Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Ethical Analysis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed1989

Ethical decision making in clinical practice.

Contemporary nursing ethics education focuses on the use of an analytical model of ethical decision making for both its process and its content. Perhaps this is the case because it bears some resemblance to the nursing process, which is taught in a similar fashion. Thus, a deductivist method of ethical decision making fits within the same general schema of the hypotheticodeductive method of decision making that is taught for nursing diagnosis. Ethics requires that nurses respect persons, inform patients and secure their consent, not inflict harm, preserve the patient's quality of life, prevent harm and remove harmful conditions, do good for patients, and minimize risk to themselves. These are among the norms of obligation that guide ethical analysis and judgment in nursing practice and are the substance of the analytical model of ethical decision making. Nursing's ethics has established high ideals and strong demands for nurses. These are demands which nurses have met and ideals which have often been realized. Whatever the strength of our science, nursing is an inherently moral endeavor and is only as strong as its commitment to its ethical obligations and values. Between the grinding edges of the forces that affect it, nursing must establish its priorities among the aspects of its environment that it attempts to control. Ethics must be chief among those priorities.

Beneficence↗
PubMed1989

Court-ordered cesarean section: an analysis of ethical concerns in compelling cases.

Two previously unreported cases are presented in which court-ordered cesarean sections were considered appropriate by physicians. An analysis of the factors that compel physicians to deem court-ordered intervention appropriate is presented. When the significance of a third-trimester fetal death or a lifetime physical or mental disability is balanced against the demand to uphold maternal autonomy at all costs, the recognized ethical principles of beneficence, nonmaleficence, justice, obstetric contract keeping, and acting in the patients' best interests combine, in rare situations, to override concerns for individual maternal autonomy and justify court-ordered intervention.

Adult↗
PubMed2004

Argument-based medical ethics: a formal tool for critically appraising the normative medical ethics literature.

Although there are critical appraisal tools for other genres of the medical literature, there currently is no formal tool for physicians to use in their critical appraisal of the normative medical ethics literature. We present a formal assessment tool for the critical appraisal of the normative medical ethics literature that incorporates the intellectual standards of argument-based medical ethics and evidence-based medicine. We draw on the intellectual standards of argument-based ethics, ethical analysis and argument, and the literature on evidence-based medicine. The tool involves 4 questions about normative medical ethics papers: (1) Does the article address a focused ethics question? (2) Are the arguments that support the results of the article valid? (3) What are the results? (4) Will the results help me in clinical practice? Obstetrician-gynecologists can use this tool to appraise the normative literature of ethics in obstetrics and gynecology formally.

Ethical Analysis↗
PubMedDate not supplied

Ethics and mental health service delivery under managed care.

The delivery of mental health services under managed care takes on different dimensions affecting the ethical considerations of providers and patients. In this article, we explore five key issues that are especially relevant to the psychiatric population: conflict of interest, confidentiality, patients' rights, underserved patients and allocation, and levels of ethical analysis. Implications for nursing are also discussed.

Delivery of Health Care↗
PubMed1999

The case for managed care: reappraising medical and socio-political ideals.

The arguments against managed care can be divided into two general clusters. One cluster concerns the way managed care undermines the ethical ideals of medical professionalism. Since those ideals largely focus on the physician-patient relation, the first cluster comes under the rubric of micro-ethics; namely, the ethics of individual-individual relations. The second cluster of criticisms focuses on macro-ethical issues, primarily on issues of justice and policy. By reviewing these arguments, it becomes clear that managed care does not easily fit within traditional modes of ethical analysis. It poses a radical challenge to current medical and socio-political norms, and even resists the distinction between micro- and macro-ethical domains, a distinction that reflects the private/public distinction. Managed care organizations call for a third way, an inter-ethic for middle level organizations. The essays in this Journal provide a first step in this radical reassessment, laying the foundation for an organizational ethic that is responsive to the realities and promise of managed care.

Ethical Analysis↗
PubMed1992

Systems ethics and the history of medical ethics.

This paper reviews the current conclusions in medical ethics which have followed the 1969-1970 Medical Ethics Discontinuity, a break that challenged the Hippocratic way of thinking about ethics. The resulting dislocations in quality of care and the medical value system are discussed, and an alternative medical ethics is offered: Systems Ethics. A methodology for a Systems Ethics analysis of cases is presented and illustrated by the case of a physician-assisted suicide. The advantages, both theoretical and clinical, of a Systems Ethics approach to medicine, which is an expansion of the Hippocratic tradition in medical ethics, are developed. Using Systems Ethics, it is possible to avoid the dangers of legalism, bureaucratic ethics, utilitarian cost cutting, and "political correctness" in medical ethics.

Beneficence↗
PubMed2003

'No-suicide contracts' and informed consent: an analysis of ethical issues.

The 'no-suicide contract' is a frequently utilized tool in both the assessment and dispersal of suicidal patients. However, little attention has been given to questioning whether suicidal persons are able to give informed consent to enter such a contract. This article utilizes both the existing literature on no-suicide contracts and the results of recent research into the effects of this tool, to examine whether its use is consistent with the legal and ethical doctrine of informed consent. Particular attention is given to issues of competence, fullness of information, voluntariness and paternalistic intervention when no-suicide contracts are used. This analysis finds the tool to be problematic and suggests that individual patients' ability to give informed consent about a no-suicide contract needs to be carefully considered by clinicians.

Adolescent↗
PubMed1997

Complexity of ethical decision making in psychiatry.

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.

Altruism↗
PubMed1988

Two ethical approaches to research on human beings.

Since World War II the Catholic Church and national and international study groups have issued separate sets of statements regarding the ethics of research involving human subjects. The Church and the study groups agree on several points, including the following: Research on human subjects is a vital part of scientific medicine. Ethical research requires the informed consent of the subject or proxy. Research on human subjects is therapeutic or nontherapeutic. The risk of harm involved in research must be considered in regard to the potential benefit. Research on human beings should be allowed only after appropriate research on animals. Researchers should practice equity in selecting subjects and scientific problems to be studied. The human subject or proxy should be free to withdraw from the research program at any time. The two sets of statements generally disagree about nontherapeutic research on embryos and about genetic research. They also disagree on the use of in vitro fertilization and embryo transplants to initiate pregnancy. The disagreements are due to dissimilar ethical systems. The Church bases ethical analysis on a study of the effect an action has on basic human goods. As a result of this analysis, the Church maintains that some human actions are good or evil in themselves. If the action is evil insofar as the natural needs and functions of a person are concerned, it is not ethically good simply because it results in a good outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Advisory Committees↗
PubMed1993

How to critically evaluate positions on obstetric ethics.

We identify three tools for the critical evaluation of positions on obstetric ethics. The first is the distinction between descriptive and normative obstetric ethics. The second comprises the "Six Cs" of rigorous ethical analysis and argument: clarity, consistency, coherence, clinical applicability, clinical adequacy and completeness. The third is the avoidance of pitfalls that might arise from failing to acknowledge the inherent limitations of fields that contribute to normative obstetric ethics: law, region, professional consensus, uses of authority and philosophy.

Bioethical Issues↗
PubMed1991

HIV-infected psychiatric patients: beyond confidentiality.

The AIDS epidemic calls for an ethical analysis of conflicting obligations surrounding HIV-infected psychiatric patients and confidentiality, as well as issues that go beyond confidentiality. Although laws pertaining to HIV infection have been enacted in a number of states, these statutes leave much discretion to health professionals. The ethical principle known as "the harm principle" can permit disclosure of confidential information and detention or isolation of psychiatric patients who pose a threat of infecting other patients. From an ethical point of view, however, the circumstances under which traditional protections may be weakened or abandoned remain limited.

AIDS Serodiagnosis↗
PubMedDate not supplied

[Hunger, solidarity, and ethics: discourse analysis of the movement Citizen's Action against Hunger and Poverty and for Life].

The article analyzes the discourse of Citizen's Action against Hunger and Poverty and for Life, a social movement led by sociologist Herbert de Souza (Betinho) that was at its peak between 1993 and 1994. From the perspective of certain concepts and principles introduced and disseminated by so-called bio-ethics, the present study identifies within this campaign an attempt to construct a social movement in Brazil displaying characteristics quite similar to those associated with 'practical ethics'. These features are apparent in the three major principles that the movement applied as strategies for fighting hunger and poverty - to wit, solidarity, partnership, and decentralization.

Brazil↗
PubMed1999

Health care rationing in the aged: ethical and clinical perspectives.

This article provides an ethical analysis of the question of whether aged patients' access to health care should be less than, the same or greater than, the access younger patients enjoy, when economic resources are limited. This topic is being urgently considered in the US because managed care is becoming more common and brings with it new challenges to traditional medical ethics, and because the prevalence of the aged is increasing as is the number of patients with Alzheimer's disease (AD). It is also critical throughout the world because new findings suggest that the progression of AD may be retarded or even reversed by providing patients with enriched interpersonal environments. If these findings are valid, it would be inhumane to not consider providing these resources to patients with AD, since these gains would be so meaningful and substantial. Deontological and consequential values influencing this question are presented and evaluated. The theories of Veatch, Callahan and Daniels in regard to allocating health care to the aged are discussed. It is argued that 2 subgroups of aged patients, the isolated and demented, are among the patients worst off because the capacity to enjoy meaningful relationships with others supercedes all others and both groups of patients have lost this capacity. We assert that, on the basis of the principle of justice according to need, these 2 groups of patients' exceptional needs should be prioritised. We then raise the question of whether the majority of the population would be willing to provide these isolated and demented aged patients this care if the new findings proved valid. We conclude that, in light of many people's fear of growing old and dying, and some peoples bias against the aged (particularly in the US), willingness to provide the necessary resources is open to debate. Finally, we provide specific examples of the kinds of interventions which might be optimal for each group of patients. For patients who are cognitively unimpaired, this might be providing home care so that they could remain closer to and in contact with their loved ones. For patients who are cognitively impaired, this might be providing interpersonal support when these patients begin to lose control, rather than applying restraints or using psychotropic medication.

Aged↗
PubMedDate not supplied

The fetus as a patient: an essential ethical concept for maternal-fetal medicine.

The objective of this paper is to provide an ethical analysis of the concept of the fetus as a patient and to identify the clinical implications of this concept for maternal-fetal medicine. The principles of beneficence and respect for autonomy are applied to the viable and previable fetus. We argue that the viable fetus is a fetal patient. The previable fetus is a fetal patient only when the pregnant woman confers such status on it. When the fetus is a patient, directive counseling for fetal benefit is ethically justified. When the fetus is not a patient, counseling should be non-directive.

Beneficence↗
PubMed2006

Rationing in the intensive care unit.

BACKGROUND: Critical care services represent a large and growing proportion of health care expenditures. Limiting the magnitude of these costs while maintaining a just allocation of these services will require rationing. We define rationing as "the allocation of healthcare resources in the face of limited availability, which necessarily means that beneficial interventions are withheld from some individuals." Although some have maintained that rationing of health care is unethical, we argue that rationing is not only unavoidable but essential to ensuring the ethical distribution of medical goods and services. PRINCIPAL FINDINGS: Intensivists have little to guide them in the rationing of critical care services. We have developed a taxonomy of the rationing choices faced by intensivists as a framework for ethical analysis. This taxonomy divides rationing decisions into three categories. First are those rationing decisions that may be justified by external constraints (such as not prescribing a potentially beneficial medication because it is not available on the hospital formulary). Second are those that may be justified by reference to clinical guidelines (as, for example, not prescribing a potentially beneficial medication because a valid guideline recommends treatment with a less expensive alternative). Third are those that are justified by individual clinical judgment (such as choosing which of two patients should be admitted into the last ICU bed, in the absence of any evidence-based guidance). Judgments made on the basis of clinical judgment deserve particular scrutiny, since they may mask unethical prejudices or bias. CONCLUSIONS: Although this taxonomy does not by itself determine which decisions are ethical, it does clarify the type of evidence that is appropriate to supporting the decision that is made. Additional work is needed to elucidate how both empirical evidence and ethical analysis can further inform the rationing decisions that arise in the taxonomy described here.

Health Care Rationing↗