ali, Joseph

2017-07-01

Health policy and systems research (HPSR) is increasingly funded and undertaken as part of health system strengthening efforts worldwide. HPSR ethics is also a relatively new and emerging field, with numerous normative and descriptive questions that have largely not been considered. Normative questions include what ethical principles and values should guide HPSR. Descriptive questions include what ethical concerns arise when conducting HPSR. A small but growing body of scholarly work characterizes the various ethics issues inherent in HPSR. Towards informing the future development of ethics guidance for HPSR, a scoping review was undertaken to: (1) identify the range of ethics issues relevant to the conduct of HPSR-with a deliberate (though not exclusive) focus on low- and middle-income country settings and (2) describe existing guidance on key ethics issues relevant to HPSR. Using the Cochrane methods as a basis, the review identified formal and informal literature on HPSR ethics by searching the following databases: PubMed's Medline, Embase, Global Health, Scopus, WHO Global Health Regional Libraries, LILACs, OpenDOAR and Bielefeld Academic Search Engine. In total, 11 062 documents were identified from the formal (10 519) and informal (543) literature. One hundred and seven of these documents (formal 99 and informal 8) met at least one inclusion criterion and underwent thematic analysis. Ethical issues in four main categories were identified: upholding autonomy, identifying and balancing risks and benefits, justice and determination of ethical review requirements. The review indicated that the ethical values behind HPSR place an emphasis on its contributing to the reduction of health disparities. Unsurprisingly then, numerous ethical concerns relating to justice arise in HPSR. However, the majority of existing guidance focuses on obtaining or waiving informed consent and, thus, appears to be insufficient for HPSR. A list of priority ethics issues in HPSR in need of guidance development is provided. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.

What are applied ethics?

PubMed

Allhoff, Fritz

2011-03-01

This paper explores the relationships that various applied ethics bear to each other, both in particular disciplines and more generally. The introductory section lays out the challenge of coming up with such an account and, drawing a parallel with the philosophy of science, offers that applied ethics may either be unified or disunified. The second section develops one simple account through which applied ethics are unified, vis-à-vis ethical theory. However, this is not taken to be a satisfying answer, for reasons explained. In the third section, specific applied ethics are explored: biomedical ethics; business ethics; environmental ethics; and neuroethics. These are chosen not to be comprehensive, but rather for their traditions or other illustrative purposes. The final section draws together the results of the preceding analysis and defends a disunity conception of applied ethics.

Fostering ethical willingness: integrating emotional and contextual awareness with rational analysis.

PubMed

Betan, E J; Stanton, A L

1999-06-01

Ethical dilemmas are inherently challenging. By definition, clinicians decide between conflicting principles of welfare and naturally confront competing pulls and inclinations. This investigation of students' responses to an ethical scenario highlights how emotions and concerns can interfere with willingness to implement ethical knowledge. Clear-cut rules are the exception in psychotherapy, and clinicians must judge ethical issues on the basis of the unique context of each case. As such, subjectivity and emotional involvement are essential tools for determining ethical action, but they must be integrated with rational analysis. Strategies for attending to influential emotions and contextual factors in order to mobilize ethical commitment are described.

Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team.

PubMed

Egede-Nissen, Veslemøy; Sellevold, Gerd Sylvi; Jakobsen, Rita; Sørlie, Venke

2018-01-01

The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges. The aim is to explore minority healthcare providers, trained nurses and nurses' assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context. The study has a qualitative design, using narrative interviews, and a phenomenological-hermeneutic analysis method to explore the experiences of challenges in dementia care. Ethical considerations: The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services. Participation and research context: Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit. The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness. The findings are discussed considering Løgstrup's ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood. The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.

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

PubMed

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

2007-01-01

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

School Principals' Perceptions of Ethically Just Responses to a Teacher Sexting Vignette: Severity of Administrator Response, Principals' Personality, and Offender Gender and Race

ERIC Educational Resources Information Center

Wagner, Kenneth

2012-01-01

Site level administrators make decisions during the course of a day that have ethical dimensions that challenge their personal values and ethics. This study examined the extent to which particular factors would affect principals' and vice principals' judgments of the ethicality of sanctions given a teacher who had been sending sexually…

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.

Educating the Whole Child: Social-Emotional Learning and Ethics Education

ERIC Educational Resources Information Center

Burroughs, Michael D.; Barkauskas, Nikolaus J.

2017-01-01

Research supporting social and emotional learning (SEL) in schools demonstrates numerous benefits for students, including increased academic achievement and social and emotional competencies. However, research supporting the adoption of SEL lacks a clear conception of "ethical competence." This lack of clarity is problematic for two…

Ethics Guidelines in Environmental Epidemiology: Their Development and Challenges We Face.

PubMed

Kramer, Shira; Soskolne, Colin L

2017-06-01

This review integrates historical developments and key events in bringing ethics into epidemiology in general and into environmental epidemiology in particular. The goal is to provide context for and discern among the various approaches and motivations that drive the need for ethical conduct in support of the public interest. The need for ethics guidelines in epidemiology is different from developments in other biomedical-related fields by virtue of its focus on populations rather than on individuals. The need for ethics guidelines in environmental epidemiology as a subspecialty of epidemiology stems from the larger scale of its mission than that of epidemiology per se. Ethics guidelines in the field of environmental epidemiology have been established. They articulate not only the profession's core values and mission, but more specifically, they address the environmental epidemiologist's obligations to the participants in research, to colleagues, and to employers. They are the product of consensus, scholarship, and diligent stewardship over several decades. The next challenge is ensuring their value and impact. The forces that support professional and institutional success, and the power of special interests, are the major threats to achieving the goals of ethical conduct and research for the public good. In environmental epidemiology, these threats have global implications.

Ethical research on the implementation of DRGs in Switzerland--a challenging project.

PubMed

Wild, Verina; Pfister, Eliane; Biller-Andorno, Nikola

2012-08-09

Diagnosis Related Groups (DRGs) are currently being introduced on a national scale as a prospective reimbursement scheme in Swiss in-patient hospital care, replacing any remaining retrospective day-rate arrangements. DRGs are expected to promote transparency and efficiency while helping to contain health care costs. The governmental decision to introduce DRGs has caused considerable controversy among different stakeholders, due to diverging appraisals of what will happen when DRGs are introduced as an economic management tool in Switzerland. The controversial discourse on DRGs is particularly interesting from an ethical point of view, since all arguments inevitably contain ethical considerations. In this paper we summarise the results of our exploratory ethical studies that have led to a larger research project funded by the Swiss National Science Foundation: "Impact of Diagnosis-Related Groups (DRGs) on patient care and professional practice" (IDoC). In section 1: 'Developing an understanding of the ethical issues at stake' we briefly explain how DRGs work, what the intended effects are, what the public is concerned about and what the scientific research tells us so far. In section 2: 'Developing an ethical framework for research on DRGs in Switzerland' we summarise the ethical issues and explain the ethical framework we will use in order to perform research on the complex issue of DRGs in Switzerland. Only once a profound understanding of the challenges exists can research on the ethical implications of DRGs be successful.

A Relational Ethics Framework for Advancing Practice with Children with Complex Health Care Needs and Their Parents.

PubMed

Carnevale, Franco A; Teachman, Gail; Bogossian, Aline

2017-12-01

Children with complex health care needs are an emerging population that commonly requires long-term supportive services. A growing body of evidence has highlighted that these children and their families experience significant challenges. Many of these challenges involve ethical concerns that have been under-recognized. In this article, we (a) outline ethical concerns that arise in clinical practice with children with complex health care needs and their families (e.g.: exclusion of children's voices in discussions and decisions that affect them; difficulties in defining their best interests; clashes across the array of social roles that parents manage; limited recognition of the ethical significance of parents' and other family members' interests) and (b) propose a relational ethics framework for addressing these concerns. Our framework draws on hermeneutical interpretation and moral experience as foundational orientations, recognizing children with complex health care needs as relationally embedded agents, who while dependent and entitled to protection, are simultaneously agential. Children's and parents' interests are relationally intertwined and interdependent. Families are recognized as significant social microcosms for the cultivation and transmission of intergenerational cultural heritage, narratives, and outlooks. We describe strategies for (a) conducting a relational ethics inquiry and (b) reconciliation of identified ethical concerns through a process of rapprochement. A relational ethics framework can promote clinical practices that are ethically attuned to the complexity of this population's needs.

Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV “Test-and-Treat”: A Systematic Review

PubMed Central

Shah, Kavita R.; Sarma, Karthik V.; Mahajan, Anish P.

2013-01-01

Despite the HIV “test-and-treat” strategy’s promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy’s success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation. PMID:23597344

Making Choices: Ethical Decisions in a Global Context.

PubMed

Bonde, Sheila; Briant, Clyde; Firenze, Paul; Hanavan, Julianne; Huang, Amy; Li, Min; Narayanan, N C; Parthasarathy, D; Zhao, Hongqin

2016-04-01

The changing milieu of research--increasingly global, interdisciplinary and collaborative--prompts greater emphasis on cultural context and upon partnership with international scholars and diverse community groups. Ethics training, however, tends to ignore the cross-cultural challenges of making ethical choices. This paper confronts those challenges by presenting a new curricular model developed by an international team. It examines ethics across a very broad range of situations, using case studies and employing the perspectives of social science, humanities and the sciences. The course has been developed and taught in a highly collaborative way, involving researchers and students at Zhejiang University, the Indian Institute of Technology, Bombay and Brown University. The article presents the curricular modules of the course, learning outcomes, an assessment framework developed for the project, and a discussion of evaluation findings.

Ethical Challenges and Complexities of Including People with Intellectual Disability as Participants in Research

ERIC Educational Resources Information Center

Iacono, Teresa

2006-01-01

The aim of this article is to consider the implications for research involving people with intellectual disability--a vulnerable group--of ethics committees' attempts to apply these guidelines. The issue explored is whether committees such as Human Research Ethics Committees (HRECS) and Institutional Review Boards (IRBs) are becoming increasingly…

Towards an Ethics of Engagement in Education in Global Times

ERIC Educational Resources Information Center

Christie, Pam

2005-01-01

Starting from the observation that patterns of educational inequality are widely known but largely invisible in public debates on education, this article argues for the importance of an ethics of education which challenges simple acceptance of "things as they are". It suggests possibilities for working with discourses of ethics, rights and…

A Five-Country Survey on Ethics Education in Preservice Teaching Programs

ERIC Educational Resources Information Center

Maxwell, Bruce; Tremblay-Laprise, Audrée-Anne; Filion, Marianne; Boon, Helen; Daly, Caroline; van den Hoven, Mariette; Heilbronn, Ruth; Lenselink, Myrthe; Walters, Sue

2016-01-01

Despite a broad consensus on the ethical dimensions of the teaching profession, and long-standing efforts to align teacher education with wider trends in professional education, little is known about how teacher candidates are being prepared to face the ethical challenges of contemporary teaching. This article presents the results of an…

Infusing Ethics into the Development of Engineers: Exemplary Education Activities and Programs

ERIC Educational Resources Information Center

National Academies Press, 2016

2016-01-01

Ethical practice in engineering is critical for ensuring public trust in the field and in its practitioners, especially as engineers increasingly tackle international and socially complex problems that combine technical and ethical challenges. This report aims to raise awareness of the variety of exceptional programs and strategies for improving…

Can Ethics Be Taught? Perspectives, Challenges, and Approaches at Harvard Business School.

ERIC Educational Resources Information Center

Piper, Thomas R.; And Others

This book describes in five chapters how the Harvard Business School has redeveloped its curriculum to place leadership, ethics, and corporate responsibility at the center of its mission. Chapter 1, "Rediscovery of Purpose: The Genesis of the Leadership, Ethics, and Corporate Responsibility Initiative," (Thomas R. Piper) describes the…

Training and Performance Improvement Professionals' Perspectives on Ethical Challenges during Evaluation

ERIC Educational Resources Information Center

Chyung, Seung Youn; Winiecki, Donald J.; Downing, Jessica L.

2010-01-01

Ethical concerns are rising in the business world. With this in mind, training and performance improvement practitioners, especially during evaluation projects, should be aware of principles and codes of ethics, and their behaviors and decisions should reflect the standards recognized by members of the professional society. A study was conducted…

The Challenge of Timely, Responsive and Rigorous Ethics Review of Disaster Research: Views of Research Ethics Committee Members.

PubMed

Hunt, Matthew; Tansey, Catherine M; Anderson, James; Boulanger, Renaud F; Eckenwiler, Lisa; Pringle, John; Schwartz, Lisa

2016-01-01

Research conducted following natural disasters such as earthquakes, floods or hurricanes is crucial for improving relief interventions. Such research, however, poses ethical, methodological and logistical challenges for researchers. Oversight of disaster research also poses challenges for research ethics committees (RECs), in part due to the rapid turnaround needed to initiate research after a disaster. Currently, there is limited knowledge available about how RECs respond to and appraise disaster research. To address this knowledge gap, we investigated the experiences of REC members who had reviewed disaster research conducted in low- or middle-income countries. We used interpretive description methodology and conducted in-depth interviews with 15 respondents. Respondents were chairs, members, advisors, or coordinators from 13 RECs, including RECs affiliated with universities, governments, international organizations, a for-profit REC, and an ad hoc committee established during a disaster. Interviews were analyzed inductively using constant comparative techniques. Through this process, three elements were identified as characterizing effective and high-quality review: timeliness, responsiveness and rigorousness. To ensure timeliness, many RECs rely on adaptations of review procedures for urgent protocols. Respondents emphasized that responsive review requires awareness of and sensitivity to the particularities of disaster settings and disaster research. Rigorous review was linked with providing careful assessment of ethical considerations related to the research, as well as ensuring independence of the review process. Both the frequency of disasters and the conduct of disaster research are on the rise. Ensuring effective and high quality review of disaster research is crucial, yet challenges, including time pressures for urgent protocols, exist for achieving this goal. Adapting standard REC procedures may be necessary. However, steps should be taken to ensure that ethics review of disaster research remains diligent and thorough.

The Challenge of Timely, Responsive and Rigorous Ethics Review of Disaster Research: Views of Research Ethics Committee Members

PubMed Central

Hunt, Matthew; Tansey, Catherine M.

2016-01-01

Background Research conducted following natural disasters such as earthquakes, floods or hurricanes is crucial for improving relief interventions. Such research, however, poses ethical, methodological and logistical challenges for researchers. Oversight of disaster research also poses challenges for research ethics committees (RECs), in part due to the rapid turnaround needed to initiate research after a disaster. Currently, there is limited knowledge available about how RECs respond to and appraise disaster research. To address this knowledge gap, we investigated the experiences of REC members who had reviewed disaster research conducted in low- or middle-income countries. Methods We used interpretive description methodology and conducted in-depth interviews with 15 respondents. Respondents were chairs, members, advisors, or coordinators from 13 RECs, including RECs affiliated with universities, governments, international organizations, a for-profit REC, and an ad hoc committee established during a disaster. Interviews were analyzed inductively using constant comparative techniques. Results Through this process, three elements were identified as characterizing effective and high-quality review: timeliness, responsiveness and rigorousness. To ensure timeliness, many RECs rely on adaptations of review procedures for urgent protocols. Respondents emphasized that responsive review requires awareness of and sensitivity to the particularities of disaster settings and disaster research. Rigorous review was linked with providing careful assessment of ethical considerations related to the research, as well as ensuring independence of the review process. Conclusion Both the frequency of disasters and the conduct of disaster research are on the rise. Ensuring effective and high quality review of disaster research is crucial, yet challenges, including time pressures for urgent protocols, exist for achieving this goal. Adapting standard REC procedures may be necessary. However, steps should be taken to ensure that ethics review of disaster research remains diligent and thorough. PMID:27327165

[Some ethical aspects of donation and transplantation].

PubMed

Martínez, K

2006-01-01

Ethical and legal consensus in our country bases the practice of donations and transplants on different ethical principles, which are contained in the legislation, closely conforming to the four principles of principialist bioethics: autonomy, beneficence, non-maleficence, and justice. The level of donations achieved in our milieu might, in fact, be related to a strict respect for these principles by the health professionals, as well as to the excellent organisation of the transplant world. Many scientific, technical and ethical challenges have had to be met to reach the present state of the transplant. And there are many current challenges. The article only analyses some of these due to their technical, ethical and social repercussions: organ transplants involving a live donor, the public request for organs, the organ market, the transplant of non-vital organs (basically the face transplant), the use of stem cells and the banks of umbilical cord cells. The aim of the article is to state the ethical problems raised by these new practices, in order to lay the foundations for a moral deliberation that must necessarily involve the whole of society.

Ethical concerns for maternal surrogacy and reproductive tourism.

PubMed

Deonandan, Raywat; Green, Samantha; van Beinum, Amanda

2012-12-01

Reproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, eight such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.

Ethical Issues in School Art Therapy

ERIC Educational Resources Information Center

Moriya, Dafna

2006-01-01

School art therapists face numerous ethical dilemmas, from referrals to therapy, through privacy, safety and predictability in the art therapy room, to the need to balance cooperation with the educational staff and its expectations of shared information with loyalty to the patient. Breach of confidentiality also has legal implications. The…

Software Piracy, Ethics, and the Academician.

ERIC Educational Resources Information Center

Bassler, Richard A.

The numerous software programs available for easy, low-cost copying raise ethical questions. The problem can be examined from the viewpoints of software users, teachers, authors, vendors, and distributors. Software users might hesitate to purchase or use software which prevents the making of back-up copies for program protection. Teachers in…

Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014-2015 Ebola outbreak: a qualitative study.

PubMed

Draper, Heather; Jenkins, Simon

2017-12-19

As part of its response to the 2014 Ebola outbreak in west Africa, the United Kingdom (UK) government established an Ebola treatment unit in Sierra Leone, staffed by military personnel. Little is known about the ethical challenges experienced by military medical staff on humanitarian deployment. We designed a qualitative study to explore this further with those who worked in the treatment unit. Semi-structured, face-to-face and telephone interviews were conducted with 20 UK military personnel deployed between October 2014 and April 2015 in one of three roles in the Ebola treatment unit: clinician; nursing and nursing assistant; and other medical support work, including infection control and laboratory and mortuary services. Many participants reported feeling ethically motivated to volunteer for deployment, but for some personal interests were also a consideration. A small minority had negative feelings towards the deployment, others felt that this deployment like any other was part of military service. Almost all had initial concerns about personal safety but were reassured by their pre-deployment 'drills and skills', and personal protective equipment. Risk perceptions were related to perceptions about military service. Efforts to minimise infection risk were perceived to have made good patient care more difficult. Significantly, some thought the humanitarian nature of the mission justified tolerating greater risks to staff. Trust in the military institution and colleagues was expressed; many participants referred to the ethical obligation within the chain of command to protect those under their command. Participants expected resources to be overwhelmed and 'empty beds' presented a significant and pervasive ethical challenge. Most thought more patients could and should have been treated. Points of reference for participants' ethical values were: previous deployment experience; previous UK/National Health Service experience; professional ethics; and, distinctly military values (that might not be shared with non-military workers). We report the first systematic exploration of the ethical challenges face by a Western medical military in the international response to the first major Ebola outbreak. We offer unique insights into the military healthcare workers' experiences of humanitarian deployment. Many participants expressed motivations that gave them common purpose with civilian volunteers.

Preparing Professionals to Face Ethical Challenges in Today's Workplace: Review of the Literature, Implications for PI, and a Proposed Research Agenda

ERIC Educational Resources Information Center

Frisque, Deloise A.; Lin, Hong; Kolb, Judith A.

2004-01-01

Ethics is very much in the news today and on the minds of those who teach and/or train current and future professionals to work successfully in today's workplaces. While there seems to be agreement that organizations need to address the topic of ethics, there is also a concern about how best to proceed. Ethics and compliance offices, professional…

Resolving Ethical Challenges in an Era of Persistent Conflict

DTIC Science & Technology

2011-04-01

pleasure. For John Stuart Mill , it was hap- piness. Others consider it interest or well-being. In the context of 36 Just War thinking, the good is...war. THE PROFESSIONAL MILITARY ETHIC: BALANCING RISK Accomplishing the Mission. Military ethics begins with the utilitarian im- perative to...avoid defeat are not just permissible, they are obliga- tory. Additionally, it is a feature of any utilitarian ethic that the greater the good, the

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.

Ethics of Cancer Gene Transfer Clinical Research.

PubMed

Kimmelman, Jonathan

2015-01-01

Translation of cancer gene transfer confronts many familiar-and some distinctive-ethical challenges. In what follows, I survey three major ethical dimensions of cancer gene transfer development. Subheading 1 centers on the ethics of planning, designing, and reporting animal studies. Subheading 2 describes basic elements of human subjects protection as pertaining to cancer gene transfer. In Subheading 3, I describe how cancer gene transfer researchers have obligations to downstream consumers of the evidence they produce.

Don't blame the 'bio'--blame the 'ethics': varieties of (bio)ethics and the challenge of pluralism.

PubMed

Charlesworth, Max

2005-01-01

We tend to think that the difficulties in bioethics spring from the novel and alarming issues that arise due to discoveries in the new biosciences and biotechnologies. But many of the crucial difficulties in bioethics arise from the assumption we make about ethics. This paper offers a brief overview of bioethics, and relates ethical 'principlism' to 'ethical fundamentalism.' It then reviews some alternative approaches that have emerged during the second phase of bioethics and argues for a neo-Aristotelian approach. Misconceptions about ethical principles and ethical reasoning not only distort our views of the business of bioethics, but they also prevent us from facing up to the formidable problems posed by ethical pluralism in so-called liberal societies.

Virtue ethics--an old answer to a new dilemma? Part 2. The case for inclusive virtue ethics.

PubMed

Misselbrook, David

2015-03-01

While Principlism is a widely accepted consensus statement for ethics, the moral theory that underpins it faces serious challenges. This two-part paper proposes a version of virtue theory as a more grounded system of moral analysis. Part 2 examines the role of basic moral theory as the foundation to ethics and suggests how virtue theory can be used as a central framework for ethics while being inclusive of insights from deontology and consequentialism. © The Royal Society of Medicine.

A perpetual source of DNA or something really different: ethical issues in the creation of cell lines for African genomics research.

PubMed

de Vries, Jantina; Abayomi, Akin; Brandful, James; Littler, Katherine; Madden, Ebony; Marshall, Patricia; Ouwe Missi Oukem-Boyer, Odile; Seeley, Janet

2014-08-07

The rise of genomic studies in Africa - not least due to projects funded under H3Africa - is associated with the development of a small number of biorepositories across Africa. For the ultimate success of these biorepositories, the creation of cell lines including those from selected H3Africa samples would be beneficial. In this paper, we map ethical challenges in the creation of cell lines. The first challenge we identified relates to the moral status of cells living in culture. There is no doubt that cells in culture are alive, and the question is how this characteristic is relevant to ethical decision-making. The second challenge relates to the fact that cells in culture are a source of cell products and mitochondrial DNA. In combination with other technologies, cells in culture could also be used to grow human tissue. Whilst on the one hand, this feature increases the potential utility of the sample and promotes science, on the other it also enables further scientific work that may not have been specifically consented to or approved. The third challenge relates to ownership over samples, particularly in cases where cell lines are created by a biobank, and in a different country than where samples were collected. Relevant questions here concern the export of samples, approval of secondary use and the acceptability of commercialisation. A fourth challenge relates to perceptions of blood and bodily integrity, which may be particularly relevant for African research participants from certain cultures or backgrounds. Finally, we discuss challenges around informed consent and ethical review. In this paper, we sought to map the myriad of ethical challenges that need to be considered prior to making cell line creation a reality in the H3Africa project. Considering the relative novelty of this practice in Africa, such challenges will need to be considered, discussed and potentially be resolved before cell line creation in Africa becomes financially feasible and sustainable. We suggest that discussions need to be undertaken between stakeholders internationally, considering the international character of the H3Africa project. We also map out avenues for empirical research.

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.

Ethics and privacy issues of a practice-based surveillance system: need for a national-level institutional research ethics board and consent standards.

PubMed

Kotecha, Jyoti A; Manca, Donna; Lambert-Lanning, Anita; Keshavjee, Karim; Drummond, Neil; Godwin, Marshall; Greiver, Michelle; Putnam, Wayne; Lussier, Marie-Thérèse; Birtwhistle, Richard

2011-10-01

To describe the challenges the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) experienced with institutional research ethics boards (IREBs) when seeking approvals across jurisdictions and to provide recommendations for overcoming challenges of ethical review for multisite and multijurisdictional surveillance and research. The CPCSSN project collects and validates longitudinal primary care health information (relating to hypertension, diabetes, depression, chronic obstructive lung disease, and osteoarthritis) from electronic medical records across Canada. Privacy and data storage security policies and processes have been developed to protect participants' privacy and confidentiality, and IREB approval is obtained in each participating jurisdiction. Inconsistent interpretation and application of privacy and ethical issues by IREBs delays and impedes research programs that could better inform us about chronic disease. The CPCSSN project's experience with gaining approval from IREBs highlights the difficulty of conducting pan-Canadian health surveillance and multicentre research. Inconsistent IREB approvals to waive explicit individual informed consent produced particular challenges for researchers. The CPCSSN experience highlights the need to develop a better process for researchers to obtain timely and consistent IREB approvals for multicentre surveillance and research. We suggest developing a specialized, national, centralized IREB responsible for approving multisite studies related to population health research.

Introduction to the Special Issue on Climate Ethics: Uncertainty, Values and Policy.

PubMed

Roeser, Sabine

2017-10-01

Climate change is a pressing phenomenon with huge potential ethical, legal and social policy implications. Climate change gives rise to intricate moral and policy issues as it involves contested science, uncertainty and risk. In order to come to scientifically and morally justified, as well as feasible, policies, targeting climate change requires an interdisciplinary approach. This special issue will identify the main challenges that climate change poses from social, economic, methodological and ethical perspectives by focusing on the complex interrelations between uncertainty, values and policy in this context. This special issue brings together scholars from economics, social sciences and philosophy in order to address these challenges.

"In the storminess": multi-disciplinary approaches to scriptural images representing ethical challenges in the pastor-congregant relationship.

PubMed

O'Connor, Thomas St James; Walsh-Bowers, Richard; Psychology, Community; Ross, Christopher; Sawchuk, Dana; Hatzipantelis, Maria

2006-01-01

In this qualitative study the authors examine the Scriptural images that 10 Lutheran pastors employed in describing the ethical challenges in the pastor-congregant relationship. The analysis of Scriptural images is part of a larger study on pastors' experiences of a mandatory workshop, "Crossing the Boundaries (CTB),"which is required of Evangelical Lutheran Church in Canada (ELCIC) seminarians. The pastors' images were analyzed from the four perspectives of depth psychology, theology, social ethics, and sociology. In commenting on tensions in the pastors' Scriptural images the authors note commonalities among the four theoretical perspectives and discuss implications for practice and future research.

Innovation in surgical technology and techniques: Challenges and ethical issues.

PubMed

Geiger, James D; Hirschl, Ronald B

2015-06-01

The pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new technology or technique, how are the outcomes of a new technology evaluated and how are the responsibilities of individual patients and society at large balanced. Ethical considerations relevant to the implementation of ECMO and robotic surgery are explored to further discussion of how we can optimize the delicate balance between innovation and regulation. Copyright © 2015 Elsevier Inc. All rights reserved.

Social Media Channels in Health Care Research and Rising Ethical Issues.

PubMed

Azer, Samy A

2017-11-01

Social media channels such as Twitter, Facebook, and LinkedIn have been used as tools in health care research, opening new horizons for research on health-related topics (e.g., the use of mobile social networking in weight loss programs). While there have been efforts to develop ethical guidelines for internet-related research, researchers still face unresolved ethical challenges. This article investigates some of the risks inherent in social media research and discusses how researchers should handle challenges related to confidentiality, privacy, and consent when social media tools are used in health-related research. © 2017 American Medical Association. All Rights Reserved.

Ethical issues in patient safety: Implications for nursing management.

PubMed

Kangasniemi, Mari; Vaismoradi, Mojtaba; Jasper, Melanie; Turunen, Hannele

2013-12-01

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in 'the ethical imperative' of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers' decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

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).

Responsibly managing students' learning experiences in student-run clinics: a virtues-based ethical framework.

PubMed

Coverdale, John H; McCullough, Laurence B

2014-01-01

Many medical schools now offer students a distinctive clinical and learning opportunity, the student-run clinic (SRC), in which generalist physicians often play the major role. Although SRCs have become popular, they pose as-yet unexplored ethical challenges for the learning experiences of students. In SRCs students not only take on a significant administrative role especially in coordinating care, but also provide direct patient care for a clinically challenging, biopsychosocially vulnerable, medically indigent population of patients. SRCs provide an exemplar of the ethical challenges of care for such patients. The ethical framework proposed in this article emphasizes that these valued learning opportunities for students should occur in the context of professional formation, with explicit attention to developing the professional virtues, with faculty as role models for these virtues. The valued learning opportunities for students in SRCs should occur in the context of professional formation, with explicit attention to developing the professional virtues of integrity, compassion, self-effacement, self-sacrifice, and courage, which are required for the appropriate care of the vulnerable populations served by SRCs.

Ethical challenges in home mechanical ventilation: a secondary analysis.

PubMed

Dybwik, Knut; Nielsen, Erik Waage; Brinchmann, Berit Støre

2012-03-01

The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for patient and family wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family.

The ACHE Code of Ethics: Its Role for the Profession.

ERIC Educational Resources Information Center

Lawler, Patricia A.

2000-01-01

Revisits the Association for Continuing Higher Education's Code of Ethics adopted in 1997. Suggests future challenges to be considered in revision, including technology, distance learning, intellectual property, and accountability. (SK)

Cognitive Maps and the Structure of Observed Learning Outcome Assessment of Physiotherapy Students' Ethical Reasoning Knowledge

ERIC Educational Resources Information Center

Jones, Mark; van Kessel, Gisela; Swisher, Laura; Beckstead, Jason; Edwards, Ian

2014-01-01

Assessment of student learning in complex areas is challenging, particularly when there is interest in students' deeper understanding and connectivity of concepts. Assessment of ethics learning has been limited by lack of consensus regarding what is effective and an overfocus on quantification at the expense of clinical or ethical relevance.…

Standing Firm on Slippery Slopes: Understanding Ethical Boundaries in Student Affairs Work

ERIC Educational Resources Information Center

Liddell, Debora; Hornak, Anne M.; Ignelzi, Michael G.

2016-01-01

Understanding ethical boundaries in student affairs work can be challenging and difficult to navigate for student affairs professionals. The purpose of this article is to examine the complexities of dual relationships and the ethical issues that may arise. As a result, the authors offer tools to (a) identify various perspectives in resolving…

Ethics of Research into Learning and Teaching with Web 2.0: Reflections on Eight Case Studies

ERIC Educational Resources Information Center

Chang, Rosemary L.; Gray, Kathleen

2013-01-01

The unique features and educational affordances of Web 2.0 technologies pose new challenges for conducting learning and teaching research in ways that adequately address ethical issues of informed consent, beneficence, respect, justice, research merit and integrity. This paper reviews these conceptual bases of human research ethics and gives…

Challenging the Teaching of Global Ethical Unity: Religious Ethical Claims as Democratic Iterations within Sustainability Didactics

ERIC Educational Resources Information Center

Franck, Olof

2017-01-01

The aim of this article is to highlight the role of religiously motivated ethics within the field of sustainability didactics. The article starts with critical reflections on the idea that religion, by proposing claims for knowledge of absolute authorities such as "divine beings or supernatural dimensions", offers capacity for uniting…

Ethics and the Promotion of Inclusiveness within Qualitative Research: Case Examples from Asia and the Pacific

ERIC Educational Resources Information Center

Czymoniewicz-Klippel, Melina T.; Brijnath, Bianca; Crockett, Belinda

2010-01-01

Qualitative researchers are often confronted by ethical challenges when making research decisions because current guidelines and principles guiding research ethics do not wholly cover the concerns that can arise in complex social research situations. In this article, the authors explore this dilemma in relation to our experiences of conducting…

Downsizing genomic medicine: approaching the ethical complexity of whole-genome sequencing by starting small.

PubMed

Sharp, Richard R

2011-03-01

As we look to a time when whole-genome sequencing is integrated into patient care, it is possible to anticipate a number of ethical challenges that will need to be addressed. The most intractable of these concern informed consent and the responsible management of very large amounts of genetic information. Given the range of possible findings, it remains unclear to what extent it will be possible to obtain meaningful patient consent to genomic testing. Equally unclear is how clinicians will disseminate the enormous volume of genetic information produced by whole-genome sequencing. Toward developing practical strategies for managing these ethical challenges, we propose a research agenda that approaches multiplexed forms of clinical genetic testing as natural laboratories in which to develop best practices for managing the ethical complexities of genomic medicine.

Cell-based interventions for neurologic conditions: ethical challenges for early human trials.

PubMed

Mathews, D J H; Sugarman, J; Bok, H; Blass, D M; Coyle, J T; Duggan, P; Finkel, J; Greely, H T; Hillis, A; Hoke, A; Johnson, R; Johnston, M; Kahn, J; Kerr, D; Kurtzberg, J; Liao, S M; McDonald, J W; McKhann, G; Nelson, K B; Rao, M; Regenberg, A; Siegel, A W; Smith, K; Solter, D; Song, H; Vescovi, A; Young, W; Gearhart, J D; Faden, R

2008-07-22

Attempts to translate basic stem cell research into treatments for neurologic diseases and injury are well under way. With a clinical trial for one such treatment approved and in progress in the United States, and additional proposals under review, we must begin to address the ethical issues raised by such early forays into human clinical trials for cell-based interventions for neurologic conditions. An interdisciplinary working group composed of experts in neuroscience, cell biology, bioethics, law, and transplantation, along with leading disease researchers, was convened twice over 2 years to identify and deliberate on the scientific and ethical issues raised by the transition from preclinical to clinical research of cell-based interventions for neurologic conditions. While the relevant ethical issues are in many respects standard challenges of human subjects research, they are heightened in complexity by the novelty of the science, the focus on the CNS, and the political climate in which the science is proceeding. Distinctive challenges confronting US scientists, administrators, institutional review boards, stem cell research oversight committees, and others who will need to make decisions about work involving stem cells and their derivatives and evaluate the ethics of early human trials include evaluating the risks, safety, and benefits of these trials, determining and evaluating cell line provenance, and determining inclusion criteria, informed consent, and the ethics of conducting early human trials in the public spotlight. Further study and deliberation by stakeholders is required to move toward professional and institutional policies and practices governing this research.

Polio immunization in Pakistan: ethical issues and challenges.

PubMed

Basharat, Sarah; Shaikh, Babar Tasneem

2017-01-01

Immunization should be considered a basic human right to health and well-being. It is everybody's business, and it is everybody's responsibility: the individual, the community, the health system and the state. This paper attempts to review some of the literature that highlights the ethical and religious concerns surrounding polio vaccination and what approaches may be used to counter the problems faced in Pakistan. This paper is developed through a literature review on public health and polio in Pakistan, consulting local, regional and globally published peer reviewed articles focussing on religion, culture, ethics and public health. Human behaviour, including the utilization and acceptability of healthcare services, is greatly influenced by religious beliefs and dogmas. Immunization, specifically for the purpose of polio eradication, has been a topic under focus and in the news in Pakistan. The government is doing its best through a variety of interventions to increase access, inform the public and increase vaccination rates. Nevertheless, the country still faces a huge challenge from certain stern pockets of uncompromising populations who resist and refuse vaccination. Beliefs, practices and cultural norms overshadow public health priorities and ethics. Understanding of the context, therefore, is critical to determine the social hindrances in polio eradication and strategize thereon. Having programmatic, system-wide, socio-cultural and of course ethical dimensions, the policy makers and the programme managers in Pakistan must attempt to address the multitude of challenges to polio vaccination, whereby the plan of action developed within the ethical norms could potentially lead to an ultimate success.

Space Exploration: Challenges in Medicine, Research, and Ethics

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.

2007-01-01

This viewgraph presentation describes the challenges that space exploration faces in terms of medicine, research and ethics. The topics include: 1) Effects of Microgravity on Human Physiology; 2) Radiation; 3) Bone; 4) Behavior and Performance; 5) Muscle; 6) Cardiovascular; 7) Neurovestibular; 8) Food and Nutrition; 9) Immunology and Hematology; 10) Environment; 11) Exploration; 12) Building Block Approach; 13) Exploration Issues; 14) Life Sciences Contributions; 15) Health Care; and 17) Habitability.

Assessing dementia in resource-poor regions.

PubMed

Maestre, Gladys E

2012-10-01

The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resource-poor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen.

Ethics and maternity care: from principles to practice.

PubMed

Lothian, Judith A

2009-01-01

In this column, the associate editor of The Journal of Perinatal Education (JPE) discusses the decision to devote an issue of JPE to the ethics of childbirth and maternity care. The current crisis in maternity care mandates a careful look at the ethical principles that provide the foundation for practice. The contents of this special issue include: a broad overview of ethics of childbearing, historical perspectives and contemporary understanding of informed decision making, the ethical issues faced by childbirth educators, and the challenges and moral distress experienced by childbirth educators and other maternity care providers when their values, beliefs, and ethical standards are in conflict with standard maternity care practices.

An investigation of how university sports team athletic therapists and physical therapists experience ethical issues.

PubMed

Riendeau, Catherine; Parent-Houle, Valérie; Lebel-Gabriel, Marie Eve; Gauvin, Patrick; Liu, Le Yu; Pearson, Isabelle; Hunt, Matthew R

2015-03-01

Qualitative study using interpretive description methodology. The purpose of this study was to better understand how ethical issues are experienced by university sports team athletic therapists and physical therapists. In clinical practice, sports teams are associated with a range of ethical issues. Issues commonly reported in the literature include confidentiality, return-to-play decisions, conflicts of interest, advertising, doping, and use of local anesthetic. To date, there has been limited examination of how athletic therapists and physical therapists involved with sports teams experience these ethical issues, and limited exploration of how these ethical issues, when encountered, are shaped by therapists' professional roles and responsibilities. Semi-structured interviews were conducted with 11 athletic or physical therapists working with sports teams in 5 Canadian provinces. The data were analyzed inductively, using a recursive approach and constant comparative techniques. Four key themes were developed relating to the participants' experiences of ethical issues: establishing and maintaining professional boundaries, striving for respectful and effective collaboration, seeking answers to ethical concerns, and living with the repercussions of challenging decisions. While many ethical issues reported by participants resemble those faced by sports medicine physicians, they are experienced in distinctive ways, due to differences in professional roles and identities. Issues concerning professional boundaries were also more prominent for the study participants than the literature has reported them to be for sports medicine physicians. Effective communication and enhanced collaboration appear to be key elements in managing these ethical challenges.

Everyday ethics issues in the outpatient clinical practice of pediatric residents.

PubMed

Moon, Margaret; Taylor, Holly A; McDonald, Erin L; Hughes, Mark T; Carrese, Joseph A

2009-09-01

To describe the ethics issues that pediatric residents encounter during routine care in an outpatient teaching clinic. Qualitative study including in-depth interviews with pediatric residents and direct observation of interactions between preceptors and residents in a pediatric teaching clinic. The Johns Hopkins Harriet Lane Pediatric Primary Care Clinic, March 20 through April 11, 2006. A convenience sample including all pediatric faculty preceptors supervising at the clinic during the 19 half-day sessions that occurred during the observation period (N = 15) and the pediatric residents seeing patients during these clinic sessions (N = 50). Main Outcome Measure Field notes of preceptor-resident discussions about patient care were made and transcribed for qualitative analysis. Qualitative analysis of the ethics content of cases presented by residents in this pediatric teaching clinic identified 5 themes for categorizing ethics challenges: (1) promoting the child's best interests in complex and resource-poor home and social settings; (2) managing the therapeutic alliance with parents and caregivers; (3) protecting patient privacy and confidentiality; (4) balancing the dual roles of learner and health care provider; and (5) using professional authority appropriately. Qualitative analysis of the ethics content of directly observed preceptor-resident case discussions yielded a set of themes describing the ethics challenges facing pediatric residents. The themes are somewhat different from the lists of residents' ethics experiences developed using recall or survey methods and may be very different from the ideas usually included in hospital-based ethics discussions. This may have implications for improving ethics education during residency training.

How organizational context affects bioethical decision-making: pharmacists' management of gatekeeping processes in retail and hospital settings.

PubMed

Chiarello, Elizabeth

2013-12-01

Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals - pharmacists - working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. Copyright © 2012 Elsevier Ltd. All rights reserved.

From global bioethics to ethical governance of biomedical research collaborations.

PubMed

Wahlberg, Ayo; Rehmann-Sutter, Christoph; Sleeboom-Faulkner, Margaret; Lu, Guangxiu; Döring, Ole; Cong, Yali; Laska-Formejster, Alicja; He, Jing; Chen, Haidan; Gottweis, Herbert; Rose, Nikolas

2013-12-01

One of the features of advanced life sciences research in recent years has been its internationalisation, with countries such as China and South Korea considered 'emerging biotech' locations. As a result, cross-continental collaborations are becoming common generating moves towards ethical and legal standardisation under the rubric of 'global bioethics'. Such a 'global', 'Western' or 'universal' bioethics has in turn been critiqued as an imposition upon resource-poor, non-Western or local medical settings. In this article, we propose that a different tack is necessary if we are to come to grips with the ethical challenges that inter-continental biomedical research collaborations generate. In particular we ask how national systems of ethical governance of life science research might cope with increasingly global research collaborations with a focus on Sino-European collaboration. We propose four 'spheres' - deliberation, regulation, oversight and interaction - as a helpful way to conceptualise national systems of ethical governance. Using a workshop-based mapping methodology (workshops held in Beijing, Shanghai, Changsha, Xian, Shenzen and London) we identified three specific ethical challenges arising from cross-continental research collaborations: (1) ambiguity as to which regulations are applicable; (2) lack of ethical review capacity not only among ethical review board members but also collaborating scientists; (3) already complex, researcher-research subject interaction is further complicated when many nationalities are involved. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments.

PubMed

Sansom-Daly, Ursula M; Wakefield, Claire E; McGill, Brittany C; Wilson, Helen L; Patterson, Pandora

2016-05-18

Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations' published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. In the study, 19 guidelines were included, yielding 11 specific "firm" and a further 123 "tentative-level" recommendations regarding the appropriateness of e-mental health, competence, legal and regulatory issues, confidentiality, consent, professional boundaries, and crisis management. International consensus yielded firm guidance across almost all areas except professional boundaries and some aspects of determining the appropriateness of e-mental health. Few guidelines specifically addressed special populations. Overall guideline quality varied; however, 42% (8/19) of the guidelines scored at least 5 out of 7. This synthesis of guidelines provides a foundation for clinicians and researchers utilizing e-mental health worldwide. The lack of specific guidance relating to special populations is an area warranting further attention in order to strengthen mental health professionals' and researchers' capacity to ethically and effectively tailor e-mental health interventions to these groups.

Institutional Ethical Review and Ethnographic Research Involving Injection Drug Users: A Case Study

PubMed Central

Small, Will; Maher, Lisa; Kerr, Thomas

2014-01-01

Ethnographic research among people who inject drugs (PWID) involves complex ethical issues. While ethical review frameworks have been critiqued by social scientists, there is a lack of social science research examining institutional ethical review processes, particularly in relation to ethnographic work. This case study describes the institutional ethical review of an ethnographic research project using observational fieldwork and in-depth interviews to examine injection drug use. The review process and the salient concerns of the review committee are recounted, and the investigators’ responses to the committee’s concerns and requests are described to illustrate how key issues were resolved. The review committee expressed concerns regarding researcher safety when conducting fieldwork and the investigators were asked to liaise with the police regarding the proposed research. An ongoing dialogue with the institutional review committee regarding researcher safety and autonomy from police involvement, as well as formal consultation with a local drug user group and solicitation of opinions from external experts, helped to resolve these issues. This case study suggests that ethical review processes can be particularly challenging for ethnographic projects focused on illegal behaviours, and that while some challenges could be mediated by modifying existing ethical review procedures, there is a need for legislation that provides legal protection of research data and participant confidentiality. PMID:24581074

Making a commitment to ethics in global health research partnerships: a practical tool to support ethical practice.

PubMed

Murphy, Jill; Hatfield, Jennifer; Afsana, Kaosar; Neufeld, Vic

2015-03-01

Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research (CCGHR) conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit (PAT) is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity.

Treating the Purple Menace: Ethical Considerations of Conversion Therapy and Affirmative Alternatives.

ERIC Educational Resources Information Center

Tozer, Erinn E.; McClanahan, Mary K.

1999-01-01

Outlines the ethical considerations for sexual orientation conversion therapy for lesbian, gay, and bisexual individuals. There are numerous reasons not to acquiesce to a client's desire to change his or her sexual orientation. Presents guidelines for responding to a client seeking reorientation and evaluating one's biases regarding lesbian, gay,…

Bakhtin and the Teaching of Literature

ERIC Educational Resources Information Center

Morson, Gary Saul

2007-01-01

In this article, the author talks about Bakhtin's ethical concerns on the teaching of novels. In his writings on ethics, Bakhtin outlined numerous ways in which thinkers can avoid engaging with the world. They can live "representatively" by allowing the ideology or religion to which they subscribe make their moral decisions for them. Intellectual…

The Ethics of Observing: Confronting the Harm of Experiential Learning

ERIC Educational Resources Information Center

Meisel, Joshua S.

2008-01-01

In this article I explore the ethical terrain of experiential learning activities drawing on my experiences leading college students on field trips into criminal justice settings. Though there are numerous educational benefits to adopting experiential learning activities, the rewards must be evaluated in light of the potential harms to nonstudent…

An in-depth analysis of ethics teaching in Canadian physiotherapy and occupational therapy programs.

PubMed

Laliberté, Maude; Hudon, Anne; Mazer, Barbara; Hunt, Matthew R; Ehrmann Feldman, Debbie; Williams-Jones, Bryn

2015-01-01

The purpose of this study was to examine current approaches and challenges to teaching ethics in entry-level Canadian physiotherapy (PT) and occupational therapy (OT) programs. Educators responsible for teaching ethics in the 28 Canadian PT and OT programs (n = 55) completed an online survey. The quantity of ethics teaching is highly variable, ranging from 5 to 65 h. Diverse obstacles to ethics teaching were reported, relating to the organization and structure of academic programs, student issues and the topic of ethics itself. Specific challenges included time constraints, large class sizes, a lack of pedagogical tools adapted to teaching this complex subject, a perceived lack of student interest for the subject and a preference for topics related to clinical skills. Of note, 65% of ethics educators who participated in the survey did not have any specialized training in ethics. Significant cross-program variation in the number of hours dedicated to ethics and the diversity of pedagogical methods used suggests that there is little consensus about how best to teach ethics. Further research on ethics pedagogy in PT and OT programs (i.e. teaching and evaluation approaches and effectiveness of current ethics teaching) would support the implementation of more evidence-based ethics education. Implications for Rehabilitation Ethics educators in Canadian PT and OT programs are experimenting with diverse educational approaches to teach ethical reasoning and decision-making to students, including lectures, problem-based learning, directed readings, videos, conceptual maps and clinical elective debriefing, but no particular method has been shown to be more effective for developing ethical decision-making/reasoning. Thus, research on the effectiveness of current methods is needed to support ethics educators and programs to implement evidence-based ethics education training. In our survey, 65% of ethics educators did not have any specialized training in ethics. Ensuring that educators are well equipped to support the development of necessary theoretical and applied competencies can be promoted by initiatives including the creation of tailored ethics teaching and evaluation tools, and by establishing communities of practice among ethics educators. This survey identified heterogeneity in ethics teaching content, format and duration, and location within the curriculum. In order to be able to assess more precisely the place accorded to ethics teaching in PT and OT programs, careful mapping of ethics content inside and across rehabilitation programs is needed - both in Canada and internationally. These initiatives would help advance understanding of ethics teaching practices in rehabilitation.

An implementation framework for the feedback of individual research results and incidental findings in research.

PubMed

Thorogood, Adrian; Joly, Yann; Knoppers, Bartha Maria; Nilsson, Tommy; Metrakos, Peter; Lazaris, Anthoula; Salman, Ayat

2014-12-23

This article outlines procedures for the feedback of individual research data to participants. This feedback framework was developed in the context of a personalized medicine research project in Canada. Researchers in this domain have an ethical obligation to return individual research results and/or material incidental findings that are clinically significant, valid and actionable to participants. Communication of individual research data must proceed in an ethical and efficient manner. Feedback involves three procedural steps: assessing the health relevance of a finding, re-identifying the affected participant, and communicating the finding. Re-identification requires researchers to break the code in place to protect participant identities. Coding systems replace personal identifiers with a numerical code. Double coding systems provide added privacy protection by separating research data from personal identifying data with a third "linkage" database. A trusted and independent intermediary, the "keyholder", controls access to this linkage database. Procedural guidelines for the return of individual research results and incidental findings are lacking. This article outlines a procedural framework for the three steps of feedback: assessment, re-identification, and communication. This framework clarifies the roles of the researcher, Research Ethics Board, and keyholder in the process. The framework also addresses challenges posed by coding systems. Breaking the code involves privacy risks and should only be carried out in clearly defined circumstances. Where a double coding system is used, the keyholder plays an important role in balancing the benefits of individual feedback with the privacy risks of re-identification. Feedback policies should explicitly outline procedures for the assessment of findings, and the re-identification and contact of participants. The responsibilities of researchers, the Research Ethics Board, and the keyholder must be clearly defined. We provide general guidelines for keyholders involved in feedback. We also recommend that Research Ethics Boards should not be directly involved in the assessment of individual findings. Hospitals should instead establish formal, interdisciplinary clinical advisory committees to help researchers determine whether or not an uncertain finding should be returned.

FY1 doctors' ethicolegal challenges in their first year of clinical practice: an interview study.

PubMed

Vivekananda-Schmidt, Pirashanthie; Vernon, Bryan

2014-04-01

There is little evidence of junior trainee perspectives in the design and implementation of medical ethics and law (MEL) curriculum in UK medical schools. To determine the ethical issues the foundation year 1 (FY1) doctors (first year after graduation)  encountered during clinical practice and the skills and knowledge of MEL, which were useful in informing MEL curriculum development. The National Research Ethics Service gave ethical approval. Eighteen one-to-one interviews were conducted in each school with FY1 doctors. Interviews were recorded and transcribed verbatim; a thematic analysis was undertaken with the transcriptions and saturation of themes was achieved. Themes closely overlapped between the two study sites. (1) Knowing my place as an FY1 (this theme consisted of four subthemes: challenging the hierarchy, being honest when the team is titrating the truth, taking consent for unfamiliar procedures and personal safety vs competing considerations); (2) Do not attempt resuscitation)/end-of-life pathway and its implications; (3) 'You have to be there' (contextualising ethics and law teaching through cases or role plays to allow students to explore future work situations); and (4) advanced interpersonal skills competency for ethical clinical practice. The data provide a snapshot of the real challenges faced by MEL FY1 doctors in early clinical practice: they may feel ill-prepared and sometimes unsupported by senior members of the team. The key themes suggest areas for development of undergraduate and postgraduate MEL curricula. We will work to develop our own curriculum accordingly. We intend to further investigate the applicability of our findings to UK medical ethics and law curriculum.

Ethics reflection groups in community health services: an evaluation study.

PubMed

Lillemoen, Lillian; Pedersen, Reidar

2015-04-17

Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health (including nursing homes and residency), - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project. A mixed-methods design with qualitative focus group interviews, observations and written reports were used to evaluate. The study was conducted at two nursing homes, two home care districts and a residence for people with learning disabilities. Participants were employees, facilitators and service managers. The study was guided by ethical standard principles and was approved by the Norwegian Social Science Data Services. We found support for ethics reflection as a valuable measure to strengthen clinical practice. New and improved solutions, more cooperation between employees, and improved collaboration with patients and their families are some of the results. No negative experiences were found. Instead, the ethics reflection based on experiences and challenges in the workplace, was described as a win-win situation. The evaluation also revealed what is needed to succeed and useful tips for further development of ethics support in community health services. Ethics reflection groups focusing on ethical challenges from the participants' daily work were found to be significant for improved practice, collegial support and cooperation, personal and professional development among staff, facilitators and managers. Resources needed to succeed were managerial support, and anchoring ethics sessions in the routine of daily work.

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

PubMed

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

2018-04-27

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

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?

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

Dharma and medical ethics.

PubMed

Seetharam, Sridevi

2013-01-01

Despite the numerous policies, regulations and laws aimed at promoting and ensuring ethical practice in healthcare, ethical misconduct remains rampant. Perhaps something more is needed to encourage a genuine and sustained moral attitude and behaviour. To a casual reader, the regulations on ethics read merely as a list of do's and don'ts and their philosophical foundation is not clear. In actuality, morality is often grounded in philosophy. Traditionally, religious and theistic philosophies drove moral behaviour. However, this is changing due to the current trend of secularism. Hindu philosophies are among the oldest philosophies that are still thriving, and this article explores these philosophies and compares and contrasts them with some of the contemporary ethical theories to assess if they can add value to the field of medical ethics. The main theme of the article is dharma or righteous conduct, the concepts related to it and how these can have a bearing on the development of an ethical attitude and the practice of medical ethics.

Cultural competence in the era of evidence-based practice.

PubMed

Engebretson, Joan; Mahoney, Jane; Carlson, Elizabeth D

2008-01-01

Cultural competence has become an important concern for contemporary health care delivery, with ethical and legal implications. Numerous educational approaches have been developed to orient clinicians, and standards and position statements promoting cultural competence have been published by both the American Medical Association and the American Nurses Association. Although a number of health care regulatory agencies have developed standards or recommendations, clinical application to patient care has been challenging. These challenges include the abstract nature of the concept, essentializing culture to race or ethnicity, and the attempts to associate culture with health disparities. To make cultural competence relevant to clinical practice, we linked a cultural competency continuum that identifies the levels of cultural competency (cultural destructiveness, cultural incapacity, cultural blindness, cultural precompetence, and cultural proficiency) to well-established values in health care. This situates cultural competence and proficiency in alignment with patient-centered care. A model integrating the cultural competency continuum with the components of evidence-based care (i.e., best research practice, clinical expertise, and patient's values and circumstances) is presented.

[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.

Self-with-Other in Teacher Practice: A Case Study through Care, Aristotelian Virtue, and Buddhist Ethics

ERIC Educational Resources Information Center

Chang, Dave; Bai, Heesoon

2016-01-01

Many teacher candidates get their first taste of life as a full-time teacher in their practicums, during which they confront a host of challenges, pedagogical and ethical. Because ethics is fundamental to the connection between teachers and students, teacher candidates are often required to negotiate dilemmas in ways that keep with the ethical…

Mr. Smith Goes to Washington: A Resource for Examining Ethical Leadership in Decision-Making.

ERIC Educational Resources Information Center

Pruitt, Randall P.

One of the challenges of a communication instructor is how to initiate the discussion of ethics in the university classroom. The classic film, "Mr. Smith Goes to Washington," has proved a useful tool for initiating discussion of ethical decision-making in leadership. This film presents a young and idealistic leader of boy ranger clubs…

Ethical and policy issues in the clinical translation of stem cells: report of a focus session at the ISSCR Tenth Annual Meeting.

PubMed

Kato, Kazuto; Kimmelman, Jonathan; Robert, Jason; Sipp, Douglas; Sugarman, Jeremy

2012-12-07

Alongside the scientific barriers to the clinical translation of stem cell research are ethical and regulatory hurdles. Some of these challenges described by the Ethics and Public Policy Committee at the ISSCR Tenth Annual Meeting are presented here. Copyright © 2012 Elsevier Inc. All rights reserved.

The anthropological approach challenges the conventional approach to bioethical dilemmas: a Kenyan Maasai perspective.

PubMed

Sharif, Thikra; Bugo, John

2015-06-01

The cultural background, religion and societal norms have a huge influence on the decision making process for physicians, patients and their families, when faced with medical ethical dilemmas. While the medical professionals, through their training, can rely on the principles of autonomy, justice, beneficence and non-maleficence to guide them, the patients can only draw from their personal and cultural experiences. To explore some of the challenges that face physicians when presented with ethical dilemmas. A review of the literature on the principles of medical ethics and the cultural practices of the Maasai tribe, as well as, interview, interaction and observation of the patients and family during patient. management. In the Maasai community in Kenya, where family is the center of all attention and decision-making, the listed ethical principles and rules have a very different understanding of the self-determination, and autonomy becomes collective rather than individualistic. Medical practitioners when faced with ethical medical dilemmas are neither comfortable in adopting the conventional bioethical guidelines, nor in offering a health care purely based on cultural and historical practice. In our set up, developing culturally relevant principles of bioethics appears to be the most effective solution in addressing medical ethical dilemmas.

The lamaze certified childbirth educator: standards of practice.

PubMed

Lothian, Judith A

2007-01-01

A student in a Lamaze Childbirth Educator Program expresses concern that some Lamaze Certified Childbirth Educators (LCCE educators) do not teach classes that reflect Lamaze standards. In this column, the ethical and professional standards of the LCCE educator and the challenges the childbirth educator experiences while practicing in the current maternity-care environment are presented and discussed. Lamaze International's Code of Ethics for Lamaze Certified Childbirth Educators provides guidance when dealing with these challenges.

Lost in Translation: The Challenge of Exporting Models of Civil Military Relations

DTIC Science & Technology

2012-03-01

society.”27 As Williams has noted, traditional mili- tary culture is confronted by a number of challenges such as cultural relativism and the...imposition of nonmilitary, social, ethical , and political criteria of evaluation on the mili- tary.28 It is these postmodern militaries, and the...members see themselves and what constitutes good governance, ethical behaviour and funda- mental courage.”45 In a study of leadership mythol- ogy in

Anticipating the Ethical Challenges of Psychiatric Genetic Testing.

PubMed

Appelbaum, Paul S; Benston, Shawna

2017-07-01

Genetic testing for mental illness is likely to become increasingly prevalent as the science behind it is refined. This article identifies anticipated ethical challenges for patients, psychiatrists, and genetic counselors and makes recommendations for addressing them. Many of the ethical challenges of psychiatric genetic testing are likely to stem from failures to comprehend the nature and implications of test results. Recent studies have identified gaps in the knowledge base of psychiatrists and genetic counselors, which limit their abilities to provide patients with appropriate education. A small number of studies have demonstrated the value of counseling in empowering patients to deal with relevant genetic information. Psychiatrists and other health professionals must be able to assist patients and families in making informed decisions about genetic testing and interpreting test results. Filling their knowledge gaps on these issues will be a critical step towards meeting these responsibilities.

The Accountability-Well-Being-Ethics framework: a new philosophical foundation for occupational therapy.

PubMed

Taff, Steven D; Bakhshi, Parul; Babulal, Ganesh M

2014-12-01

The context that supported occupational therapy's inception has been replaced with new challenges brought on by globalization and dramatic changes in health care. Thus, the profession's philosophical grounding needs to be reframed to (a) achieve balance between science-driven and holistic elements, (b) operate within larger contexts on problems brought on by sociopolitical and natural determinants of health, and (c) maintain an ethical identity across all arenas of practice. This paper presents a brief discussion of the philosophical underpinnings in occupational therapy's history, outlines new global challenges for the profession, and proposes a new framework to address these challenges through education, practice, and research. Occupational therapy finds itself practising in a growing number of middle- and low-income countries where its roles and values need to be context and culture specific. The Accountability-Well-Being-Ethics framework guides the three domains of education, research, and practice to be relevant in an increasingly complex world.

Ethical genetic research in Indigenous communities: challenges and successful approaches.

PubMed

McWhirter, Rebekah E; Mununggirritj, Djapirri; Marika, Dipililnga; Dickinson, Joanne L; Condon, John R

2012-12-01

Indigenous populations, in common with all populations, stand to benefit from the potential of genetic research to lead to improvements in diagnostic and therapeutic tools for a wide range of complex diseases. However, many Indigenous communities, especially ones that are isolated, are not included in genetic research efforts. This situation is largely a consequence of the challenges of ethically conducting genetic research in Indigenous communities and compounded by Indigenous peoples' negative past experiences with genetic issues. To examine ways of addressing these challenges, we review one investigation of a cancer cluster in remote Aboriginal communities in Arnhem Land, Australia. Our experiences demonstrate that genetic research can be both ethically and successfully conducted with Indigenous communities by respecting the authority of the community, involving community members, and including regular community review throughout the research process. Copyright © 2012 Elsevier Ltd. All rights reserved.

Advancing Ethical Neuroscience Research.

PubMed

Borah, B Rashmi; Strand, Nicolle K; Chillag, Kata L

2016-12-01

As neuroscience research advances, researchers, clinicians, and other stakeholders will face a host of ethical challenges. The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has published two reports that provide recommendations on how to advance research endeavors ethically. The commission addressed, among other issues, how to prioritize different types of neuroscience research and how to include research participants who have impaired consent capacity. The Bioethics Commission's recommendations provide a foundation for ethical guidelines as neuroscience research advances and progresses. © 2016 American Medical Association. All Rights Reserved.

Teaching ethics in a Masters Program in Public Health in Lithuania

PubMed Central

Jakusovaite, Irayda; Bankauskaite, Vaida

2007-01-01

This article aims to present 10 years of experience of teaching ethics in a Masters Program in Public Health in Lithuania, and to discuss the content, skills, teaching approach and tools of this programme. In addition, the article analyses the links between ethics and law, identifies the challenges of the teaching process and suggests future teaching strategies. The important role of teaching ethics in countries that are in transition owing to a radically changing value system is emphasised. PMID:17601872

Ethical review of research on human subjects at Unilever: reflections on governance.

PubMed

Sheehan, Mark; Marti, Vernon; Roberts, Tony

2014-07-01

This article considers the process of ethical review of research on human subjects at a very large multinational consumer products company. The commercial context of this research throws up unique challenges and opportunities that make the ethics of the process of oversight distinct from mainstream medical research. Reflection on the justification of governance processes sheds important, contrasting light on the ethics of governance of other forms and context of research. © 2013 John Wiley & Sons Ltd.

Ethics in psychosocial interventions

PubMed Central

Kurpad, Sunita Simon

2018-01-01

It is important for health professionals to have an ethical framework to help take decisions regarding psychosocial interventions in patients with addictive disorders. As patients with addictive disorders are vulnerable to unethical actions in the name of treatment, therapists need to aware of their role in delivering ethical care - not just in their own clinical practice but in the setting in which they deliver the interventions. This article aims to sensitize the health professional to the various arenas in which ethical challenges may arise. PMID:29540933

Cultural diversity and the case against ethical relativism.

PubMed

Brannigan, M

2000-01-01

The movement to respect cultural diversity, known as multiculturalism, poses a daunting challenge to healthcare ethics. Can we construct a defensible passage from the fact of cultural differences to any claims regarding morality? Or does multiculturalism lead to ethical relativism? Macklin argues that, in view of a leading distinction between universalism in ethics and moral absolutism, the only reasonable passage avoids both absolutism and relativism. She presents a strong case against ethical relativism and its pernicious consequences for cross-cultural issues in healthcare. She also provides sound criteria for the assessment of a culture's moral progress.

[Henri Atlan's levels of ethics and the challenge of the "fourth level"].

PubMed

Aleksandrowicz, Ana Maria Coutinho

2008-01-01

This article presents the ideas on ethics by the contemporary French biophysicist and Spinozist philosopher Henri Atlan, based on his singular epistemological position, in constant transit between naturalistic philosophy (in alliance with cognitive sciences) and his refusal to a natural foundations of ethics. It underlines Atlan's defense of casuistry towards bioethics dilemmas and associates it to his proposal of different levels of ethics. The text introduces a reflection concerning Atlan's ideas about the possible passage between the third and the fourth levels of ethics, stressing its positive impact in individuals and social groups' life quality.

A consideration of the ethics of brain death--what are the ethical guidelines for physician, family and society in dealing with brain death?

PubMed

Brooks, C M

1985-06-01

There is at present considerable confusion with respect to ethical guidelines that should govern the behavior of society and the physician confronted by problems resulting from recent attainments of medicine and science. The use of life supporting devices raises the problem of determining when death has occurred and what is proper ethical procedure in dealing with the deficient half life caused by "Brain Death." Some guidance is obtained from a consideration of the nature of life, the nature of death, the nature of man, and the essence lost in death of man. A parallel consideration of the nature of ethics, the bases of ethics and of ethical decision can be helpful. An individual may have ideals which control behavior, even elevate ethical standards; others entertain concepts that destroy social ethics. Ethics control and direct social interactions; ethics determine the quality of social behavior--ethics are established by societies not by individuals. Numerous commissions have endeavored to define the requirements of physicians for diagnosing brain death and for appropriate subsequent actions. The rationales presented, however, are not invariably accepted by lay society. The problem is created by numerous trends. Among them are the "rightest" movement which, though possessing many virtues, has its excesses such as expressed in the "right to life movement." These have not been beneficial and have necessitated "right to death movements." Opposition is also due to the fact that society's concepts of the medical profession have changed. The practice of organ transplantation has created problems. Finally, the concept of death as other than evil is no longer generally accepted. As more biological manipulations are possible ever more difficult ethical problems will arise. It is a certainty, however, that when brain death has occurred life of man and that of the individual has ended. Although others might not agree, our ethic requires us to use life assist techniques to preserve the vegetative man, the individual who can still breathe spontaneously though lacking consciousness and behavioral ability. All the codes of medical ethics state that a physician shall not kill--this does not mean he cannot permit the terminal phases of death when the essence of human life is lost. A major question is the ethical responsibility of one society toward another. Can an affluent society squander its resources in the preservation of ineffectual life in the body after "brain death" when others are without the medical assistance which would permit total living?

75 FR 52533 - Public Meeting of the Presidential Commission for the Study of Bioethical Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... biology, including its potential benefits and risks, and appropriate ethical boundaries and principles... synthetic biology, the challenges and risks, and the ethical boundaries that may be important to formulation...

75 FR 66378 - Public Meeting of the Presidential Commission for the Study of Bioethical Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

... of synthetic biology, including its potential benefits and risks, and appropriate ethical boundaries... science of synthetic biology, the challenges and risks, and the ethical boundaries that may be important...

Anticipated Ethics and Regulatory Challenges in PCORnet: The National Patient-Centered Clinical Research Network.

PubMed

Ali, Joseph; Califf, Robert; Sugarman, Jeremy

2016-01-01

PCORnet, the National Patient-Centered Clinical Research Network, seeks to establish a robust national health data network for patient-centered comparative effectiveness research. This article reports the results of a PCORnet survey designed to identify the ethics and regulatory challenges anticipated in network implementation. A 12-item online survey was developed by leadership of the PCORnet Ethics and Regulatory Task Force; responses were collected from the 29 PCORnet networks. The most pressing ethics issues identified related to informed consent, patient engagement, privacy and confidentiality, and data sharing. High priority regulatory issues included IRB coordination, privacy and confidentiality, informed consent, and data sharing. Over 150 IRBs and five different approaches to managing multisite IRB review were identified within PCORnet. Further empirical and scholarly work, as well as practical and policy guidance, is essential if important initiatives that rely on comparative effectiveness research are to move forward.

Ethical challenges and opportunities for nurses in HIV and AIDS community-based participatory research in Jamaica.

PubMed

Davison, Colleen M; Kahwa, Eulalia; Atkinson, Uki; Hepburn-Brown, Cerese; Aiken, Joyette; Dawkins, Pauline; Rae, Tania; Edwards, Nancy; Roelofs, Susan; MacFarlane, Denise

2013-02-01

As part of a multinational program of research, we undertook a community-based participatory research project in Jamaica to strengthen nurses' engagement in HIV and AIDS policy. Three leadership hubs were purposefully convened and included small groups of people (6-10) from diverse HIV and AIDS stakeholder groups in Jamaica: frontline nurses and nurse managers in primary and secondary care settings; researchers; health care decision makers; and other community members. People living with HIV or AIDS were among the hub members. Using a relational public health ethics framework, we outline some of the ethical challenges and opportunities experienced by the research team and the leadership hubs. Data included research assistant field notes and hub progress reports. Emerging ethical concerns were associated with relational personhood, social justice, relational autonomy, relational solidarity, and sustainability of the hub activities.

Ethical challenges in Emergency Medical Services: controversies and recommendations.

PubMed

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

2013-10-01

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

e-Health promises and challenges: some ethical considerations.

PubMed

Kluge, Eike-Henner W

2011-01-01

eHealth is a cost-effective and efficient way of providing health care to patients who would otherwise be excluded or underserviced. However, eHealth also presents a series of ethical and legal challenges which, if not met before its implementation, can undermine its success. Among other things, privacy, consent and liability are implicated, as are changes in the health care professional-patient relationship and in the role of health informatics professionals. Legacy systems and interoperability present further challenges, and outsourcing may pose special problems. This paper highlights some of these issues and outlines their implications.

Ethics: an essential dimension of soliciting philanthropic gifts from donors.

PubMed

Chervenak, Frank A; McCullough, Laurence B; Fraley, Milinda; Golding, Joe

2010-12-01

Obstetrics and gynecology continues to experience fiscal pressures that challenge its core missions. In such an increasingly economically unforgiving environment, philanthropy will become a major source of revenue. This article provides ethical guidance for seeking philanthropic gifts by translating ethical theory into practice. The basis for this guidance is an account of the ethics of philanthropy that identifies both its consequentialist and deontologic components and shows their relevance to the ethical significance of donors' motivations and directiveness. The prevention of abuse of vulnerable donors and of distortions of the physician-patient relationship is emphasized. Ethics is an essential component of the responsible solicitation of philanthropic support from donors. Copyright © 2010 Mosby, Inc. All rights reserved.

International service learning programs: ethical issues and recommendations.

PubMed

Reisch, Rebecca A

2011-08-01

Inequities in global health are increasingly of interest to health care providers in developed countries. In response, many academic healthcare programs have begun to offer international service learning programs. Participants in these programs are motivated by ethical principles, but this type of work presents significant ethical challenges, and no formalized ethical guidelines for these activities exist. In this paper the ethical issues presented by international service learning programs are described and recommendations are made for how academic healthcare programs can carry out international service learning programs in a way that minimizes ethical conflicts and maximizes benefits for all stakeholders. Issues related to project sustainability and community involvement are emphasized. © 2011 Blackwell Publishing Ltd.

Procurement Ethics: Have We Resolved the Army’s Expeditionary Contracting Problems?

DTIC Science & Technology

2011-03-11

Distribution A: Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT The United States Army discovered numerous occurrences of unethical behavior by...The United States Army discovered numerous occurrences of unethical behavior by contracting officials and contractors while providing contracting...ARMY’S EXPEDITIONARY CONTRACTING PROBLEMS? The United States Army discovered numerous occurrences of unethical behavior by contracting officials

Direct-to-Consumer Genetic Testing: Finding a Clear Path Forward.

PubMed

Seward, Brendan

2017-01-01

Regulatory compliance in the direct-to-consumer genetic testing market is highly sophisticated as there are numerous federal, state, and ethical barriers to entry. In 2010, amid an underregulated market, 23andMe sought to do what few companies in the medical industry had attempted before-disregard the guidance and requests of the US Food and Drug Administration. This regulatory strategy effectively destined the company's Personal Genome Service for failure; however, the company changed course and has been granted several regulatory clearances. This exemplifies the importance of a healthy relationship with regulatory agencies, although challenges remain. The DTC industry continues to have a perplexing regulatory framework at both the federal and state level. There are also ethical concerns with the monetization of deidentified genetic health information, as genetic data have an inherent level of identifiability and are not fully protected by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in these scenarios. Although some DTC tests are now cleared in the United States, the concern that a learned intermediary is needed for interpretation of results remains. The regulatory oversight of this market will need to continue to develop to ensure the protection of consumer health and privacy.

Ethical considerations in HIV prevention and vaccine research in resource-limited settings.

PubMed

Garner, Samual A; Anude, Chuka J; Adams, Elizabeth; Dawson, Liza

2014-09-01

HIV prevention research has been facing increasing ethical and operational challenges. Factors influencing the design and conduct of HIV prevention trials include a rapidly changing evidence base, new biomedical prevention methods and modalities being tested, a large diversity of countries, sites and populations affected by HIV and participating in trials, and challenges of developing and making available products that will be feasible and affordable for at-risk populations. To discuss these challenges, a meeting, Ethical considerations around novel combination prevention modalities in HIV prevention and vaccine trials in resource-limited settings, was convened by NIH/NIAID/Division of AIDS on April 22-23, 2013. Several themes emerged from the meeting: (1) because of both trial design and ethical complexities, choosing prevention packages and designing combination prevention research trials will need to be evaluated on a case by case basis in different clinical trials, countries, and health systems; (2) multilevel stakeholder engagement from the beginning is vital to a fair and transparent process and also to designing ethical and relevant trials; (3) research should generally be responsive to a host country's needs, and sponsors and stakeholders should work together to address potential barriers to future access; and finally, (4) another meeting including a broader group of stakeholders is needed to address many of the outstanding ethical issues raised by this meeting. We offer an overview of the meeting and the key discussion points and recommendations to help guide the design and conduct of future HIV prevention and vaccine research in resource-limited settings.

Formulating the American Geophysical Union's Scientific Integrity and Professional Ethics Policy: Challenges and lessons learned: Chapter 8

USGS Publications Warehouse

Gundersen, Linda C.; Townsend, Randy

2017-01-01

Creating an ethics policy for a large, diverse geosciences organization is a challenge, especially in the midst of the current contentious dialogue in the media related to such issues as climate change, sustaining natural resources, and responding to natural hazards. In 2011, the American Geophysical Union (AGU) took on this challenge, creating an Ethics Task Force to update their ethics policies to better support their new Strategic Plan and respond to the changing scientific research environment. Dialogue with AGU members and others during the course of creating the new policy unveiled some of the following issues to be addressed. Scientific results and individual scientists are coming under intense political and public scrutiny, with the efficacy of the science being questioned. In some cases, scientists are asked to take sides and/or provide opinions on issues beyond their research, impacting their objectivity. Pressure related to competition for funding and the need to publish high quality and quantities of papers has led to recent high profile plagiarism, data fabrication, and conflict of interest cases. The complexities of a continuously advancing digital environment for conducting, reviewing, and publishing science has raised concerns over the ease of plagiarism, fabrication, falsification, inappropriate peer review, and the need for better accessibility of data and methods. Finally, students and scientists need consistent education and encouragement on the importance of ethics and integrity in scientific research. The new AGU Scientific Integrity and Ethics Policy tries to address these issues and provides an inspirational code of conduct to encourage a responsible, positive, open, and honest scientific research environment.

Is Formal Environmental Education Friendly to Nature? Environmental Ethics in Science Textbooks for Primary School Pupils in Poland

ERIC Educational Resources Information Center

Gola, Beata

2017-01-01

Due to the increased interest in ecology, global warming and numerous environmental problems, ecological issues are becoming extremely important in education. Many researchers and thinkers believe that solutions to environmental problems are affected by the environmental ethics adopted. This article identifies which of the three branches of…

NASA and Ethics: Training and Practice

DOT National Transportation Integrated Search

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, assessme...

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes.

PubMed

Clarinval, Caroline; Biller-Andorno, Nikola

2014-06-23

This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context.

Mediating patienthood-from an ethics of to an ethics with technology.

PubMed

Kiran, Asle H

2017-01-01

The changes that happen to healthcare services after the implementation of new assistive healthcare technologies (also called 'welfare technology' in the Nordic countries) concern more than increased efficiency and reducing healthcare expenditure. Of particular interest from an ethical point of view are the manners in which technologies shape the roles and identities of care receivers and healthcare personnel. The notion of 'patienthood' is explored in this paper as something that is both challenged by new technologies, and as something that is opened up for active and potentially positive reshaping when care receivers support their illness or frailty with assistive healthcare technologies. This dual effect of technologies (as both challenge and opportunity) requires a rethinking of ethics of technologies, which for most part have been preoccupied with ethical issues prior to the implementation of a new technology into a healthcare service. Ethics of technology should also contribute to the concrete efforts of care receivers to establish something approximating a 'good patienthood' in relation to a new technology, making it opportune to dub it, instead, an ethics with technology. This paper explores how assistive healthcare technologies impact on care receivers and the care situation, and in relation to the notion of patienthood, before turning to what this implies for an ethics that has as its goal to support care receivers to reach a life with the technology that is in line with their own notions of well-being and a good life. © 2016 John Wiley & Sons Ltd.

Identifying Unique Ethical Challenges of Indigenous Field-Workers: A Commentary on Alexander and Richman's "Ethical Dilemmas in Evaluations Using Indigenous Research Workers"

ERIC Educational Resources Information Center

Smith, Nick L.

2008-01-01

In contrast with nonindigenous workers, to what extent do unique ethical problems arise when indigenous field-workers participate in field studies? Three aspects of study design and operation are considered: data integrity issues, risk issues, and protection issues. Although many of the data quality issues that arise with the use of indigenous…

Medicine beyond borders: the legal and ethical challenges.

PubMed

Kassim, Puteri Nemie J

2009-09-01

The ease and affordability of international travel has contributed to the rapid growth of the healthcare industry where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the countries that they are visiting. A combination of many factors has led to the recent increase in popularity of medical tourism such as exorbitant costs of healthcare in industrialized nations, favorable currency exchange rates in the global economy, rapidly improving technology in many countries of the world and most importantly proven safety of healthcare in selected foreign nations. Nevertheless, the development of medical tourism has certainly awakened many ethical and legal issues, which must be addressed. Issues pertaining to malpractice, consumer protection, organ trafficking, alternative medicine and telemedicine need comprehensive legal regulatory framework to govern them. Ethical issues are also been raised by the promotion of medical tourism in particular those pertaining to doctor and patient relationship. A future, where medical law is subsumed into various legal and ethical dimensions, poses serious challenges for the practice and ethics of medicine.

Stem Cell Trials for Cardiovascular Medicine: Ethical Rationale

PubMed Central

Teraa, Martin; Hesam, Husna; van Delden, Johannes J.M.; Verhaar, Marianne C.; Bredenoord, Annelien L.

2014-01-01

Stem cell-based interventions provide new treatment prospects for many disease conditions, including cardiovascular disorders. Clinical trials are necessary to collect adequate evidence on (long-term) safety and efficacy of novel interventions such as stem cells, but the design and launch of clinical trials, from first-in-human studies to larger randomized controlled trials (RCTs), is scientifically and ethically challenging. Stem cells are different from traditional pharmaceuticals, surgical procedures, and medical devices in the following ways: the novelty and complexity of stem cells, the invasiveness of the procedures, and the novel aim of regeneration. These specifics, combined with the characteristics of the study population, will have an impact on the design and ethics of RCTs. The recently closed JUVENTAS trial will serve as an example to identify the (interwoven) scientific and ethical challenges in the design and launch of stem cell RCTs. The JUVENTAS trial has investigated the efficacy of autologous bone marrow cells in end-stage vascular patients, in a double-blind sham-controlled design. We first describe the choices, considerations, and experiences of the JUVENTAS team. Subsequently, we identify the main ethical and scientific challenges and discuss what is important to consider in the design of future stem cell RCTs: assessment of risks and benefits, the choice for outcome measures, the choice for the comparator, the appropriate selection of participants, and adequate informed consent. Additionally, the stem cell field is highly in the spotlight due to the (commercial) interests and expectations. This warrants a cautious pace of translation and scrupulous set up of clinical trials, as failures could put the field in a negative light. At the same time, knowledge from clinical trials is necessary for the field to progress. We conclude that in the scientifically and ethically challenging field of stem cell RCTs, researchers and clinicians have to maneuver between the Skylla of hyper accelerated translation without rigorously conducted RCTs and the Charybdis of the missed opportunity of valuable knowledge. PMID:24164351

The Lamaze Certified Childbirth Educator: Standards of Practice

PubMed Central

Lothian, Judith A.

2007-01-01

A student in a Lamaze Childbirth Educator Program expresses concern that some Lamaze Certified Childbirth Educators (LCCE educators) do not teach classes that reflect Lamaze standards. In this column, the ethical and professional standards of the LCCE educator and the challenges the childbirth educator experiences while practicing in the current maternity-care environment are presented and discussed. Lamaze International's Code of Ethics for Lamaze Certified Childbirth Educators provides guidance when dealing with these challenges. PMID:18408808

Stakeholders' views on the ethical challenges of pragmatic trials investigating pharmaceutical drugs.

PubMed

Kalkman, Shona; van Thiel, Ghislaine J M W; Grobbee, Diederick E; Meinecke, Anna-Katharina; Zuidgeest, Mira G P; van Delden, Johannes J M

2016-08-22

We explored the views of key stakeholders to identify the ethical challenges of pragmatic trials investigating pharmaceutical drugs. A secondary aim was to capture stakeholders' attitudes towards the implementation of pragmatic trials in the drug development process. We conducted semistructured, in-depth interviews among individuals from different key stakeholder groups (academia and independent research institutions, the pharmaceutical industry, regulators, Health Technology Assessment (HTA) agencies and patients' organizations) through telephone or face-to-face sessions. Interviews were structured around the question "what challenges were experienced or perceived during the design, conduct and/or review of pragmatic trials." Respondents were additionally asked about their views on implementation of pragmatic trials in the drug development process. Thematic analysis was used to identify the ethically relevant features across data sets. We interviewed 34 stakeholders in 25 individual sessions and four group sessions. The four perceived challenges of ethical relevance were: (1) less controlled conditions creating safety concerns, (2) comparison with usual care potentially compromising clinical equipoise, (3) tailored or waivers of informed consent affecting patient autonomy, and (4) minimal interference with "real-world" practice reducing the knowledge value of trial results. We identified stakeholder concerns regarding risk assessment, use of suboptimal usual care as a comparator, tailoring of informed consent procedures and ensuring the social value of pragmatic trials. These concerns increased when respondents were asked about pragmatic trials conducted before market authorization.

Calculus formation: nurses' decision-making in abortion-related care.

PubMed

McLemore, Monica R; Kools, Susan; Levi, Amy J

2015-06-01

Nurses routinely provide care to patients in ethically challenging situations. To explore the continuum between conscientious objectors and designated staff in the provision of care to women seeking abortions, the aim of this study was to thickly describe decision-making, using abortion as the clinical context to elucidate how nurses approach ethically challenging work. A purposive sample of 25 nurses who worked in abortion clinics, emergency departments, intensive care units, labor, and delivery, operating rooms, and post anesthesia care units were interviewed. Qualitative description and thematic analysis were used to identify the cognitive, emotional, and behavioral processes in nurses' decisions to care for women needing abortions. Nurses developed and used multifaceted, real-time calculi when making decisions about their participation in emergent or routine abortion care. Nurses tacked back and forth between the personal and professional and/or held multiple contradictory positions simultaneously. Nurses weighed the role and opinion of others to determine if they know how to or know why they would provide abortion care to women, particularly in the elective abortion context. The parameters of the nurse-patient relationship were complex and specific to the experiences of both the nurse and patient. Findings from this study further develop the science of ethically challenging decision-making and expand our understanding of factors that influence how nurses develop relationships to ethically challenging work. © 2015 Wiley Periodicals, Inc.

Varying ethics rules in clinical research and routine patient care – research ethics committee chairpersons’ views in Finland

PubMed Central

2014-01-01

Background To present empirical data on how the variation in regulating clinical research and patient care was perceived in Finland between 2009 and 2012. Methods Notes of interviews with 22 research ethics committee (REC) chairpersons were analyzed to identify whether differences in the regulation of clinical research and patient care were addressed. REC chairpersons’ opinions on three imaginary cases of clinical research projects challenging current research ethics rules (vignettes) were requested with a questionnaire; 18 of the 22 interviewed chairpersons responded. Results Based on REC chairpersons’ interviews, the differences between care and research regulation were not considered important issues in Finland. In the vignettes, REC chairpersons’ assumptions on how their REC would decide varied in regard to allowing research without informed consent, while solutions that are not allowed by current law were even anticipated. Mostly, but not always, the chairpersons’ own personal view agreed with their REC. Conclusions The distinction between care and research regulation has not been publicly challenged by Finnish RECs, even though it is a challenge when research relevant to health care is carried out. There is a need for debate and changes in laws and practices. PMID:24666735

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.

Ethical Challenges of Personal Disclosure in Gaining Entry with Religious Congregations.

PubMed

Todd, Nathan R

2017-12-01

This is a story about learning how to navigate my social identities as a non-religious gay man attempting to conduct data-based consultation with a religious congregation. Beyond my own growth in knowing myself better, this story speaks to the larger ethical challenge of how we build trust in community relationships, and in particular how much of our personal selves we need to disclose in the process of an individual or group deciding to work with us. Individuals and groups make decisions to work with us based on who they perceive us to be; thus, what is our ethical obligation to disclose aspects of who we are to promote full informed consent? To illustrate this ethical challenge of personal disclosure, I tell the story of discussions I had with three different religious leaders and a congregational committee about potentially working together. Throughout these stories, I reflect on my own messy process of growth as a window into the more general question of how we navigate our identities and values as community psychologists in the work we do with communities. © Society for Community Research and Action 2017.

Cellular therapies for heart disease: unveiling the ethical and public policy challenges.

PubMed

Raval, Amish N; Kamp, Timothy J; Hogle, Linda F

2008-10-01

Cellular therapies have emerged as a potential revolutionary treatment for cardiovascular disease. Promising preclinical results have resulted in a flurry of basic research activity and spawned multiple clinical trials worldwide. However, the optimal cell type and delivery mode have not been determined for target patient populations. Nor have the mechanisms of benefit for the range of cellular interventions been clearly defined. Experiences to date have unveiled a myriad of ethical and public policy challenges which will affect the way researchers and clinicians make decisions for both basic and clinical research. Stem cells derived from embryos are at the forefront of the ethical and political debate, raising issues of which derivation methods are morally and socially permissible to pursue, as much as which are technically feasible. Adult stem cells are less controversial; however, important challenges exist in determining study design, cell processing, delivery mode, and target patient population. Pathways to successful commercialization and hence broad accessibility of cellular therapies for heart disease are only beginning to be explored. Comprehensive, multi-disciplinary and collaborative networks involving basic researchers, clinicians, regulatory officials and policymakers are required to share information, develop research, regulatory and policy standards and enable rational and ethical cell-based treatment approaches.

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.

Ethical Issues Surrounding Personalized Medicine: A Literature Review.

PubMed

Salari, Pooneh; Larijani, Bagher

2017-03-01

More than a decade ago, personalized medicine was presented in modern medicine. Personalized medicine means that the right drug should be prescribed for the right patient based on genetic data. No doubt is developing medical sciences, and its shift into personalized medicine complicates ethical challenges more than before. In this review, we categorized all probable ethical considerations of personalized medicine in research and development and service provision. Based on our review, extensive changes in healthcare system including ethical changes are needed to overcome the ethical obstacles including knowledge gap and informed consent, privacy and confidentiality and availability of healthcare services. Furthermore social benefit versus science development and individual benefit should be balanced. Therefore guidelines and regulations should be compiled to represent the ethical framework; also ethical decision making should be day-to-day and individualized.

Doing qualitative research on suicide in a developing country: practical and ethical challenges.

PubMed

Mugisha, James; Knizek, Birthe Loa; Kinyanda, Eugene; Hjelmeland, Heidi

2011-01-01

This article describes and discusses the challenges faced by researchers who conducted a qualitative interview study on attitudes toward suicide among the Baganda, Uganda. Many of the challenges addressed in this article have not been described earlier in suicide research conducted in the developing world. The aim of this study was to explore attitudes and cultural responses toward suicide among the Baganda, Uganda. Data were collected and analyzed using grounded theory. A total of 28 focus group discussions and 30 key informant interviews were conducted. The findings of this study are organized under two broad categories: community access challenges and expectation challenges. Community access challenges entailed cultural, legal, rapport, informed consent, language, and other research process related issues that could hinder effective access to the study respondents. Expectation challenges concerned how to deal with the immediate and strategic needs of the study communities. This study demonstrates that culturally sensitive approaches to data collection can reduce ethical challenges and, through innovative approaches, practical challenges faced during data collection can be minimized.

A Case of Attempted Suicide in Huntington's Disease: Ethical and Moral Considerations.

PubMed

Furfari, Kristin; Zehnder, Nichole; Abbott, Jean

2016-01-01

A 62-year-old female with Huntington's disease presented after a suicide attempt. Her advance directive stated that she did not want intubation or resuscitation, which her family acknowledged and supported. Despite these directives, she was resuscitated in the emergency department and continued to state that she would attempt suicide again. Her suicidality in the face of a chronic and advancing illness, and her prolonged consistency in her desire to take her own life, left careproviders wondering how to provide ethical, respectful care to this patient. Tension between the ethical principles of autonomy and beneficence is central in this case. The patient's narrative demonstrated that her suicide was an autonomous decision, free from coercion or disordered thinking from mental illness. Beneficence then would seem to necessitate care aligned with the patient's desire to end her life, which created ethical uneasiness for her family and careproviders. The case highlights several end-of-life ethical considerations that have received much recent attention. With ongoing discussions about the legalization of aid in dying across the country, caregivers are challenged to understand what beneficence means in people with terminal illnesses who want a say in their death. This case also highlights the profound moral distress of families and careproviders that arises in such ethically challenging scenarios. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Institutional ethical review and ethnographic research involving injection drug users: a case study.

PubMed

Small, Will; Maher, Lisa; Kerr, Thomas

2014-03-01

Ethnographic research among people who inject drugs (PWID) involves complex ethical issues. While ethical review frameworks have been critiqued by social scientists, there is a lack of social science research examining institutional ethical review processes, particularly in relation to ethnographic work. This case study describes the institutional ethical review of an ethnographic research project using observational fieldwork and in-depth interviews to examine injection drug use. The review process and the salient concerns of the review committee are recounted, and the investigators' responses to the committee's concerns and requests are described to illustrate how key issues were resolved. The review committee expressed concerns regarding researcher safety when conducting fieldwork, and the investigators were asked to liaise with the police regarding the proposed research. An ongoing dialogue with the institutional review committee regarding researcher safety and autonomy from police involvement, as well as formal consultation with a local drug user group and solicitation of opinions from external experts, helped to resolve these issues. This case study suggests that ethical review processes can be particularly challenging for ethnographic projects focused on illegal behaviours, and that while some challenges could be mediated by modifying existing ethical review procedures, there is a need for legislation that provides legal protection of research data and participant confidentiality. Copyright © 2013 Elsevier Ltd. All rights reserved.

Factors affecting ethical behavior in pediatric occupational therapy: A qualitative study

PubMed Central

Kalantari, Minoo; Kamali, Mohammad; Joolaee, Soodabeh; Shafarodi, Narges; Rassafiani, Mehdi

2015-01-01

Background: It is the responsibility of each occupational therapist to always act ethically and professionally in a clinical setting. However, there is little information available concerning the factors influencing ethical behavior of occupational therapists at work. Since no study has been conducted in Iran on this topic, this qualitative study aimed to identify the factors influencing ethical behavior of pediatric occupational therapists. Methods: Twelve pediatric occupational therapists participated in this study. The sampling was purposeful, and the interviews continued until reaching data saturation. All interviews were recorded and transcribed. The data were analyzed by qualitative content analysis, and the ethics of qualitative research was considered. Results: The factors influencing ethical behavior were classified into four main categories including organizational factors, therapist related factors, client’s family issues, and social factors. Conclusion: This study identified numerous factors influencing the ethical behavior of pediatric occupational therapists that could be used to train occupational therapists, human resources managers, professional policy makers, and could also be used to conduct future researches, and produce tools. PMID:26913245

Demarcation of the ethics of care as a discipline: discussion article.

PubMed

Klaver, Klaartje; van Elst, Eric; Baart, Andries J

2014-11-01

This article aims to initiate a discussion on the demarcation of the ethics of care. This discussion is necessary because the ethics of care evolves by making use of insights from varying disciplines. As this involves the risk of contamination of the care ethical discipline, the challenge for care ethical scholars is to ensure to retain a distinct care ethical perspective. This may be supported by an open and critical debate on the criteria and boundaries of the ethics of care. As a contribution, this article proposes a tentative outline of the care ethical discipline. What is characteristic of this outline is the emphasis on relational programming, situation-specific and context-bound judgments, a political-ethical perspective, and empirical groundedness. It is argued that the ethics of care is best developed further by means of an intradisciplinary approach. Two intradisciplinary examples show how within the frame of one discipline, other disciplines are absorbed, both with their body of knowledge and their research methodology. © The Author(s) 2013.

Doing "Good Work": Negotiating Possibilities in Ethical Challenges

ERIC Educational Resources Information Center

Burge, Elizabeth J.

2009-01-01

In this article, the author takes a look at how reflective and courageous practitioners show their critical and constructive thinking for handling the intellectual and interpersonal complexities of ethical analysis. The author also discusses six lessons practitioners need to learn.

The American Nurses Association Code of Ethics: a reflection on the ethics of respect and human dignity with nurse as expert.

PubMed

Milton, Constance L

2003-10-01

The American Nurses Association Code of Ethics for Nurses calls for the nurse to practice with compassion and respect for every individual. What are the ethics and challenges of practicing professional nursing with expertise and educating a new generation of nurses while incorporating the interpretive statements into practice? This column differentiates the traditional biomedical views on human dignity and respect while exploring the embedded ethics of respect and self-determination and what it truly means to be an expert of nursing from the theoretical perspective of the human becoming school of thought.

Fundamental Ethical Principles in Sports Medicine.

PubMed

Devitt, Brian M

2016-04-01

In sports medicine, the practice of ethics presents many unique challenges because of the unusual clinical environment of caring for players within the context of a team whose primary goal is to win. Ethical issues frequently arise because a doctor-patient-team triad often replaces the traditional doctor-patient relationship. Conflict may exist when the team's priority clashes with or even replaces the doctor's obligation to player well-being. Customary ethical norms that govern most forms of clinical practice, such as autonomy and confidentiality, are not easily translated to sports medicine. Ethical principles and examples of how they relate to sports medicine are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Good epidemiology, good ethics: empirical and ethical dimensions of global public health.

PubMed

Rentmeester, Christy A; Dasgupta, Rajib

2012-01-01

This paper examines the following ethically and epidemiologically relevant challenges, as yet neglected in public health ethics: how to distribute resources and health risks and benefits, how to define evidentiary criteria that justify public health interventions, and how to define terms in which programme goals, successes, and failures will be assessed and monitored. We illuminate critical intersections of empirical and ethical dimensions of public health work, drawing upon three global public health interventions-inclusion of the Hepatitis B vaccine in the Universal Immunisation Programme, Universal Salt Iodisation, and the Global Polio Eradication Initiative-and suggest strategies for addressing and responding to them.

Ethical and cultural striving: Lived experiences of minority nurses in dementia care.

PubMed

Egede-Nissen, Veslemøy; Sellevold, Gerd Sylvi; Jakobsen, Rita; Sørlie, Venke

2017-09-01

Nursing workforce in Western European health institutions has become more diverse because of immigration and recruitment from Asian, African, and East-European countries. Minority healthcare providers may experience communication problems in interaction with patients and coworkers, and they are likely to experience conflict or uncertainty when confronted with different cultural traditions and values. Persons with dementia are a vulnerable group, and the consequences of their illness challenge the ability to understand and express oneself verbally. The large number of minority healthcare providers in nursing homes underlines the importance to obtain better knowledge about this group's experiences with the care challenges in dementia care units. Can you tell about any challenges in the experiences in the encounter with persons suffering from dementia? Participants and research context: Five minority healthcare providers in a nursing home, in a dementia unit. All guidelines for research ethic were followed. Ethical consideration: The participants were informed that participation was voluntary, and they were guarantied anonymity. We used a qualitative method, conducting individual interviews, using a narrative approach. In the analysis, we applied a phenomenological-hermeneutical method, developed for researching life experiences. One theme and four subthemes: striving to understand the quality of care for persons with dementia. The subthemes: sensitivity to understand the patients' verbal and nonverbal expressions. To understand gratefulness, understand the patient as an adult and autonomous person, and understand the patient as a patient in a nursing home. Challenges comprise both ethical and cultural striving to understand persons with dementia. To care for persons with dementia in an unfamiliar context may be understood as a striving for acting ethically, when at the same time striving to adapt and acculturate to new cultural norms, in order to practice good dementia care.

Exercising restraint: clinical, legal and ethical considerations for the patient with Alzheimer's disease.

PubMed

McBrien, Barry

2007-04-01

The number of older people using emergency care is increasing steadily and older people account for over half of all emergency admissions. In the emergency setting, nurses caring for older people with Alzheimer's disease can be faced with many complex ethical and legal challenges. Moreover, challenges such as the use of physical restraint can precipitate conflict when the nurse is placed in the precarious position of doing good, respecting autonomy and avoiding paternalism. Although, there is no complete set of "rules" that can provide nurses with an answer to each dilemma, it is of significant value for nurses to have sound knowledge of ethical and legal positions in order to analyse the many complex situations that they may encounter.

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.

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

PubMed

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

2013-06-01

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

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.

Ethical aspects of tissue engineering: a review.

PubMed

de Vries, Rob B M; Oerlemans, Anke; Trommelmans, Leen; Dierickx, Kris; Gordijn, Bert

2008-12-01

Tissue engineering (TE) is a promising new field of medical technology. However, like other new technologies, it is not free of ethical challenges. Identifying these ethical questions at an early stage is not only part of science's responsibility toward society, but also in the interest of the field itself. In this review, we map which ethical issues related to TE have already been documented in the scientific literature. The issues that turn out to dominate the debate are the use of human embryonic stem cells and therapeutic cloning. Nevertheless, a variety of other ethical aspects are mentioned, which relate to different phases in the development of the field. In addition, we discuss a number of ethical issues that have not yet been raised in the literature.

Developing an Evaluation Tool for Assessing Clinical Ethics Consultation Skills in Simulation Based Education: The ACES Project.

PubMed

Wasson, Katherine; Parsi, Kayhan; McCarthy, Michael; Siddall, Viva Jo; Kuczewski, Mark

2016-06-01

The American Society for Bioethics and Humanities has created a quality attestation (QA) process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (ACES) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described.

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

Teaching medical ethics to meet the realities of a changing health care system.

PubMed

Millstone, Michael

2014-06-01

The changing context of medical practice--bureaucratic, political, or economic--demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.

End User Evaluations

NASA Astrophysics Data System (ADS)

Jay, Caroline; Lunn, Darren; Michailidou, Eleni

As new technologies emerge, and Web sites become increasingly sophisticated, ensuring they remain accessible to disabled and small-screen users is a major challenge. While guidelines and automated evaluation tools are useful for informing some aspects of Web site design, numerous studies have demonstrated that they provide no guarantee that the site is genuinely accessible. The only reliable way to evaluate the accessibility of a site is to study the intended users interacting with it. This chapter outlines the processes that can be used throughout the design life cycle to ensure Web accessibility, describing their strengths and weaknesses, and discussing the practical and ethical considerations that they entail. The chapter also considers an important emerging trend in user evaluations: combining data from studies of “standard” Web use with data describing existing accessibility issues, to drive accessibility solutions forward.

Medical safety in boxing: administrative, ethical, legislative, and legal considerations.

PubMed

Schwartz, Michael B

2009-10-01

The roles and responsibilities of the ringside physician are complex and have evolved into a unique specialty in sport medicine. In addition to the medical aspects of ringside medicine, the doctor is now responsible for many administrative, ethical, and legal considerations. This article reviews and details the numerous roles the ringside physician plays in the sport of boxing.

Manipulating Memories: The Ethics of Yesterday's Science Fiction and Today's Reality.

PubMed

Robillard, Julie M; Illes, Judy

2016-12-01

The paper addresses recent advances in memory manipulation from the perspective of the four key pillars of neuroethics: the self, social policy, neurotechnology, and education and outreach. We provide examples for each pillar, assess their neuroethical implications, and conclude with a call for an ethics framework that is specifically tailored for the ethical challenges of memory manipulation. © 2016 American Medical Association. All Rights Reserved.

Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent

PubMed Central

Kreitmair, Karola

2018-01-01

This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer. PMID:29685865

Screening Jews and genes: a consideration of the ethics of genetic screening within the Jewish community: challenges and responses.

PubMed

Levin, M

1999-01-01

Screening for genetic disorders, particularly Tay-Sachs Disease, has been traditionally welcome by the Jewish community. I review the history of genetic screening among Jews and the views from the Jewish tradition on the subject, and then discuss ethical challenges of screening and the impact of historical memories upon future acceptance of screening programs. Some rational principles to guide future design of genetic screening programs among Jews are proposed.

Responsible authorship in engineering fields: an overview of current ethical challenges.

PubMed

Borenstein, Jason

2011-06-01

The primary aim of this article is to identify ethical challenges relating to authorship in engineering fields. Professional organizations and journals do provide crucial guidance in this realm, but this cannot replace the need for frequent and diligent discussions in engineering research communities about what constitutes appropriate authorship practice. Engineering researchers should seek to identify and address issues such as who is entitled to be an author and whether publishing their research could potentially harm the public.

Social learning in the Anthropocene: Novel challenges, shadow networks, and ethical practices.

PubMed

Schmidt, Jeremy J

2017-05-15

The Anthropocene presents novel challenges for environmental management. This paper considers the challenges that the Anthropocene poses for social learning techniques in adaptive management. It situates these challenges with respect to how anthropogenic forcing on the Earth system affects the conditions required for: (1) The cooperative exercises of social learning; (2) The techniques used for assessing the fit of institutions to social-ecological systems; and, (3) The strategies employed for identifying management targets that are transformed by human action. In view of these challenges, the paper then examines how the practices of shadow networks may provide paths for incorporating a broader, more robust suite of social learning practices in the Anthropocene. The paper emphasizes how novel challenges in the Anthropocene demand increased attention to ethical practices, particularly those that establish center-periphery relationships between social learning communities and shadow networks. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ethics and Information Technology: Some Principles To Guide Students.

ERIC Educational Resources Information Center

Bodi, Sonia

1998-01-01

Discusses the ethical challenges of information technology, particularly electronic indexes and the Internet; considers principles to guide students; and discusses possible librarian responses. Topics include Kant's categorical imperative, ownership, right to privacy, social responsibility, self-respect, plagiarism and copyrights, and three…

Methods to address poultry robustness and welfare issues through breeding and associated ethical considerations

USDA-ARS?s Scientific Manuscript database

Management practices and rearing conditions employed for domestic animal production including laying hens are continusly changing based on ethical and scientific results. This presents challenges especially regarding managing competitive social interactions (social stress) between animals. Selective...

Ethical analysis in public health.

PubMed

Roberts, Marc J; Reich, Michael R

2002-03-23

Public-health regularly encounters serious ethical dilemmas, such as rationing scarce resources, influencing individuals to change their behaviour, and limiting freedom to diminish disease transmission. Yet unlike medical ethics, there is no agreed-upon framework for analysing these difficulties. We offer such a framework. It distinguishes three philosophical views, often invoked in public-health discourse: positions based on outcomes (utilitarianism), positions focused on rights and opportunities (liberalism), and views that emphasise character and virtue (communitarianism). We explore critical variations within each approach, and identify practical problems that arise in addressing the ethical dimensions of health policy. We conclude by examining challenges posed by the feminist argument of ethics-of-care and by postmodern views about the nature of ethics. Health professionals need enhanced skills in applied philosophy to improve the coherence, transparency, and quality of public deliberations over ethical issues inherent in health policy.

Interprofessional Clinical Ethics Education: The Promise of Cross-Disciplinary Problem-Based Learning.

PubMed

Kurtz, Melissa J; Starbird, Laura E

2016-09-01

A review of Lin et al.'s pilot study exploring the effects of an interprofessional, problem-based learning clinical ethics curriculum on Taiwanese medical and nursing students' attitudes towards interprofessional collaboration highlights the benefits of interprofessional collaboration and offers insight into how problem-based learning might be universally applied in ethics education. Interprofessional collaboration is an ideal approach for exploring ethical dilemmas because it involves all relevant professionals in discussions about ethical values that arise in patient care. Interprofessional ethics collaboration is challenging to implement, however, given time constraints and organizational and practice demands. Nevertheless, we suggest that when professionals collaborate, they can collectively express greater commitment to the patient. We also suggest future research avenues that can explore additional benefits of interprofessional collaboration in clinical ethics. © 2016 American Medical Association. All Rights Reserved.

Regulation of genomic and biobanking research in Africa: a content analysis of ethics guidelines, policies and procedures from 22 African countries.

PubMed

de Vries, Jantina; Munung, Syntia Nchangwi; Matimba, Alice; McCurdy, Sheryl; Ouwe Missi Oukem-Boyer, Odile; Staunton, Ciara; Yakubu, Aminu; Tindana, Paulina

2017-02-02

The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate research based on sharing, causing confusion about what is allowed, where and when. In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents. Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines. There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance to ethics committees and researchers.

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

Does medical education erode medical trainees' ethical attitude and behavior?

PubMed Central

Yavari, Neda

2016-01-01

In the last few years, medical education policy makers have expressed concern about changes in the ethical attitude and behavior of medical trainees during the course of their education. They claim that newly graduated physicians (MDs) are entering residency years with inappropriate habits and attitudes earned during their education. This allegation has been supported by numerous research on the changes in the attitude and morality of medical trainees. The aim of this paper was to investigate ethical erosion among medical trainees as a serious universal problem, and to urge the authorities to take urgent preventive and corrective action. A comparison with the course of moral development in ordinary people from Kohlberg’s and Gilligan's points of view reveals that the growth of ethical attitudes and behaviors in medical students is stunted or even degraded in many medical schools. In the end, the article examines the feasibility of teaching ethics in medical schools and the best approach for this purpose. It concludes that there is considerable controversy among ethicists on whether teaching ethical virtues is plausible at all. Virtue-based ethics, principle-based ethics and ethics of care are approaches that have been considered as most applicable in this regard. PMID:28050246

Informed consent in the context of pharmacogenomic research: ethical considerations.

PubMed

Howard, H C; Joly, Y; Avard, D; Laplante, N; Phillips, M; Tardif, J C

2011-06-01

Although the scientific research surrounding pharmacogenomics (PGx) has been relatively plentiful, the ethical research concerning this discipline has developed rather conservatively. Following investigation of the ethical, legal and social issues (ELSI) of PGx research, as well as consulting with key stakeholders, we identified six outstanding ethical issues raised by the informed consent process in PGx research: (1) scope of consent; (2) consent to 'add-on' studies; (3) protection of personal information; (4) commercialization; (5) data sharing; and (6) potential risks stemming from population-based research. In discussing these six areas as well as offering specific considerations, this article offers a solid base from which future practical guidelines for informed consent in PGx research can be constructed. As such, this effort works toward filling the ELSI gap and provides ethical support to the numerous PGx projects undertaken by researchers every year.

Creating a Controlled Vocabulary for the Ethics of Human Research: Towards a Biomedical Ethics Ontology

PubMed Central

Koepsell, David; Arp, Robert; Fostel, Jennifer; Smith, Barry

2009-01-01

Ontologies describe reality in specific domains in ways that can bridge various disciplines and languages. They allow easier access and integration of information that is collected by different groups. Ontologies are currently used in the biomedical sciences, geography, and law. A Biomedical Ethics Ontology (BMEO) would benefit members of ethics committees who deal with protocols and consent forms spanning numerous fields of inquiry. There already exists the Ontology for Biomedical Investigations (OBI); the proposed BMEO would interoperate with OBI, creating a powerful information tool. We define a domain ontology and begin to construct a BMEO, focused on the process of evaluating human research protocols. Finally, we show how our BMEO can have practical applications for ethics committees. This paper describes ongoing research and a strategy for its broader continuation and cooperation. PMID:19374479

A systematic approach to engineering ethics education.

PubMed

Li, Jessica; Fu, Shengli

2012-06-01

Engineering ethics education is a complex field characterized by dynamic topics and diverse students, which results in significant challenges for engineering ethics educators. The purpose of this paper is to introduce a systematic approach to determine what to teach and how to teach in an ethics curriculum. This is a topic that has not been adequately addressed in the engineering ethics literature. This systematic approach provides a method to: (1) develop a context-specific engineering ethics curriculum using the Delphi technique, a process-driven research method; and (2) identify appropriate delivery strategies and instructional strategies using an instructional design model. This approach considers the context-specific needs of different engineering disciplines in ethics education and leverages the collaboration of engineering professors, practicing engineers, engineering graduate students, ethics scholars, and instructional design experts. The proposed approach is most suitable for a department, a discipline/field or a professional society. The approach helps to enhance learning outcomes and to facilitate ethics education curriculum development as part of the regular engineering curriculum.

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes

PubMed Central

Clarinval, Caroline; Biller-Andorno, Nikola

2014-01-01

Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context. PMID:24987575

The Challenges of Participant Photography: A Critical Reflection on Methodology and Ethics in Two Cultural Contexts.

PubMed

Murray, Linda; Nash, Meredith

2017-05-01

Photovoice and photo-elicitation are two common methods of participant photography used in health research. Although participatory photography has many benefits, this critical reflection provides fellow researchers with insights into the methodological and ethical challenges faced when using such methods. In this article, we critically reflect on two studies that used participatory photography in different cultural contexts. The first study used photo-elicitation to investigate mothers' experiences of infant settling in central Vietnam. The second study used photovoice to explore pregnant embodiment in Australia. Following a discussion of the literature and a detailed overview of the two studies, we examine the methodological challenges in using participant photography before, during and after each study. This is followed by a discussion of ethical concerns that arose in relation to the burden of participation, confidentiality, consent, and the photographing of families and children. To conclude, we highlight implications for using participatory photography in other settings.

Ethics, the law, and prisoners: protecting society, changing human behavior, and protecting human rights.

PubMed

Trestman, Robert L

2014-09-01

Restricting a person's liberty presents society with many inherent ethical challenges. The historical purposes of confinement have included punishment, penitence, containment, rehabilitation, and habilitation. While the purposes are indeed complex, multifaceted, and at times ambiguous or contradictory, the fact of incarceration intrinsically creates many ethical challenges for psychiatrists working in correctional settings. Role definition of a psychiatrist may be ambiguous, with potential tensions between forensic and therapeutic demands. Privacy may be limited or absent and confidentiality may be compromised. Patient autonomy may be threatened to address real or perceived security concerns. Care delivery may actually have harmful consequences in court cases for pretrial detainees or lethal consequences for those under a death sentence. An absence of data and targeted research hampers the development of evidence-based care delivery for the disenfranchised, understudied, and disproportionately ill prisoner population. In this review paper, I discuss a few of the challenges and dilemmas routinely faced and present a series of questions. Where feasible, proposed resolutions are offered.

The ethical framing of personalized medicine.

PubMed

Joly, Yann; Saulnier, Katie M; Osien, Gladys; Knoppers, Bartha M

2014-10-01

Personalized medicine encompasses the use of biological information such as genomics to provide tailored interventions for patients. The review explores the ethical, legal, and social issues that have emerged with personalized medicine and must be considered because of the complex nature of providing individualized care within a clinical setting. Recent studies found that the use of personalized medicine presents challenges in multiple areas: biobanking and informed consent, confidentiality, genetic discrimination, return of results, access to treatment, clinical translation, direct-to-consumer genetic testing, emerging duties, and knowledge mobilization. Although personalized medicine provides benefits in treating patients in a manner that is more suited to their genetic profile, there are challenges that must be discussed to ensure the protection and fair treatment of individuals. The issues concerning personalized medicine are widespread, and range from individual privacy to the stratification and discrimination of sub-populations based on ethnicity. These issues have considerable impact on the individual and society. A thorough exploration of these ethical issues may identify novel challenges as well as potential avenues for resolution.

Ethics of clinical trials.

PubMed

Iyalomhe, G B S; Imomoh, P A

2007-01-01

Although clinical trials are conducted far more ethically and safer now than they were some decades ago, the elimination of gross abuses has tended to highlight more subtle ethical problems. Therefore, research in man, especially clinical drug trials, must now take into account ethical and legal requirements. This review examines the progress of clinical trial ethics, highlights the major ethical principles and challenges involved in the conduct of clinical trials, and suggests measures to ensure scientifically and ethically sound clinical trials. An internet search and a perusal of the literature on the history of clinical trials, medical ethics and good clinical practice, reveal that apart from laying a general principle, the Oath of Hippocrates did not provide a guide on the specific ethical problems involved in undertaking research, an important arm of advancement in medical knowledge. Hence, to avert continued ethical abuses of subjects during clinical research, the current reference guideliNe--the Helsinki Declaration of 1964 (revised in 1975), was adopted by the World Medical Assembly. It emphasized four major principles: autonomy, nonmaleficience, beneficence and justice. In applying these principles, the researcher must obtain a written free and well informed consent from patients who should be aware of their right to withdraw from trial at any moment. Where possible, a new drug should always first be compared to placebo in order to prove its superiority. He must ethically monitor and assess risks and benefits of the trial throughout its duration and use a fair procedure in selecting research subjects and must respect the concept of inviolability of the human person. Ethical challenges confronting clinical trials include the appropriateness of the proposed research, obtaining free informed consent, use of medications after completion of drug trials, drug toxicities and long-term side effects as well as the release and publication of research result. To improve protection for research subjects and have ethically sound clinical trials, there is need to adhere to global standards and legislations; establish, strengthen and empower regulatory bodies; develop partnership among stakeholders; intensify public enlightenment and train research personnel.

Ethical Issues Involving Research Conducted with Homebound Older Adults

ERIC Educational Resources Information Center

Locher, Julie L.; Bronstein, Janet; Robinson, Caroline O.; Williams, Charlotte; Ritchie, Christine S.

2006-01-01

Conducting research in the home setting with homebound older adults presents distinct ethical and practical challenges that require special consideration. This article describes the methodological issues that make studying homebound older adults especially vulnerable to therapeutic misconception and researcher role conflict and offers practical…

Sorting Out the Ethics of Propaganda.

ERIC Educational Resources Information Center

Cunningham, Stanley B.

1992-01-01

Adduces a number of considerations that challenge the neutralist thesis of propaganda and which, at the same time, serve to substantiate the belief that propaganda is something wrong. Argues that a theory of propaganda, adequately considered, can and should include a broad ethical determination of propaganda. (NH)

Empowering Reflective Ethical Engagement in Field Settings

ERIC Educational Resources Information Center

Cohen, Perrin

2010-01-01

Intrinsic to experiential learning is the challenge of empowering students to both reflectively engage with and inquire into ethical issues, while facing time, task, social, and other daily pressures. As designated "learners" in a professional setting, experiential education students typically see themselves as having little authority…

Ethics and Regulatory Challenges and Opportunities in Patient-Centered Comparative Effectiveness Research.

PubMed

Sugarman, Jeremy

2016-04-01

The Affordable Care Act includes provisions for the conduct of large-scale, patient-centered comparative effectiveness research. Such efforts aim toward the laudable moral goal of having evidence to improve health care decision making. Nevertheless, these pragmatic clinical research efforts that typically pose minimal incremental risk and are enmeshed in routine care settings perhaps surprisingly encounter an array of ethics and regulatory challenges and opportunities for academic health centers. An emphasis on patient-centeredness forces an examination of the appropriateness of traditional methods used to protect the rights, interests, and welfare of participants. At the same time, meaningful collaboration with patients throughout the research process also necessitates ensuring that novel approaches to research (including recruitment and consent) entail necessary protections regarding such issues as privacy. As the scientific and logistical aspects of this research are being developed, substantial attention is being focused on the accompanying ethics and regulatory issues that have emerged, which should help to facilitate ethically appropriate research in a variety of contexts.

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.

Conjoined Twins: Philosophical Problems and Ethical Challenges

PubMed Central

Savulescu, Julian; Persson, Ingmar

2016-01-01

We examine the philosophical and ethical issues associated with conjoined twins and their surgical separation. In cases in which there is an extensive sharing of organs, but nevertheless two distinguishable functioning brains, there are a number of philosophical and ethical challenges. This is because such conjoined twins: 1. give rise to puzzles concerning our identity, about whether we are identical to something psychological or biological;2. force us to decide whether what matters from an ethical point of view is the biological life of our organisms or the existence of our consciousness or mind;3. raise questions concerning when, if ever, it is morally acceptable to sacrifice one of us to save another;4. force us to reflect on the conditions for ownership of organs and the justification of removal of organs for transplantation which causes the death of the donor;5. raise questions about who should take decisions about life-risking treatments when this cannot be decided by patients themselves. We examine and suggest answers to these questions. PMID:26671962

Beyond antidoping and harm minimisation: a stakeholder-corporate social responsibility approach to drug control for sport.

PubMed

Mazanov, Jason

2016-04-01

Debate about the ethics of drug control in sport has largely focused on arguing the relative merits of the existing antidoping policy or the adoption of a health-based harm minimisation approach. A number of ethical challenges arising from antidoping have been identified, and a number of, as yet, unanswered questions remain for the maturing ethics of applying harm minimisation principles to drug control for sport. This paper introduces a 'third approach' to the debate, examining some implications of applying a stakeholder theory of corporate social responsibility (CSR) to the issue of doping in sport. The introduction of the stakeholder-CSR model creates an opportunity to challenge the two dominant schools by enabling a different perspective to contribute to the development of an ethically robust drug control for sport. 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/

Investigating the origin of AIDS: some ethical dimensions

PubMed Central

Martin, B

2003-01-01

The theory that AIDS originated from contaminated polio vaccines raises a number of challenging issues with ethical dimensions. The Journal of Medical Ethics dealt with a submission about the theory a decade ago; subsequent developments have raised further issues. Four areas of contention are addressed: whether the theory should be investigated; whether anyone should be blamed; whether defamation actions are appropriate, and whether the scientific community has a responsibility to examine unorthodox theories. PMID:12930866

Social and Leadership Factors Influencing Moral Decision Making in Canadian Military Operations: An Annotated Bibliography

DTIC Science & Technology

2011-03-01

emphasis on challenges to or failures of moral and ethical decision making. To conduct our literature review, a number of core concepts were identified...The research team identified a number of core concepts , relating specifically to the social and leadership factors that influence moral and ethical...decision making (see Table 1). Table 1: Keywords Core Concepts Related Keywords Moral *1, immoral Ethic*, unethical Decision making Decision

Closing unprofitable services: ethical issues and management responses.

PubMed

Summers, James W

1985-01-01

Closing unprofitable services often requires as much analysis, public relations, marketing, and planning as any expansion. Further, issues about ethics, indigents, and the hospital mission force the consideration of values explicitly if a marketing fiasco is to be avoided. By integrating values analysis with more traditional management tasks, the challenges of service closure can be converted into opportunities to demonstrate how your institution has met or exceeded its ethical obligations. A case involving OB is developed to show how ethical and management issues blend into one another. Specific strategies for consensus building and marketing of the legitimacy of the hospital's position are given. Institutional ethics committees are one primary mechanism for developing a plan to benefit from unpleasant decisions.

Patients who make terrible therapeutic choices.

PubMed

Curzer, Howard J

2014-01-01

The traditional approaches to dental ethics include appeals to principles, duties (deontology), and consequences (utilitarianism). These approaches are often inadequate when faced with the case of a patient who refuses reasonable treatment and does not share the same ethical framework the dentist is using. An approach based on virtue ethics may be helpful in this and other cases. Virtue ethics is a tradition going back to Plato and Aristotle. It depends on forming a holistic character supporting general appropriate behavior. By correctly diagnosing the real issues at stake in a patient's inappropriate oral health choices and working to build effective habits, dentists can sometimes respond to ethical challenges that remain intractable given rule-based methods.

Cultural context in medical ethics: lessons from Japan.

PubMed

Powell, Tia

2006-04-03

This paper examines two topics in Japanese medical ethics: non-disclosure of medical information by Japanese physicians, and the history of human rights abuses by Japanese physicians during World War II. These contrasting issues show how culture shapes our view of ethically appropriate behavior in medicine. An understanding of cultural context reveals that certain practices, such as withholding diagnostic information from patients, may represent ethical behavior in that context. In contrast, nonconsensual human experimentation designed to harm the patient is inherently unethical irrespective of cultural context. Attempts to define moral consensus in bioethics, and to distinguish between acceptable and unacceptable variation across different cultural contexts, remain central challenges in articulating international, culturally sensitive norms in medical ethics.

Cultural context in medical ethics: lessons from Japan

PubMed Central

Powell, Tia

2006-01-01

This paper examines two topics in Japanese medical ethics: non-disclosure of medical information by Japanese physicians, and the history of human rights abuses by Japanese physicians during World War II. These contrasting issues show how culture shapes our view of ethically appropriate behavior in medicine. An understanding of cultural context reveals that certain practices, such as withholding diagnostic information from patients, may represent ethical behavior in that context. In contrast, nonconsensual human experimentation designed to harm the patient is inherently unethical irrespective of cultural context. Attempts to define moral consensus in bioethics, and to distinguish between acceptable and unacceptable variation across different cultural contexts, remain central challenges in articulating international, culturally sensitive norms in medical ethics. PMID:16759415

Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context.

PubMed

London, Leslie; Tangwa, Godfrey; Matchaba-Hove, Reginald; Mkhize, Nhlanhla; Nwabueze, Remi; Nyika, Aceme; Westerholm, Peter

2014-06-23

International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region.

Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

PubMed Central

2014-01-01

Background International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. Summary A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region. PMID:24957477

The ethics of data collection: unintended consequences?

PubMed

Wainwright, Delia; Sambrook, Sally

2010-01-01

The aims is to consider the political and ethical challenges involved in conducting ethnographic managerial/organisational behaviour research within the highly regulated health and social care context, in light of the emergence of more stringent "ethical approval" policies and requirements set by Local Research Ethics Committees in the United Kingdom. In the attempt and requirement to protect "vulnerable" employees, this paper aims to present an unintended paradox of consequences when participants voluntarily revealed themselves. The authors briefly review literature on research ethics and present an understanding of the ethical regulations currently existing within the British National Health Service. Within an ethnographic case study exploring the psychological contract, the authors consider the issues that arose during one stage of data collection: a qualitative questionnaire survey with 13 participants, including members of the lead author's team. Incorporating excerpts from the researcher's reflexive journal, the paper exposes the struggles of being an "insider" researcher and the tensions this raises for data analysis when participants voluntarily revealed themselves. Ethnography is at "risk" within health and social care and ethnographic "managerial" research is likely to be unduly restricted and potentially threatened. The evidence suggests that some employees either did not wish to be protected or, conversely, felt compelled to reveal their identities, raising questions of their motivation and creating a paradox of unintended consequences. This paper offers an insight into the challenges of conducting nurse-managerial ethnography in compliance with ethical guidelines, yet disrupted by participants. The findings will be useful to other nurse-researchers attempting to conduct insider research.

Initiatives by the government and physician groups to improve awareness of medical ethics: Challenges in Japan

PubMed Central

MORIOKA, Yasuhiko

2012-01-01

Physicians have been required to possess high ethical standards, as medical practice is directly involved with patients' lives. Although ethics arise out of an individual's consciousness, ethical regulations imposed by the nation/government together with self-regulation by physician groups are important in the practice of ethics, for which reason countries around the world undertake various initiatives. This paper investigates physician licensure, organizations governing physician status, the role of physician groups, and the actual conditions of lifelong learning and ethics education in developed countries worldwide, in contrast with which it throws problems in the situation in Japan into relief. Organizations governing physician status, the form of medical associations, and the improvement of lifelong learning are pointed out as critical issues especially in Japan. PMID:22498978

Resolving legal, ethical, and human rights challenges in HIV vaccine research.

PubMed

Patterson, D

2000-01-01

In the absence of a cure for AIDS, attention has turned to the possibility of developing a preventive vaccine for HIV infection. Yet many scientific, ethical, legal, and economic obstacles remain. At the current rate, the development and production of an effective vaccine could take 15 to 20 years or longer. If tens of millions more HIV infections and deaths are to be avoided in the coming decades, vaccine research needs to be greatly expedited. Furthermore, it must be undertaken ethically, and the products of this research must benefit people in developing countries. This article, an edited and updated version of a paper presented at "Putting Third First," addresses challenges arising in HIV preventive vaccine research in developing countries. It does not address clinical research in developing countries relating to treatments or therapeutic vaccines. Nor does it address legal and ethical issues relating to HIV vaccine research in industrialized countries, although similar issues arise in both contexts. The article concludes that while ethical codes are silent on the obligation to undertake research and development, international law provides strong legal obligations--particularly with regard to industrialized states--that should be invoked to accelerate HIV vaccine development, and distribution.

Xenotransplantation-theological-ethical considerations in an interdisciplinary symposium.

PubMed

Sautermeister, Jochen; Mathieu, Richard; Bogner, Veronika

2015-01-01

Unlike allotransplantation, reflections on xenotransplantation are infrequent in theological literature. However, xenotransplantation poses questions specifically concerning ethical and theological aspects that are imperative to address, such as personal identity between the poles of body, soul, and mind, the relationship between humans and animals, as well as challenges regarding specific issues of medical and social ethics. This study summarizes the lectures of the symposium on "Xenotransplantation-a challenge to theological ethics," which took place in Munich from September 30 until October 2, 2013, and analyses the implications of xenotransplantation from the perspectives of Christian theological ethics, biblical theology, and systematic theology. Furthermore, the issue of xenotransplantation is addressed from the perspectives of Judaism and Islam. Beyond these theological deliberations, the metaphorical and religious meaning of the human heart, which may have an impact on the societal acceptability of xenotransplantation, as well as the Christian notion of compassion regarding animals, is analyzed from the perspective of historical sciences. According to the perspectives of Christianity, Judaism, and Islam, there are no specifically religious fundamental and generally binding reasons to prohibit xenotransplantation as a means of treating grave and life-threatening organ insufficiencies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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.

Ethical Challenges of Randomized Violence Intervention Trials: Examining the SHARE intervention in Rakai, Uganda

PubMed Central

Wagman, Jennifer A.; Paul, Amy; Namatovu, Fredinah; Ssekubugu, Robert; Nalugoda, Fred

2016-01-01

Objective We identify complexities encountered, including unanticipated crossover between trial arms and inadequate ‘standard of care’ violence services, during a cluster randomized trial (CRT) of a community-level intimate partner violence (IPV) and HIV prevention intervention in Uganda. Methods Concepts in public health ethics - beneficence, social value of research, fairness, standard of care, and researcher responsibilities for post-trial benefits - are used to critically reflect on lessons learned and guide discussion on practical and ethical challenges of violence intervention CRTs. Results Existing ethical guidelines provide incomplete guidance for responding to unexpected crossover in CRTs providing IPV services. We struggled to balance duty of care with upholding trial integrity, and identifying and providing appropriate standard of care. While we ultimately offered short-term IPV services to controls, we faced additional challenges related to sustaining services beyond the ‘short-term’ and post-trial. Conclusion Studies evaluating community-level violence interventions, including those combined with HIV reduction strategies, are limited yet critical for developing evidence-based approaches for effectively preventing IPV. Although CRTs are a promising design, further guidance is needed to implement trials that avoid introducing tensions between validity of findings, researchers’ responsibilities to protect participants, and equitable distribution of CRT benefits. PMID:27453794

Inclusion and exclusion in nutrigenetics clinical research: ethical and scientific challenges.

PubMed

Hurlimann, T; Stenne, R; Menuz, V; Godard, B

2011-01-01

There are compelling reasons to ensure the participation of ethnic minorities and populations of all ages worldwide in nutrigenetics clinical research. If findings in such research are valid for some individuals, groups, or communities, and not for others, then ethical questions of justice--and not only issues of methodology and external validity--arise. This paper aims to examine inclusion in nutrigenetics clinical research and its scientific and ethical challenges. In total, 173 publications were identified through a systematic review of clinical studies in nutrigenetics published between 1998 and 2007. Data such as participants' demographics as well as eligibility criteria were extracted. There is no consistency in the way participants' origins (ancestry, ethnicity, or race) and ages are described in publications. A vast majority of the studies identified was conducted in North America and Europe and focused on 'white' participants. Our results show that pregnant women (and fetuses), minors, and the elderly (≥ 75 years old) remain underrepresented. Representativeness in nutrigenetics research is a challenging ethical and scientific issue. Yet, if nutrigenetics is to benefit whole populations and be used in public and global health agendas, fair representation as well as clear descriptions of participants in publications are crucial. Copyright © 2012 S. Karger AG, Basel.

A community-based participatory research study of HIV and HPV vulnerabilities and prevention in two Pacific Islander communities: ethical challenges and solutions.

PubMed

DiStefano, Anthony; Peters, Ruth; Tanjasiri, Sora Park; Quitugua, Lourdes; Dimaculangan, Jeany; Hui, Brian; Barrera-Ng, Angelica; Vunileva, 'Isileli; Tui'one, Vanessa; Takahashi, Lois

2013-02-01

We describe ethical issues that emerged during a one-year CBPR study of HIV and human papillomavirus (HPV) vulnerabilities and prevention in two Pacific Islander (PI) communities, and the collaborative solutions to these challenges reached by academic and community partners. In our project case study analysis, we found that ethical tensions were linked mainly to issues of mutual trust and credibility in PI communities; cultural taboos associated with the nexus of religiosity and traditional PI culture; fears of privacy breaches in small, interconnected PI communities; and competing priorities of scientific rigor versus direct community services. Mutual capacity building and linking CBPR practice to PI social protocols are required for effective solutions and progress toward social justice outcomes.

Clinical report--guidelines for the ethical conduct of studies to evaluate drugs in pediatric populations.

PubMed

Shaddy, Robert E; Denne, Scott C

2010-04-01

The proper ethical conduct of studies to evaluate drugs in children is of paramount importance to all those involved in these types of studies. This report is an updated revision to the previously published guidelines from the American Academy of Pediatrics in 1995. Since the previous publication, there have been great strides made in the science and ethics of studying drugs in children. There have also been numerous legislative and regulatory advancements that have promoted the study of drugs in children while simultaneously allowing for the protection of this particularly vulnerable group. This report summarizes these changes and advances and provides a framework from which to guide and monitor the ethical conduct of studies to evaluate drugs in children.

Ethical Decisions in Turbulent Times

ERIC Educational Resources Information Center

Shapiro, Joan Poliner; Gross, Steven Jay; Shapiro, Susan H.

2008-01-01

Education leaders make difficult ethical decisions each day. Using the story of a preschool director in lower Manhattan on September 11, 2001, the authors detail a series of paradigms to help educational leaders navigate rationally through challenging and complex circumstances when they are under considerable emotional stress. One approach which…

"Put on a Happy Face"

ERIC Educational Resources Information Center

Morris, Michael

2004-01-01

All evaluators face the challenge of striving to adhere to the highest possible standards of ethical conduct. Translating the AEA's Guiding Principles and the Joint Committee's Program Evaluation Standards into everyday practice, however, can be a complex, uncertain, and frustrating endeavor. Moreover, acting in an ethical fashion can require…

Implementation of Ethical Higher Education Marketing

ERIC Educational Resources Information Center

Gibbs, Paul; Murphy, Patrick

2009-01-01

With consumerism changing students to customers and teachers to service providers, ever more vulnerable and naive students enroll and, instead of collaboration between institutions, there is competition. There has been a call in the literature to face these challenges through ethical leadership in universities. Specifically, concern has been…

Facebook: Maintaining Ethical Practice in the Cyberspace Age

ERIC Educational Resources Information Center

Birky, Ian; Collins, Wanda

2011-01-01

Current technology provides counseling center clinicians regular and immediate access to the students they work with via social networking. Focusing on Facebook in particular, this article discusses the opportunities and challenges this access creates and specifically explores how utilization of ethical, clinical, and cultural lenses might affect…

Preparing for the Learning Organization.

ERIC Educational Resources Information Center

Salner, Marcia

1999-01-01

A seminar to prepare students for learning organizations was based on Perry's theory of intellectual and ethical development. Developmental assignments were designed to assist cognitive growth and self-awareness. Challenges arose from differences in group composition (younger or mixed-age students) and the ethics of attempting to alter students'…

Health and wellness policy ethics.

PubMed

Cavico, Frank J; Mujtaba, Bahaudin G

2013-08-01

This perspective is an ethical brief overview and examination of "wellness" policies in the modern workplace using practical examples and a general application of utilitarianism. Many employers are implementing policies that provide incentives to employees who lead a "healthy" lifestyle. The authors address how these policies could adversely affect "non-healthy" employees. There are a wide variety of ethical issues that impact wellness policies and practices in the workplace. The authors conclude that wellness programs can be ethical, while also providing a general reflective analysis of healthcare challenges in order to reflect on the externalities associated with such policies in the workplace.

Spinning a stem cell ethics web.

PubMed

McDonald, Michael; Longstaff, Holly

2013-01-01

The goal of this study was to provide an ethics education resource for trainees and researchers in the Canadian Stem Cell Network that would address the multiple ethical challenges in stem cell research including accountability in and for research across its multiple dimensions. The website was built using a bottom-up type approach based on an ethics needs assessment in combination with a top-down expert-driven component. There have been 3,615 visitors to the website since it was launched in July, 2011. The ongoing rate of returning visitors (20%) indicates that the website is becoming a valuable tool used multiple times.

Engineering ethics in Puerto Rico: issues and narratives.

PubMed

Frey, William J; O'Neill-Carrillo, Efraín

2008-09-01

This essay discusses engineering ethics in Puerto Rico by examining the impact of the Colegio de Ingenieros y Agrimensores de Puerto Rico (CIAPR) and by outlining the constellation of problems and issues identified in workshops and retreats held with Puerto Rican engineers. Three cases developed and discussed in these workshops will help outline movements in engineering ethics beyond the compliance perspective of the CIAPR. These include the Town Z case, Copper Mining in Puerto Rico, and a hypothetical case researched by UPRM students on laptop disposal. The last section outlines four future challenges in engineering ethics pertinent to the Puerto Rican situation.

A day in the life of a junior doctor: everyday ethical encounters.

PubMed

Quarini, Catherine J

2010-11-01

This paper presents a hypothetical 'day in the life' of junior doctors working on a busy hospital ward. It illustrates the fact that, although the everyday ethical encounters faced by doctors are generally not as dramatic as some of the ethical issues discussed at medical school, the underlying principles, such as consent, confidentiality and resource allocation, are highly relevant to daily practice. After presenting some of the ethical challenges faced by junior doctors, from patients confused by poor explanations to inadequate consent procedures, the paper ends with suggestions on how to improve the situation.

Participatory action research: considerations for ethical review.

PubMed

Khanlou, N; Peter, E

2005-05-01

This paper addresses the distinctive nature of participatory action research (PAR) in relation to ethical review requirements. As a framework for conducting research and reducing health disparities, PAR is gaining increased attention in community and public health research. As a result, PAR researchers and members of Research Ethics Boards could benefit from an increased understanding of the array of ethical concerns that can arise. We discuss these concerns in light of commonly held ethical requirements for clinical research (social or scientific value, scientific validity, fair subject/participant selection, favourable risk-benefit ratio, independent review, informed consent, and respect for potential and enrolled participants) and refer to guidelines specifically developed for participatory research in health promotion. We draw from our community-based experiences in mental health promotion research with immigrant and culturally diverse youth to illustrate the ethical advantages and challenges of applying a PAR approach. We conclude with process suggestions for Research Ethics Boards.

Teaching Engineering Ethics to PhD Students: A Berkeley-Delft Initiative : Commentary on "Ethics Across the Curriculum: Prospects for Broader (and Deeper) Teaching and Learning in Research and Engineering Ethics".

PubMed

Taebi, Behnam; Kastenberg, William E

2016-07-13

A joint effort by the University of California at Berkeley and Delft University of Technology to develop a graduate engineering ethics course for PhD students encountered two types of challenges: academic and institutional. Academically, long-term collaborative research efforts between engineering and philosophy faculty members might be needed before successful engineering ethics courses can be initiated; the teaching of ethics to engineering graduate students and collaborative research need to go hand-in-hand. Institutionally, both bottom-up approaches at the level of the faculty and as a joint research and teaching effort, and top-down approaches that include recognition by a University's administration and the top level of education management, are needed for successful and sustainable efforts to teach engineering ethics.

Should professional ethics education incorporate single-professional or interprofessional learning?

PubMed

Caldicott, Catherine V; Braun, Eli A

2011-03-01

Since ethical issues in the contemporary delivery of health care involve doctors, nurses, technicians, and members of other health professions, the authors consider whether members of diverse health care occupations might benefit from studying ethics in a single classroom. While interprofessional courses may be better at teaching the ethics of the relationships between and among the various health professions, single-professional courses may be better at teaching the ethics of relationships between particular kinds of professionals and patients. An ethics instructor's professional discipline affects his/her credibility with the students, and the course readings may not always be relevant to the actual work of a given discipline. With these challenges in mind, the authors suggest that the boundaries of ethics education in the health professions be reconceived to accommodate the professional mission of a specific discipline as well as the interdependence and collaboration that marks high quality health care.

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.

Measuring 'virtue' in medicine.

PubMed

Kotzee, Ben; Ignatowicz, Agnieszka

2016-06-01

Virtue-approaches to medical ethics are becoming ever more influential. Virtue theorists advocate redefining right or good action in medicine in terms of the character of the doctor performing the action (rather than adherence to rules or principles). In medical education, too, calls are growing to reconceive medical education as a form of character formation (rather than instruction in rules or principles). Empirical studies of doctors' ethics from a virtue-perspective, however, are few and far between. In this respect, theoretical and empirical study of medical ethics are out of alignment. In this paper, we survey the empirical study of medical ethics and find that most studies of doctors' ethics are rules- or principles-based and not virtue-based. We outline the challenges that exist for studying medical ethics empirically from a virtue-based perspective and canvas the runners and riders in the effort to find virtue-based assessments of medical ethics.

Assessing the Public’s Views in Research Ethics Controversies: Deliberative Democracy and Bioethics as Natural Allies

PubMed Central

Kim, Scott Y. H.; Wall, Ian F.; Stanczyk, Aimee; Vries, Raymond De

2010-01-01

In a Liberal Democracy, Policy Decisions regarding ethical controversies, including those in research ethics, should incorporate the opinions of its citizens. Eliciting informed and well-considered ethical opinions can be challenging. The issues may not be widely familiar and they may involve complex scientific, legal, historical, and ethical dimensions. Traditional surveys risk eliciting superficial and uninformed opinions that may be of dubious quality for policy formation. We argue that the theory and practice of deliberative democracy (DD) is especially useful in overcoming such inadequacies. We explain DD theory and practice, discuss the rationale for using DD methods in research ethics, and illustrate in depth the use of a DD method for a long-standing research ethics controversy involving research based on surrogate consent. The potential pitfalls of DD and the means of minimizing them as well as future research directions are also discussed. PMID:19919315

Assessing the public's views in research ethics controversies: deliberative democracy and bioethics as natural allies.

PubMed

Kim, Scott Y H; Wall, Ian F; Stanczyk, Aimee; De Vries, Raymond

2009-12-01

In a liberal democracy, policy decisions regarding ethical controversies, including those in research ethics, should incorporate the opinions of its citizens. Eliciting informed and well-considered ethical opinions can be challenging. The issues may not be widely familiar and they may involve complex scientific, legal, historical, and ethical dimensions. Traditional surveys risk eliciting superficial and uninformed opinions that may be of dubious quality for policy formation. We argue that the theory and practice of deliberative democracy (DD) is especially useful in overcoming such inadequacies. We explain DD theory and practice, discuss the rationale for using DD methods in research ethics, and illustrate in depth the use of a DD method for a longstanding research ethics controversy involving research based on surrogate consent. The potential pitfalls of DD and the means of minimizing them as well as future research directions are also discussed.

The agency problem and medical acting: an example of applying economic theory to medical ethics.

PubMed

Langer, Andreas; Schröder-Bäck, Peter; Brink, Alexander; Eurich, Johannes

2009-03-01

In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician-patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician-patient relationship in a descriptive heuristic sense. The principal-agent theory can be used to analytically grasp existing action problems in the physician-patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients' increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician's necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics.

Staff experiences of closing out a clinical trial involving withdrawal of treatment: qualitative study.

PubMed

Lawton, Julia; White, David; Rankin, David; Elliott, Jackie; Taylor, Carolin; Cooper, Cindy; Heller, Simon; Hallowell, Nina

2017-02-07

The ending of a clinical trial may be challenging, particularly if staff are required to withdraw the investigated treatment(s); however, this aspect of trial work is surprisingly under-researched. To address this gap, we explored the experiences of staff involved in closing out a trial that entailed withdrawal of treatment (insulin pumps) from some patients. Interviews were conducted with n = 22 staff, recruited from seven trial sites. Data were analysed thematically. Staff described a myriad of ethical and emotional challenges at closeout, many of which had been unforeseen when the trial began. A key challenge for staff was that, while patients gave their agreement to participate on the understanding that pump treatment could be withdrawn, they often found themselves benefitting from this regimen in ways they could not have foreseen. Hence, as the trial progressed, patients became increasingly anxious about withdrawal of treatment. This situation forced staff to consider whether the consent patients had given at the outset remained valid; it also presented them with a dilemma at closeout because many of those who had wanted to remain on a pump did not meet the clinical criteria required for post-trial funding. When deciding whether to withdraw treatment, staff not only had to take funding pressures and patient distress into account, but they also found themselves caught between an ethic of Hippocratic individualism and one of utilitarianism. These conflicting pressures and ethical considerations resulted in staff decision-making varying across the sites, an issue that some described as a further source of ethical unease. Staff concluded that, had there been more advanced planning and discussion, and greater accountability to an ethics committee, some of the challenges they had confronted at closeout could have been lessened or even prevented. The same kinds of ethical issues that may vex staff at the beginning of a trial (e.g. patients having unrealistic expectations of trial participation; staff experiencing conflicts between research and clinical roles) may re-present themselves at the end. To safeguard the wellbeing of staff and patients, greater planning, coordination and ethical oversight should go into the closeout of trials involving withdrawal of treatment(s). International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ISRCTN61215213 . Registered on 11 May 2011.

Ethical consequences for professionals from the globalization of food, nutrition and health.

PubMed

Solomons, Noel W

2002-01-01

Globalization is the process of increasing interconnections and linkages, within societies and across geography, due to improved communication and expanded world trade. It limits the differentiation wrought by human cultural evolution, and homogenizes health practices, diet and lifestyle. There are both beneficial and adverse consequences of the globalization process. Globalization also presents a challenge to the development of ethics for practice and advocacy by food and nutrition professionals. Among the related terms, 'morals', 'values' and 'ethics', the latter connotes the basic rules of conduct for interactions within society and with the inanimate environment; rules based on recognized principles (ethical principles). The application of these principles is to resolve ethical dilemmas that arise when more than one interest is at play. Recognized ethical principles include autonomy, beneficence, non-maleficence, justice, utility and stewardship. These can be framed in the context of issues that arise during advocacy for material and behavioural changes to improve the nutritional health of populations. Clearly, at the global level, codes of good conduct and the construction of good food governance can be useful in institutionalizing ethical principles in matters of human diets and eating practices. Ethical dilemmas arise in the context of innate diversity among populations (some individuals benefit, whereas others suffer from the same exposures), and due to the polarity of human physiology and metabolism (practices that prevent some diseases will provoke other maladies). Moreover, the autonomy of one individual to exercise independent will in addressing personal health or treatment of the environment may compromise the health of the individual's neighbours. The challenges for the professional in pursuit of ethical advocacy in a globalized era are to learn the fundamentals of ethical principles; to bear in mind a respect for difference and differentiation that continues to exist, and which should exist, among individuals and societies; and to avoid a total homogenization of agriculture and food supplies.

Human embryonic stem cell research: implications from an ethical and legal standpoint.

PubMed

Trepagnier, D M

2000-12-01

The purpose of this paper is to discuss the ethical and legal implications of one of the newest and most controversial medical breakthroughs. Stem cell research has been performed on mice for many years, but human embryonic stem cells are believed by scientists to be the basis for possible treatments and/or cures to many diseases affecting millions of people around the world. In order to perform research on human embryonic stem cells, numerous ethical issues must be addressed. Guidelines and protocols can be established in order to allow scientists to pursue new medical advances while maintaining the highest ethical standards in the use of human embryos. An alternative to using embryos is adult stem cells which have recently proven to be more versatile than previously believed. Opposing views will always be encountered when facing new science technologies. Where should the ethical line be drawn?

A fallacious jar? The peculiar relation between descriptive premises and normative conclusions in neuroethics.

PubMed

Wagner, Nils-Frederic; Northoff, Georg

2015-06-01

Ethical questions have traditionally been approached through conceptual analysis. Inspired by the rapid advance of modern brain imaging techniques, however, some ethical questions appear in a new light. For example, hotly debated trolley dilemmas have recently been studied by psychologists and neuroscientists alike, arguing that their findings can support or debunk moral intuitions that underlie those dilemmas. Resulting from the wedding of philosophy and neuroscience, neuroethics has emerged as a novel interdisciplinary field that aims at drawing conclusive relationships between neuroscientific observations and normative ethics. A major goal of neuroethics is to derive normative ethical conclusions from the investigation of neural and psychological mechanisms underlying ethical theories, as well as moral judgments and intuitions. The focus of this article is to shed light on the structure and functioning of neuroethical arguments of this sort, and to reveal particular methodological challenges that lie concealed therein. We discuss the methodological problem of how one can--or, as the case may be, cannot--validly infer normative conclusions from neuroscientific observations. Moreover, we raise the issue of how preexisting normative ethical convictions threaten to invalidate the interpretation of neuroscientific data, and thus arrive at question-begging conclusions. Nonetheless, this is not to deny that current neuroethics rightly presumes that moral considerations about actual human lives demand empirically substantiated answers. Therefore, in conclusion, we offer some preliminary reflections on how the discussed methodological challenges can be met.

Ethical issues of obesity surgery--a health technology assessment.

PubMed

Saarni, Samuli I; Anttila, Heidi; Saarni, Suoma E; Mustajoki, Pertti; Koivukangas, Vesa; Ikonen, Tuija S; Malmivaara, Antti

2011-09-01

New surgical technologies may challenge societal values, and their adoption may lead to ethical challenges. Despite proven cost-effectiveness, obesity (bariatric) surgery and its public funding have been questioned on ethical arguments relating to, for example, the self-inflicted or non-disease nature of obesity. Our aim was to analyze the ethical issues relevant to bariatric surgery. A comprehensive health technology assessment was conducted on bariatric surgery for morbid obesity using the EUnetHTA method, including a fully integrated ethical analysis. The ethical arguments suggesting that obesity should not be surgically treated because it is self-inflicted were rejected. Medicalization of obesity may have both positive and negative effects that impact the various stakeholders differently, thus being difficult to balance. Informing bariatric surgery patients and actively supporting their autonomy is exceptionally important, as the benefits and harms of both obesity and bariatric surgery are complex, and the outcome depends on how well the patient understands and adheres to the life-long changes in eating habits required. Justice considerations are important in organizing surgical treatment of obesity, as the obese are discriminated against in many ways and obesity is more common in socioeconomically disadvantaged populations who might have problems of access to treatments. Obesity should be treated like other diseases in health care, and obesity surgery rationed like other cost-effective treatments. Positive actions to ensure patient autonomy and just access to surgical treatments may be warranted.

Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent.

PubMed

Martinez-Martin, Nicole; Kreitmair, Karola

2018-04-23

This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer. ©Nicole Martinez-Martin, Karola Kreitmair. Originally published in JMIR Mental Health (http://mental.jmir.org), 23.04.2018.

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

Ethics of birth at the limits of viability: the risky business of prediction.

PubMed

Shinwell, Eric S

2015-01-01

Infants born at the limits of viability present neonatologists in particular and society in general with difficult challenges. Ethical and legal considerations establish a framework for action, although this varies between countries, departments and individuals and shows dynamic changes over time. This brief review includes a vignette telling a familiar story. In this case, the parents ask searching questions and the caring, knowledgeable neonatologist uses up-to-date information to offer empathic and thoughtful guidance - a challenge for all. © 2015 S. Karger AG, Basel.

Ethics in the Legal and Business Practices of Radiation Oncology.

PubMed

Wall, Terry J

2017-10-01

Ethical issues arise when a professional endeavor such as medicine, which seeks to place the well-being of others over the self-interest of the practitioner, meets granular business and legal decisions involved in making a livelihood out of a professional calling. The use of restrictive covenants, involvement in self-referral patterns, and maintaining appropriate comity among physicians while engaged in the marketplace are common challenges in radiation oncology practice. A paradigm of analysis is presented to help navigate these management challenges. Copyright © 2017 Elsevier Inc. All rights reserved.

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 Space Shuttle Disaster: Ethical Issues in Organizational Decision-Making.

ERIC Educational Resources Information Center

Kramer, Ronald C.; Jaksa, James A.

Arguing that the issue of organizational decision making and bureaucratic responsibility in the use of technologies with potential for creating social harm should concern everyone, this paper explores the ethical issues raised by organizational decisions concerning the launch of the space shuttle "Challenger." The paper first describes a…

Ethics Inside and Out: The Case of "Guidoriccio."

ERIC Educational Resources Information Center

Swan, John

1991-01-01

Discusses an apparent case of censorship via card catalog indexing in a Florentine research library. The challenge to the authenticity of a fresco by Simone Martini is explained, the ethics of collegiality are considered, and attempts to find redress through various library associations are recounted. (18 references) (LRW)

Employment Counseling and Organizational Ethical Values

ERIC Educational Resources Information Center

Valentine, Sean

2004-01-01

Employment counseling is commonly used in companies to assist employees with various personal and professional challenges that are confronted in the workplace. Such guidance could affect the degree to which employees believe a company proactively supports an ethical orientation; the purpose of this study was to explore this issue. A self-report…

Case Method Strategies for Teaching Sexual Ethics to Relativists and Skeptics

ERIC Educational Resources Information Center

Vacek, Edward

2017-01-01

Many undergraduates are culturally shaped to avoid making ethical judgments. They spontaneously adopt relativist and skeptical strategies such as "It all depends," or "Whose morality?" or "Who's to say?" as ways of fending off the challenge of making moral decisions. The current tsunami that is washing away…

Critical Thinking for Natural Resource, Agricultural, and Environmental Ethics Education

ERIC Educational Resources Information Center

Quinn, Courtney; Burbach, Mark E.; Matkin, Gina S.; Flores, Kevin

2009-01-01

Future decision makers in natural resource fields will be required to make judgments on issues that lack clear solutions and with information complicated by ethical challenges. Therefore, natural resource, environmental, and agricultural professionals must possess the ability to think critically about the consequences of policy, economic systems,…

Postmortem Confidentiality: An Ethical Issue

ERIC Educational Resources Information Center

Bradley, Loretta J.; Hendricks, Bret; Kabell, Douglas R.

2011-01-01

In an era of increased need and expectation for confidentiality, the counseling record of the deceased client challenges confidentiality. Using ethical codes and legal mandates, the authors explore whether the counseling record of a deceased client should be released when the client's will and the client's counseling records are silent on this…

Code of ethics for the national pharmaceutical system: Codifying and compilation

PubMed Central

Salari, Pooneh; Namazi, Hamidreza; Abdollahi, Mohammad; Khansari, Fatemeh; Nikfar, Shekoufeh; Larijani, Bagher; Araminia, Behin

2013-01-01

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conduct was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conduct is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended. PMID:24174954

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.

Examining why ethics is taught to veterinary students: a qualitative study of veterinary educators' perspectives.

PubMed

Magalhães-Sant'Ana, Manuel; Lassen, Jesper; Millar, Kate M; Sandøe, Peter; Olsson, I Anna S

2014-01-01

Although it is widely agreed that veterinary students need to be introduced to ethics, there is limited empirical research investigating the reasons why veterinary ethics is being taught. This study presents the first extensive investigation into the reasons for teaching veterinary ethics and reports data collected in semi-structured interviews with educators involved in teaching undergraduate veterinary ethics at three European schools: the University of Copenhagen, the University of Nottingham, and the Technical University of Lisbon (curricular year 2010-2011). The content of the interview transcripts were analyzed using Toulmin's argumentative model. Ten objectives in teaching veterinary ethics were identified, which can be grouped into four overarching themes: ethical awareness, ethical knowledge, ethical skills, and individual and professional qualities. These objectives include recognizing values and ethical viewpoints, identifying norms and regulations, developing skills of communication and decision making, and contributing to a professional identity. Whereas many of the objectives complement each other, there is tension between the view that ethics teaching should promote knowledge of professional rules and the view that ethics teaching should emphasize critical reasoning skills. The wide range of objectives and the possible tensions between them highlight the challenges faced by educators as they attempt to prioritize among these goals of ethics teaching within a crowded veterinary curriculum.

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

PubMed

Bain, Luchuo Engelbert

2017-01-01

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

Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK.

PubMed

Phelps, Kay; Regen, Emma; Oliver, David; McDermott, Chris; Faull, Christina

2017-06-01

Ventilatory support has benefits including prolonging survival for respiratory failure in motor neurone disease (MND). At some point some patients may wish to stop the intervention. The National Institute of Health and Care Excellence (NICE) guidance recommends research is needed on ventilation withdrawal. There is little literature focusing on the issues doctors encounter when withdrawing ventilation at the request of a patient. To identify and explore with doctors the ethical and legal issues that they had encountered in the withdrawal of ventilation at the request of a patient with MND. A retrospective thematic analysis of interviews of 24 doctors (including palliative care, respiratory, neurology and general practice) regarding their experiences with withdrawal of ventilation support from patients with MND. Respondents found withdrawal of ventilation at the request of patients with MND to pose legal, ethical and moral challenges in five themes: ethical and legal rights to withdrawal from treatment; discussions with family; discussions with colleagues; experiences of legal advice; issues contributing to ethical complexity. Though clear about the legality of withdrawal of treatment in theory, the practice led to ethical and moral uncertainty and mixed feelings. Many respondents had experienced negative reactions from other healthcare professionals when these colleagues were unclear of the distinction between palliation of symptoms, withdrawal of treatment and assisted death. Legal, ethical and practical guidance is needed for professionals who support a patient with MND who wishes to withdraw from ventilation. Open discussion of the ethical challenges is needed as well as education and support for professionals. 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.

Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK

PubMed Central

Phelps, Kay; Regen, Emma; Oliver, David; McDermott, Chris; Faull, Christina

2017-01-01

Background Ventilatory support has benefits including prolonging survival for respiratory failure in motor neurone disease (MND). At some point some patients may wish to stop the intervention. The National Institute of Health and Care Excellence (NICE) guidance recommends research is needed on ventilation withdrawal. There is little literature focusing on the issues doctors encounter when withdrawing ventilation at the request of a patient. Aim To identify and explore with doctors the ethical and legal issues that they had encountered in the withdrawal of ventilation at the request of a patient with MND. Method A retrospective thematic analysis of interviews of 24 doctors (including palliative care, respiratory, neurology and general practice) regarding their experiences with withdrawal of ventilation support from patients with MND. Results Respondents found withdrawal of ventilation at the request of patients with MND to pose legal, ethical and moral challenges in five themes: ethical and legal rights to withdrawal from treatment; discussions with family; discussions with colleagues; experiences of legal advice; issues contributing to ethical complexity. Though clear about the legality of withdrawal of treatment in theory, the practice led to ethical and moral uncertainty and mixed feelings. Many respondents had experienced negative reactions from other healthcare professionals when these colleagues were unclear of the distinction between palliation of symptoms, withdrawal of treatment and assisted death. Conclusions Legal, ethical and practical guidance is needed for professionals who support a patient with MND who wishes to withdraw from ventilation. Open discussion of the ethical challenges is needed as well as education and support for professionals. PMID:26362794

Ethical considerations for the design and implementation of child injury prevention interventions: the example of delivering and installing safety equipment into the home.

PubMed

Scholtes, Beatrice; Schröder-Bäck, Peter

2017-12-11

Public health ethics is a growing field of academic interest but ethical discussion of injury prevention seems to have received limited attention. Interventions that promise to be effective are not necessarily-without explicit justification-'good' and 'right' interventions in every sense. This paper explores public health ethics in the context of child injury prevention with the objective to initiate interdisciplinary dialogue on the ethics of child safety interventions. A framework of seven public health ethics principles (non-maleficence, health maximisation, beneficence, respect for autonomy, justice, efficiency and proportionality) were applied to an intervention to promote child safety in the home. Preventing child injury in the home is ethically challenging due to the requirement for the state to intervene in the private sphere. Non-maleficence and beneficence are difficult to judge within this intervention as these are likely to be highly dependent on the nature of intervention delivery, in particular, the quality of communication. Respect for autonomy is challenged by an intervention occurring in the home. The socioeconomic gradient in child injury risk is an important factor but a nuanced approach could help to avoid exacerbating inequalities or stigmatisation. Equally, a nuanced approach may be necessary to accommodate the principles of proportionality and efficiency within the local context. We conclude that this intervention is justifiable from an ethical perspective but that this type of reflection loop is helpful to identify the impact of interventions beyond effectiveness. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.