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PubMed2002

Imaginative ethics--bringing ethical praxis into sharper relief.

The empirical basis for this article is three years of experience with ethical rounds at Uppsala University Hospital. Three standard approaches of ethical reasoning are examined as potential explanations of what actually occurs during the ethical rounds. For reasons given, these are not found to be satisfying explanations. An approach called "imaginative ethics", is suggested as a more satisfactory account of this kind of ethical reasoning. The participants in the ethical rounds seem to draw on a kind of moral competence based on personal life experience and professional competence and experience. By listening to other perspectives and other experiences related to one particular patient story, the participants imagine alternative horizons of moral experience and explore a multitude of values related to clinical practice that might be at stake. In his systematic treatment of aesthetics in the Critique of Judgement, Kant made use of an operation of thought that, if applied to ethics, will enable us to be more sensitive to the particulars of each moral situation. Based on this reading of Kant, an account of imaginative ethics is developed in order to bring the ethical praxis of doctors and nurses into sharper relief. The Hebraic and the Hellenic traditions of imagination are used in order to illuminate some of the experiences of ethical rounds. In conclusion, it is argued that imaginative ethics and principle-based ethics should be seen as complementary in order to endow a moral discourse with ethical authority. Kantian ethics will do the job if it is remembered that Kant suggested only a modest, negative role of principle-based deliberation.

Ethical Analysis↗
PubMed1985

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

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?

Attitude to Death↗
PubMed1980

[Medical ethics and politics - one aspect of the history of medical ethics].

Medical ethics became a medical topic of its own in the 16th and 17th centuries as a part of what could be called "public medicine". They served the interests of University-trained doctors by strenghthening their autonomy and by submitting their rivals to medical control. The patients' interests are considered more or less identical with the doctor's. Towards the 19th century an ideologization of medical ethics is observable which has partly been responsible for the inhumane ethical concepts of certain of the 20th century collectivists as well as for certain inhumanities within individualistic ethics of our times and regions. When these ideologies became problematic the question of the relation between patient's and doctor's interests arose. For this and other reasons medical ethics have been rethought in the 60s of the present century. Increased attention has been paid to the realm of non-standardizable ethical behaviour. Thus "situation ethics" were conceived - and, more recently, "communication ethics" which arises from social interchange. Where his own interests are concerned, these ethical concepts require the doctor, not to pursue or deny them but simply to be aware of and to discuss them openly. The practical equivalent of communication ethics is the doctor's dialogue with a patient who personally looks after his own interests, as well as ethical commissions and interdisciplinary symposia on medical ethics. Thus medical ethics are again part of a "public medicine". This development is congruent with the interests of the medical profession insofar as this profession and its concepts have been severely criticized in the last twenty years - an open discussion of medical ethics might contribute to medicine's equilibrium.

Ethics, Medical↗
PubMed1992

Ethics are local: engaging cross-cultural variation in the ethics for clinical research.

Relatively little consideration has heretofore been given to the interaction between Western clinical research ethics and non-Western ethical expectations. How should any conflict that might arise when a biomedical investigator and a research subject come from different cultural settings and have different ethical expectations be addressed? Which ethics should govern such trans-cultural clinical research? The answers to these questions are of increasing importance because many countries of the developing world are presently sites of field testing of biomedical agents sponsored and administered by countries of the developed world, especially in the context of the AIDS pandemic. Drawing mainly on examples from Asian medical systems and settings, I elucidate four possible ethical models to guide the conduct of transcultural biomedical research. Two assume that research ethics are culturally relative and two assume that a unified, universalistic conceptualization of research ethics is possible. All four, however, are problematic and are to a large extent deficient. The cause of the deficiencies of these models lies, I argue, in the way that ethics are ordinarily conceived. The proper approach to ethical conflict recognizes that culture shapes (1) the content of ethical precepts, (2) the form of ethical precepts, and (3) the way ethical conflict is handled. Medical ethics may be viewed in cross-cultural perspective as a form of 'local knowledge', and any differences in such knowledge between cultures--since such differences will not conveniently disappear--must be engaged and negotiated.

Beneficence↗
PubMed2005

The current state of clinical ethics and healthcare ethics committees in Belgium.

Ethics committees are the most important practical instrument of clinical ethics in Belgium and fulfil three tasks: the ethical review of experimental protocols, advising on the ethical aspects of healthcare practice, and ethics consultation. In this article the authors examine the current situation of ethics committees in Belgium from the perspective of clinical ethics. Firstly, the most important steps which thus far have been taken in Belgium are examined. Secondly, recent opinion by the Belgian Advisory Committee on Bioethics with regard to ethics committees is presented and the activities of Belgian ethics committees are discussed. Finally, the option to bring research ethics and clinical ethics under the roof of just one committee is criticised using a pragmatic and a methodological argument. Concomitantly, the authors build an argument in favour of the further development of ethics consultation.

Belgium↗
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↗
PubMed2004

Contrasting the American College of Healthcare Executives' code of ethics with undergraduate health administration students' values and ethical decision choices.

Although administrative ethics are imbedded into the code of ethics of the American College of Healthcare Executives (ACHE), understanding the values and ethical decision-making practices of health administration students can help shape content and curriculum for health administration programs in the future. The study surveyed a sample of undergraduate health administration students to examine their sense of honesty and ethical decision-making practices. The sampled students completed the Comparative Emphasis Scale, which measured the student's sense of honesty, fairness, and integrity, and 10 short cases of administrative ethical issues derived from the ACHE Code of Ethics. The findings from the study indicated that the health administrative students had moderate to high mean scores on the ethical scales measuring achievement (15.86), concern for others (17.82), fairness (17.67), and honesty (18.21). The students' overall mean score for the 10 ethical cases was 3.51 on a 5-point scale, with 1 indicating a low likelihood and 5 a high likelihood. Pearson's product-moment correlation coefficient showed a minimum relationship between results of the Comparative Emphasis Scale and responses to ethical decision-making cases, and it showed no significant relationship between race, gender, and class (freshman, sophomore, junior, or senior) of the students. The results of the study have indicated that the sampled undergraduate health administration students respond at a moderate to high ethical level to this standardized scale and cases involving ACHE administrative ethical issues. Future research should explore the relationship between select variables concerning employment history, industry, position, and demographics characteristics in people's ethical choices.

Adult↗
PubMed1997

Development, reliability, and validity testing of the Ethical Behavior Test: a measure for nurses' ethical behavior.

The need for reliable and valid measures for ethical behavior of nurses has encouraged the authors to develop a new instrument to measure students' ethical behavior in daily nursing dilemmas. Characteristic of the instrument presented is the inclusion of two fundamental components of ethical behavior: (1) ethical reasoning (and the resulting decision), and (2) the actual implementation of the ethical decision. As for many instruments, Kohlberg's theory of moral development has been used as the conceptual framework. However, Kohlberg's abstract justice orientation was refined by a care perspective and representative nursing dilemmas were used to make the instrument conceptually more appropriate for measuring nurses' ethical behavior. The analysis of the psychometric properties of the instrument has provided several relevant indications for the reliability and validity of the ethical reasoning and implementation scores. The revealed inconsistencies in the Ethical Behavior Test could be satisfactorily interpreted in terms of Kohlberg's theory and related empirical research findings, supporting the reliability of the ethical behavior scores. The content validity rests upon the careful development of the instrument resulting in an optimal mix of dilemmas, arguments and care situations to reveal nurses' ethical behavior and in a substantial degree of correspondence between the concept and operationalization. The congruency between the patterns of ethical behavior and Kohlberg's theoretical insights about ethical reasoning and practice support the construct validity of the instrument.

Adult↗
PubMed1993

The transfer of patients' ethics information among cooperating institutions: a future function of ethics networks.

With increasing use of ethics resources by health care teams, the number of patients transferred from one care setting to another who may have had ethics consultations is rising rapidly. There has been virtually no discussion in the ethics literature and no experience in our community addressing questions concerning the continuity of ethics care and the transfer of ethics information. Our ethics committee faced the following questions during a recent consultation. Should there be continuity of ethics care between institutions? If so, what should be the nature of the communication? How is continuity best accomplished? Do ethics consultants or committees incur additional liability following the transfer of care? Where should the boundaries of confidentiality be drawn? How can existing health care ethics networks facilitate continuity of ethics care? We address these ethical and logistical questions and hope to encourage others to report their views on these issues.

Communication↗
PubMedDate not supplied

Taking on organizational ethics. To do so, ethics committees must first prepare themselves.

Healthcare ethics committees which have focused almost entirely on clinical ethics, now need to prepare to deal with organizational ethics, a field that is attracting increasing attention. As they did with clinical ethics, ethics committees members must educate themselves in the demands of the newer field. As before, they must respect the perspectives of the actual decision makers while maintaining an independent framework for analyzing the issues at stake. They must ensure that management is properly represented on the committee if they need guidance from a professional ethicist they should seek one with a strong background in business ethics and social justice. Healthcare organizations are likely to need help with a wide range of ethical issues involving patient services (rationing of resources, for example), business and service plans (mergers and joint ventures, for example), business and professional integrity (conflicts of interest, for example), employee rights and responsibilities (downsizing, for example), and the organization's role in in the community (advocacy and lobbying, for example). To be helpful to the organization, the ethics committee must be prepared to say when cost factors trump other considerations and when they do not. An ethics committee will often be asked to give advice on specific occasions-a proposed new policy, for instance. The most important part of its response is its analysis of the issue. Finally, an ethics committee should view its organization as part of the larger social context.

Committee Membership↗