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PubMed1988

Food refusal amongst nursing home patients as conceptualized by nurses' aids and enrolled nurses: an interview study.

One hundred and forty-three nurses' aids and 48 enrolled nurses at nursing homes in Sweden were interviewed about food refusal among patients. It became evident that their concepts of 'food refusal' and 'forced feeding' were very vague. This could partly be explained by the lack of knowledge among staff of how to interpret the frequent ambiguous eating behaviours among demented patients. It has been suggested that concept clarification and ethical analysis might reduce anxiety among staff caring for patients with severe eating problems.

Ethics, Nursing↗
PubMed2006

Doctor-patient sexual relationships in medical oaths.

BACKGROUND: Doctor-patient sexual relationship is considered to be unfair because the first party would be abusing the second party's vulnerability. The prohibition of this relationship is noted in the Hippocratic oath. Currently, a reprise of the use of oaths in medical schools can be observed. AIM: To determine whether the prohibition has been maintained and how its expression has varied in the oaths during different periods. METHODS: 50 oaths were studied: 13 ancient-medieval and 37 modern-contemporary. Of the 50 texts, 19 were versions of the original oaths. The oaths that pointed out the prohibited doctor-patient relationship referred to any sexual aspect or included paragraphs that began as the Hippocratic oath does were noted. RESULTS: Of the 24 (48%) texts that expressed the prohibition, 8 (62%) were ancient-medieval and 16 (43%) were modern-contemporary. Some expressly call it Hippocratic oath, many use general terminology (corruption or vice) and others describe it in association with other commitments (abortion and euthanasia). CONCLUSIONS: The clause on the prohibition of the doctor-patient sexual relationship in Hippocratic oath was included to be for legal, economic and social reasons at the time. That the clause is found mostly in the ancient-medieval oaths can be attributed to the influence of the original. This commitment is generalised and associated with others by contemporary formulas. Currently, sexual relationships are the subject of legal and ethical analysis and their inclusion in the oaths is being debated.

Codes of Ethics↗
PubMed2004

Determining the reporting quality of RCTs in clinical pharmacology.

BACKGROUND: The Consolidated Standards for Reporting Trials (CONSORT) are recommendations for improving the quality of reports of randomized controlled trials (RCTs). OBJECTIVE: To determine the extent to which clinical pharmacology journals implement specific CONSORT recommendations. DESIGN AND SETTING: Analysis of RCTs published between May 2002 and May 2003 in four clinical pharmacology journals. MAIN OUTCOME MEASURES: Proportion of RCTs that published a participant flow diagram and that reported on randomization and restriction methods, allocation concealment, blinding, intention-to-treat analysis, ethical considerations, adverse events and source of funding. RESULTS: Of 482 clinical trials, 193 were RCTs. Healthy participants were involved in 129 [66.8%, 95% confidence interval (CI) 59.9, 73.1] trials, patients who required treatment in 61 (31.6%, 95% CI 25.4, 38.4) trials and both in three (1.6%, 95% CI 0.5, 4.4) trials. The following items were infrequently reported: sequence generation (17%), allocation concealment (3%), use of restriction (16%), description of blinding (26%), and flow diagrams of study participants (2%). In contrast, the following areas were often reported: use of intention-to-treat analysis (79%), description of withdrawals (92.2%) and description of adverse events (71%), ethics review (94%) and informed consent (95%). Sources of funding were reported in 56% of studies. CONCLUSION: The use of the selected CONSORT items is limited in these journals, possibly as many items may not be relevant to the types of studies published in clinical pharmacology journals. Further efforts are required to determine the applicability of CONSORT to RCTs in clinical pharmacology.

Humans↗
PubMed2003

Respect for the developmentally disabled and forgoing life-sustaining treatment.

A developmentally disabled person should be treated at all times as a unique individual and not as some anonymous "disabled person." The developmentally disabled should not be subjected to invasive medical treatment that is unduly burdensome or nonbeneficial, or be forced to endure a quality of life not meaningful to them as individuals. They have a right to refuse or accept treatment that a surrogate must exercise on behalf of each individual in a responsible and careful manner. Three cases and a preliminary approach to the ethical analysis of decisions to allow developmentally disabled persons to die by forgoing medical treatment are offered. The "best interests" of a developmentally disabled individual, properly understood, can serve as a useful and ethically defensible standard for determining the ethical propriety of surrogate decision making about forgoing life-sustaining medical treatment of the disabled.

Adolescent↗
PubMed2005

Ethics and interpreting in psychotherapy with refugee children and families.

Basic ethical principles like autonomy, non-maleficence, beneficence and justice should be taken into consideration step by step when treating refugee children and their families. These principles may be considered from the point of view of each of the actors involved--patient, therapist and interpreter. This paper is focused on the role of the interpreter and on different aspects to be considered by the therapist when working with interpreters in psychotherapeutic treatment of refugee children and families. Elements of case histories are used to illustrate situations faced in working with an interpreter. An ethical analysis of a case where a teenage refugee received therapeutic treatment using an interpreter is made.

Affect↗
PubMed1995

Aristotle, nursing and health care ethics.

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

Ethical Theory↗
PubMedDate not supplied

Physician collaboration dilemma.

This dilemma which was submitted to DCCN for review involves a collaboration problem between two physicians, the family, and a nurse with both legal and ethical implications. Following the case is a legal and an ethical analysis by DCCN consultants in these fields. This case is from a Neonatal Intensive Care Unit (NICU) setting, but these conflicts between medical departments occur in all critical care settings, so the key legal and ethical issues are applicable in all ICU settings.

Communication↗
PubMed2002

Ethical and economic issues in the use of zero-emission vehicles as a component of an air-pollution mitigation strategy.

The air pollution generated by motor vehicles and by static sources is, in certain geographic areas, a very serious problem, a problem that exists because of a failure of the marketplace. To address this marketplace failure, the State of California has mandated that by 2003, 10% of the Light-Duty Vehicle Fleet (LDV) be composed of Zero-Emission Vehicles (ZEVs). However, the policy-making process that was utilized to generate the ZEV mandate was problematic and the resulting ZEV mandate is economically unsound. Moreover, an ethical analysis, based primarily upon the work of John Rawls, suggests that implementation of the California ZEV mandate is--in spite of the wide latitude that ought to be given to policy decision makers--unethical. A more ethical and economically efficient approach to the pollution caused by marketplace failure is one that relies on market incentives and thereby achieves the desired improvement in air quality by appealing both to the self-interest of motorists and to those businesses that are directly or indirectly involved with the automobile industry. Such an approach would take better advantage of the creative forces of the market and improvements in technology over time and avoid the infringements on individual liberty and fairness embodied in the ZEV mandate.

Air Pollution↗
PubMed1992

Legal and ethical issues in HIV testing, Part 2.

In part 1 of this two-part series, legal and ethical issues in HIV testing were examined, such as the ELISA test, informed consent, confidentiality, and mandatory vs. voluntary testing. In this article, the author presents the most important legal and ethical concerns related to legislation for testing, testing in the workplace, Centers for Disease Control guidelines and recommendations, ethical analysis, and implications for nurse executives.

AIDS Serodiagnosis↗
PubMed2001

Getting scientists to think about what they are doing.

Research scientists are trained to produce specialised bricks of knowledge, but not to look at the whole building. Increasing public concern about the social role of science is forcing science students to think about what they are actually learning to do. What sort of knowledge will they be producing, and how will it be used? Science education now requires serious consideration of these philosophical and ethical questions. But the many different forms of knowledge produced by modern science cannot be covered by any single philosophical principle. Sociology and cognitive psychology are also needed to understand what the sciences have in common and the significance of what they generate. Again traditional modes of ethical analysis cannot deal adequately with the values, norms and interests activated by present-day technoscience without reference to its sociological, political and economic dimensions. What science education now requires is 'metascience', a discipline that extends beyond conventional philosophy and ethics to include the social and humanistic aspects of the scientific enterprise. For example, students need to learn about the practices, institutions, career choices, and societal responsibilities of research scientists, and to rehearse in advance some of the moral dilemmas that they are likely to meet. They need also to realise that science is changing rapidly, not only in its research techniques and organisational structures but also in its relationships with society at large.

Education↗
PubMed1999

Theoretical aids in teaching medical ethics.

Medical ethics could be better understood if some basic theoretical aspects of practices in health care are analysed. By discussing the underlying ethical principles that govern medical practice, the student should also become familiar with the notion that medical ethics is much more than the external application of socially accepted moral standards. Professions in general and medicine in particular have internal values that command their moral virtuosity at the same time as their technical excellence. Three examples where clinical practice can be clearly shown to require an ethical analysis are given: medical praxiology illustrates the motives, means and aims of physicians and patients; clinical decision-making as a practical syllogism that reaches prescriptive conclusions based on medical knowledge and the patient's wishes/intentions. Finally, diagnostics as an ethical bayesian approach is discussed, where the patient informedly decides the benefits and risks of further testing.

Diagnosis↗
PubMed2007

Inventors as investigators: the ethics of patents in clinical trials.

CONTEXT: The Bayh-Dole Act and renewed emphasis on translational research have stimulated patenting activities at universities. PURPOSE: To examine how different institutions manage possible patent-related conflicts of interest in human subjects research, and to provide an ethical analysis and recommendations. METHOD: Policies of nine major professional organizations, 13 of the largest recipients of federal biomedical funding in the United States and Canada, and 17 biomedical journals were canvassed. Disagreements in policies were used as the basis for analyzing the ethics of inventorship in clinical trials. RESULTS: Policies varied along three lines. First, some policies did not define patent inventorship as a potential conflict of interest. Second, some of those that did define it as such used licensing as a trigger for conflict of interest management. Third, several policies imposed presumptive restrictions on an investigator's participation in a trial involving his or her invention. CONCLUSIONS: The author defends on ethical grounds restrictive policies on patent holding in clinical trials and rejects objections to restrictive policies. The author recommends five policies: (1) any related patent holding should always be disclosed to IRBs and research subjects, (2) investigators who hold conflicting patents should be presumptively barred from certain activities in a study, (3) institutional interests in patents should be managed and disclosed to research subjects, (4) IRBs should also be informed of an investigator's filed (not just held) patents on an experimental agent, and (5) the stringency of policies should be adjusted according to a patent's earning potential and the risk associated with a study.

Academic Medical Centers↗
PubMed1991

Clinical skills for the 1990s: six lessons from HMO practice.

Clinical practice in health maintenance organizations (HMOs) currently has many of the features that will become increasingly common in the managed-care environment in which mental health treatment will be provided in the 1990s. HMO policies calling for cost containment, attention to outcomes, practice audits, and treatment guidelines create distinctive demands on clinicians regarding their focus of attention, clinical stance, and professional role. The author identifies six crucial skills that can help clinicians meet these demands effectively: population-oriented practice management, population-oriented program development, ability to apply an adult developmental model, command of a broad repertoire of methodologies, ethical analysis, and advocacy. He uses brief case examples to illustrate how these skills may be used in managed-care settings.

Clinical Competence↗
PubMed2000

Futilitarianism: knowing how much is enough in end-of-life health care.

The concept of futility is frequently invoked by doctors as providing ethical justification for the unilateral witholding/withdrawal of treatment of marginal benefit. The term now appears in many institutional policies. Yet it provokes controversy in its application, often being characterized as an unwarranted infringement of patient autonomy. This paper explores the substance of assertions of futility and attempts to dissect out the issues commonly intertwined in appeals to the concept. An ethical analysis of its component parts is presented using a principle-based approach to derive appropriate duties of care applicable in specific scenarios. The usefulness of the concept of futility is challenged and an alternative model is offered to deal with the ethical dilemmas posed by the availability of treatments of marginal benefit.

Ethics, Medical↗
PubMed2003

Research ethics committees in developing countries and informed consent: with special reference to Turkey.

Research ethics committees (RECs) are the institutional equivalent of institutional review boards (IRBs) with respect to their role in the ethical analysis of research projects. In Turkey, as in most developing countries, these committees were initiated as a result of pressure from the Western scientific community. Since their formation, RECs have faced problems because of an underdeveloped scientific culture and the absence of established ethical standards. On the one hand, the standards of the RECs and IRBs in the developed world seemed too hard to achieve; on the other, some of the international regulatory rules, such as respect for autonomy, are not culturally sensitive. In addition to problems facing RECs, researchers have had difficulties in fulfilling RECs' requisites. Respect for autonomy is a good example for Turkey. The social construct of Turkish society is not based on the Western concept of autonomy; it is based on "collective autonomy," which is completely different from the Western definition. Cultural interpretation of concepts is the perception of concepts effected by their cultural connections with other concepts. For example, "motherhood" as a concept has many cultural connections, so when it is used we have to consider those culturally determined contexts. In some countries, the familiar concept and term are kept separated from the one that is imported. In others, the imported concept alters the original concepts content. Although its course varies in different countries, it always puts extraordinary pressure on RECs and researchers in their relationship between themselves and other parties with conflicting interests. In this article, some of the main concerns of RECs in developing countries are discussed, with special reference to Turkey. The universality of regulatory norms is questioned and the importance of culturally sensitive and effective safeguards emphasized.

Ethics Committees↗
PubMed1999

Ethics, medicine and society: imperatives for the future.

Historically, medicine has been a caring profession and social factors have directly and indirectly affected clinical practice, yet the social roots of disease and suffering in patients and the ethics of patient care have often been left out of medical teaching and discussions at medical conferences. As health and social problems are inseparable, ethically, medicine and medical teaching need to respond to social suffering, and should help to solve the economic problems in health care. Further, since all intervention in the lives of human beings carries ethical content through the nature of care, ethical competence involving ethical analysis, critical thinking, and problem-solving should be developed in medical students and doctors simultaneously with clinical judgement and expertise.

Caribbean Region↗
PubMed1998

The internal morality of medicine: explication and application to managed care.

Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular.

Contracts↗
PubMed1997

Ethical aspects of prehospital CPR.

Obvious reasons to withhold CPR are signs of death or fatal trauma. If there is any doubt about the appropriateness of CPR, resuscitative measures should be performed. However, CPR should not be attempted like a reflex action, without considering the individual circumstances, the patient's preferences and his prognosis. Age or preexisting diseases are factors that might affect the withholding or withdrawing of CPR, although the decision should not be based solely on these factors, but on criteria with a better predictive value, such as the initial cardiac rhythm and the course of CPR application. Changes in cardiac rhythm might be of prognostic value, because rhythms other than ventricular tachycardia or fibrillation tend to predominate the longer an arrest is in progress. The outcome worsens with prolonged CPR. A termination of unsuccessful CPR after 30 to 45 minutes seems to be reasonable. With respect to the preservation of life as one of the main goals of medicine we have to accept the ethical dilemma that CPR is performed in a number of patients although retrospectively it turns out to have been inappropriate or unwanted by the patient. Nevertheless, therapeutic interventions might be stopped later on after additional information has been obtained. Ethical principles should be taken into account as an action guide when considering the decision to withhold or to terminate resuscitative efforts. However, a detailed and individual ethical analysis in case of conflict is difficult and often impossible in the prehospital emergency situation.

Age Factors↗