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At least 235 records · Page 13Linked to original sources
PubMed1997

Clinical pragmatism: a method of moral problem solving.

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.

Catholicism↗
PubMed2001

An ethics framework for public health.

More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed. To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community.

Bioethics↗
PubMed1993

Genetically modified animals: ethical issues.

The method of ethical analysis is reviewed and applied to questions relating to the unintended consequences, ownership, and metaphysical significance of genetically modified animals. The question of how genetics and recombinant DNA discoveries have an impact on human understanding of the moral community and the limits of acceptable action are emphasized. The potential for genetically modified animals presents a challenge to implicit norms for defining these boundaries. Four philosophical responses to this challenge are reviewed: fundamentalism, conventionalism, dualism, and naturalism. The naturalist response is most consistent with contemporary biology, but it also entails that animals have limited moral significance.

Agriculture↗
PubMed2005

Best interests, dementia, and end of life decision-making: the case of Mrs S.

In this paper, I present an ethical analysis of the case of an elderly woman with dementia, Mrs S. The hospital treating Mrs S sought to cease her dialysis treatment despite Mrs S's family's protestations that continuing the treatment was in her best interests. Assuming Brock's framework as a theoretical background, I consider the case in terms of three questions. Firstly, was 'best interests' the appropriate basis for deciding on a course of action in this situation? Secondly, assuming the appropriateness of a best interests principle, was it in Mrs S's best interests for the dialysis treatment to be withdrawn as the hospital suggested? And thirdly, if it was in Mrs S's best interests for dialysis to be withdrawn, was the hospital right to pursue this course of action in light of the family's disagreement? Based on the changes to the patient's 'self' associated with dementia, I argue that a best interests principle was appropriate, that continuing dialysis was not in Mrs S's best interests, and that the hospital should have pursued cessation of treatment, even in light of the family's contrary wishes.

Aged↗
PubMed1989

An analysis of ethics consultation in the clinical setting.

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.

Ethicists↗
PubMed2004

Control group selection in critical care randomized controlled trials evaluating interventional strategies: An ethical assessment.

BACKGROUND: Ethical concern has been raised with critical care randomized controlled trials in which the standard of care reflects a broad range of clinical practices. Commentators have argued that trials without an unrestricted control group, in which standard practices are implemented at the discretion of the attending physician, lack the ability to redefine the standard of care and might expose subjects to excessive harms due to an inability to stop early. OBJECTIVE: To develop a framework for analyzing control group selection for critical care trials. METHOD: Ethical analysis. RESULTS: A key ethical variable in trial design is the extent with which the control group adequately reflects standard care practices. Such a control group might incorporate either the "unrestricted" practices of physicians or a protocol that specifies and restricts the parameters of standard practices. Control group selection should be determined with respect to the following ethical objectives of trial design: 1) clinical value, 2) scientific validity, 3) efficiency and feasibility, and 4) protection of human subjects. Because these objectives may conflict, control group selection will involve trade-offs and compromises. Trials using a protocolized rather than an unrestricted standard care control group will likely have enhanced validity. However, if the protocolized control group lacks representativeness to standard care practices, then trials that use such groups will offer less clinical value and could provide less assurance of protecting subjects compared with trials that use unrestricted control groups. For trials evaluating contrasting strategies that do not adequately represent standard practices, use of a third group that is more representative of standard practices will enhance clinical value and increase the ability to stop early if needed to protect subjects. These advantages might come at the expense of efficiency and feasibility. CONCLUSION: Weighing and balancing the competing ethical objectives of trial design should be done for each trial.

Control Groups↗
PubMed2004

A qualitative analysis of ethical problems experienced by physicians and nurses in intensive care units in Turkey.

In this qualitative study, we aimed to identify and compare the ethical problems perceived by physicians and nurses in intensive care units at Baskent University hospitals in Turkey. A total of 21 physicians and 22 nurses were asked to describe ethical problems that they frequently encounter in their practice. The data were analyzed using an interactive model. The core problem for both physicians and nurses was end-of-life decisions (first level). In this category, physicians were most frequently concerned with euthanasia while nurses were more concerned with do-not-resuscitate orders (second level). At the third level, we saw that almost all of the participants' responses related to negative perceptions about euthanasia. Communication and hierarchical problems were the second most reported main category. Nurses were more likely to cite problems with hierarchy than physicians. At the third level, a large percentage of nurses described communication problems with authority and hierarchical problems with physicians. In the same category, physicians were most often concerned with communication problems with patients' relatives. The ethical problems were reported at different frequencies by physicians and nurses. We asked the participants about ethical decision-making styles. The results show that nurses and physicians do not follow a systematic pattern of ethical decision making.

Attitude of Health Personnel↗
PubMed2001

A comparative analysis of ethical development of student nurses registered for a basic degree and basic diploma programme in KwaZulu Natal.

A comparative descriptive study was conducted to establish whether the Comprehensive Basic Nursing Course (CBNC) is able to develop students ethically, and how educational preparation from two different programmes (basic degree and basic diploma) influence their ethical development. This study was conducted because of the concerns on the escalating number of litigations instituted against nurses. Several studies have indicated that some of these litigations are as a result of the growing complexity of the health care system and the society's increasing awareness of their human rights. Some studies have shown that nurses are failing to make principled and ethically sound decisions because they are inadequately prepared to handle ethical issues in an ethically responsible manner. A purposively selected sample of third and fourth year students from both programmes was used. Data was collected from both groups through the use of questionnaires. The findings revealed that the students are developing ethically in a CBNC but the level of ethical development is influenced by their educational preparation, teaching approaches and strategies used, clinical environment, hospital bureaucracy, rules and policies.

Adult↗
PubMed2001

Ethical aspects of substance abuse and intervention: reflecting on methadone maintenance in New Zealand.

Divergent perspectives of the nature of substance use have shaped societal attitudes and legislative action toward management of the implications of drug abuse and addiction at an individual and societal level. When it comes to substance abuse issues, policy and ethical analysis become intertwined. The current review entails an ethical evaluation of drug addiction, involving a comparison of different perspectives of substance use and an assessment of the treatment approaches and legal policies derived from these models. The aims of substance use policy directives will be ethically considered in terms of the balance of harm versus benefit, patient/client autonomy and rights and the duties or role of the health care provider in dealing with the problems of addiction.

Ethical Analysis↗