[Professional Ethics Council, ethics and textbooks. Violation in the need of ethically responsible trials].
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Clinical Trials as Topic↗
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[Professional Ethics Council, ethics and textbooks. What gives the Professional Ethics Council the responsibility and right to express their opinion?].
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Ethics Committees↗
Ethics consultants and ethics committees.
To address moral questions in patient care, hospitals and health care systems have enlisted the help of hospital ethicists, ethics committees, and ethics consultation services. Most physicians have not been trained in the concepts, skills, or language of clinical ethics, and few ethicists have been trained in clinical medicine, so neither group can fully identify, analyze, and resolve clinical ethical problems. Some ethics committees have undertaken clinical consultations themselves, but liability concerns and variable standards for membership hinder their efforts. An ethics consultation service comprising both physician-ethicists and nonphysician-ethicists brings complementary viewpoints to the management of particular cases. If they are to be effective consultants, however, nonphysician-ethicists need to be "clinicians": professionals who understand an individual patient's medical condition and personal situation well enough to help in managing the case. Ethics consultants and ethics committees may work together, but they have separate identities and distinct objectives: ethics consultants are responsible for patient care, while ethics committees are administrative bodies whose primary task is to advise in creating institutional policy.
Consultants↗
Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees.
OBJECTIVES: Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment. DESIGN: Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons. SETTING: Israel five years after the passage of the Patients' Rights Act. MAIN MEASUREMENTS: Patients' rights and informal ethics committee structure and function. RESULTS: One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction. CONCLUSIONS: Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement.
Confidentiality↗
Ethical and unethical conduct in psychoanalysis. Correlations between logic, ethics and science.
This paper, written by a logician and two psychoanalysts, deals with the existence of logical relationships between ethics and psychoanalysis, which can be expressed as propositions. With a view to focusing the discussion on this point, the authors have deliberately abstained from any polemics concerning the scientific status of psychoanalysis, and concentrate on a consideration of the ethical implications of the conduct of psychoanalysts in the exercise of their profession. In this approach, the theoretical statements and technical rules of psychoanalysis as manifested in its daily practice inevitably have connexions with metaethics and normative ethics. The authors discuss in turn the ethical classification of human conduct, the classes of ethical propositions, the problem of means, ends and values, and the concrete ethical questions raised by the practice of psychoanalysis. Their argument is based on consideration of the existence of empirical, pure ethical and mixed ethical statements, analogous to the familiar categories of empirical, theoretical and mixed statements, or rules of correspondence. Mixed ethical statements are deemed to serve as new rules of correspondence, whereby logical bridges could be constructed between the factual aspect of psychoanalysis and pure ethical statements. If this approach is valid, a sufficient foundation exists to express views on the ethical characteristics of psychoanalytic conduct.
Countertransference↗
The ethics of nursing care and 'the ethic of care'.
Recent discussions concerning the ethics of nursing care have gained added impetus from articulations of the so-called 'ethic of care' in moral philosophy. This paper addresses the question of recognizing and elaborating the ethics of nursing care by exploring the problems and the possibilities of these intersecting discourses. In the first part of the paper it is argued that appropriation of 'the ethic of care' by nursing theorists as the central value of nursing, in contradistinction to other moral values such as beneficence or justice, runs the risk of reinforcing the conventional approaches to ethics that 'the ethic of care' seeks to overturn. Central to 'the ethic of care' is the recognition that caring entails a focus on the particularities and context of the relationships in which it is expressed. Accordingly the application of a unitary concept of care to the context of nursing relations may seriously distort their diverse and complex-specific ethical possibilities. The dynamic complexity of nursing ethics may be more adequately understood by working through an array of specific examples of nursing practice highlighting the differences and similarities between them and other ethical practices of care. Experience of a set of examples in this way will draw attention to the multiplicity, ambiguity, and particularity of the ethics of nursing care. In the second part of the paper a beginning is made on this project by addressing the work of several different theorists of care who have examined different practices of nursing from the overlapping perspectives of nurses, patients and the socio-historical construction of their relationships.
Empathy↗
A quick guide to ethical theory in healthcare: solving ethical dilemmas in nutrition support situations.
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.
Aged↗
A fundamental ethical approach to nursing: some proposals for ethics education.
The purpose of this article is to explore a fundamental ethical approach to nursing and to suggest some proposals, based on this approach, for nursing ethics education. The major point is that the kind of nursing ethics education that is given reflects the theory that is held of nursing. Three components of a fundamental ethical view on nursing are analysed more deeply: (1) nursing considered as moral practice; (2) the intersubjective character of nursing; and (3) moral perception. It is argued that the fundamental ethical view on nursing goes together with a virtue ethics approach. Suggestions are made for the ethics education of nurses. In particular, three implications are considered: (1) an attitude versus action-orientated ethics education; (2) an integral versus rationalistic ethics education; and (3) a contextual model of ethics education. It will also be shown that the European philosophical background offers some original ideas for this endeavour.
Education, Nursing↗
Ethical challenges in neonatal research: Summary report of the ethics group of the newborn drug development initiative.
BACKGROUND: The Newborn Drug Development Initiative (NDDI) was established to address the lack of substantive data supporting efficacy and safety of drugs in the neonate. OBJECTIVE: This commentary summarizes some of the ethical issues involved in neonatal drug development. METHODS: At the NDDI workshop held March 29 and 30, 2004, in Baltimore, Maryland, members of the Ethics Group were dispersed among the subspecialty groups before convening to discuss common ethical themes. The Ethics Group then met together to identify and discuss those ethical themes that were both important and shared among the groups. These themes are discussed and illustrated with the other NDDI group reports. This workshop was cosponsored by the National Institute of Child Health and Human Development and the US Food and Drug Administration. RESULTS: Neonatal drug research is scientifically and ethically necessary to establish the efficacy and safety of drugs widely used in newborn medicine. However, research involving neonates must be carefully designed to balance potential risks and benefits, with consideration given to the component analysis of risk. The protocols proposed by the NDDI groups would be considered greater than minimal risk and offering prospect for direct benefit, thus adhering to the Department of Health and Human Services' pediatric research regulations (Subpart D). The NDDI groups all proposed randomized controlled clinical trials, with careful attention to scientifically and ethically appropriate control groups. Multiple regulatory bodies have affirmed that in the absence of proven effective treatment or when a proven treatment offers marginal benefits, study designs with placebo controls are ethical. Obtaining parental permission is a complex issue, with a paucity of evidence describing the feasibility of informed and voluntary consent under conditions of duress and a short therapeutic window. The Subpart D regulations offer sufficient protection to critically ill neonates. The application of the revised Subpart B regulations would restrict the use of a waiver of consent for minimal risk research and for emergency research, and would not allow research that offers no direct benefit and no more than a minor increase over minimal risk. CONCLUSIONS: Multisite collaboration involving standards of care and institutional review board procedures may be important for establishing scientific and ethical consistency. Ongoing dialogue among researchers, clinicians, parents, and other interested parties is essential to promoting ethically and scientifically sound neonatal clinical research.
Biomedical Research↗
Moving from codes of ethics to ethical relationships for midwifery practice.
This discussion examines the emergence of professional codes of ethics, influences that shape contemporary midwifery ethics, and the adequacy of codes to actualize values embedded in the midwifery ethics discourse. It considers the traditions of professional practice, the impact of institutionalization on health care, the application of a code of practice as a recent addition to those traditions, and the strengths and weaknesses of codes of ethics as models for ethical responses. That is, it sets out to articulate and deconstruct existing frames of ethical response. The ethics of strangers (normative theory and abstract principles) are rejected as inadequate, and the ethics of intimates (feminist-relational ethics) are proposed as a more adequate guide for well-woman centred midwifery practice.
Bioethical Issues↗
[A separation of public health ethics from medical ethics].
Until now there are only a few approaches in the German-speaking realm to establish an explicit ethical framework for moral issues of public health--although a need for public health ethics in times of SARS and avian flu is obvious. One deficit of the discussion so far is that there is no systematic separation of medical ethics and public health ethics. Thus, the core and interdisciplinary focus of public health is often not met. However, to frame discussions of moral issues within a specific public health ethics framework seems to be fruitful. This paper deals with the conceptual differences of medical ethics and public health ethics. The discussion helps both applied ethical discourses to sharpen their focus and strengthen their appeal. The author develops and presents a conceptual and normative frame for public health ethics and offers a concise set of ethical principles for the discussion of moral challenges in public health.
Ethics, Medical↗
Bridging Western ethics and Japanese local ethics by listening to nurses' concerns.
Among Japanese nurses ethics is perceived as being distant and unrelated to their practice, although this is filled with ethical concerns and the making of ethical decisions. The reasons for this dissociation are the primacy of western values in modem Japanese health care systems and the suppression of Japanese nurses' indigenous ethical values because of domination by western ethics. A hermeneutic study was conducted to listen to the ethical voices of Japanese nurses. Seven ethical concerns were revealed. Although some of these concerns may seem to share similar values with western ethical principles, the basis for the concerns was unique and rooted in the Japanese cultural value system. The meanings of each concern are explicated in conjunction with related background meanings. Listening and trying to understand these nurses' voices in their own context suggests a way of bridging the gap between abstract and universal ethics and practical and local ethics.
Adult↗
Ethics of justice vs the ethics of care in moral decision making.
The question to be addressed in this paper is: How can the ethics of justice and the ethics of care be used complementary to each other in ethical decision making within the health care team? Various arguments are presented that justify the reasons that the ethics of justice and the ethics of care should be used complementary to each other for effective ethical decision making within the health care team. The objective is to explore and describe the compatibility of the ethics of justice and the ethics of care from two perspectives: firstly an analysis of the characteristics of the two ethical theories, and secondly the scientific-philosophical viewpoints of these theories. The two theories are incompatible when viewed from these perspectives. For a probable solution to this incompatibility arguments are presented from the perspectives of reflection and virtue-based ethics.
Decision Making↗
Do clinical clerks suffer ethical erosion? Students' perceptions of their ethical environment and personal development.
BACKGROUND: Little is known about the ethical dilemmas that medical students believe they encounter while working in hospitals or how students feel these dilemmas affect them. The authors examine how clinical students perceive their ethical environment, their feelings about their dilemmas, and whether these dilemmas erode students' ethical principles. METHOD: An anonymous mail survey was sent in 1992-93 to the 1,853 third- and fourth-year medical students enrolled at six Pennsylvania medical schools. The survey addressed whether students had encountered situations they felt were ethically problematic, their attitudes toward these situations, and their perceptions of their personal ethical development. Data were analyzed with logistic regression; respondents' comments were analyzed qualitatively. RESULTS: Of the 665 students (36%) who responded, 58% reported having done something they believed was unethical, and 52% reported having misled a patient; 80% reported at least one of these two behaviors. In addition, 98% had heard physicians refer derogatorily to patients; 61% had witnessed what they believed to be unethical behavior by other medical team members, and of these students, 54% felt like accomplices. Many students reported dissatisfaction with their actions and ethical development: 67% had felt bad or guilty about something they had done as clinical clerks; 62% believed that at least some of their ethical principles had been eroded or lost. Controlling for other factors, students who had witnessed an episode of unethical behavior were more likely to have acted improperly themselves for fear of poor evaluation [odds ratio, OR, 1.37 (95% CI, 1.18-1.60)] or to fit in with the team [OR 1.45 (1.25-1.69)]. Moreover, students were twice as likely to report erosion of their ethical principles if they had behaved unethically for fear of poor evaluation [OR 2.25 (1.47-3.45)] or to fit in with the team [OR 1.78 (1.18-2.71)]. CONCLUSION: The ethical dilemmas that medical students perceive as affecting them while serving as clinical clerks are apparently common and often detrimental, and warrant the attention of physicians, educators, and ethicists.
Adult↗
Korean nursing students' ethical problems and ethical decision making.
This Korean study replicated a previously published American study. The conceptual framework and method combined ethical enquiry and phenomenology. The research questions were: (1) What is nursing students' experience of ethical problems involving nursing practice? and, (2) What is nursing students' experience of using an ethical decision-making model? The participants were 97 senior baccalaureate nursing students, each of whom described one ethical problem and chose to use one of five ethical decision-making models. From 97 ethical problems, five content categories emerged, the largest being health professionals (69%). The basic nature of the ethical problems was the students' experience of conflict, resolution and rationale. Using an ethical decision-making model helped 94% of the students. A comparison of the Korean and American results yields important implications for nursing ethics education, practice and research.
Adult↗
The role of ethical principles in health care and the implications for ethical codes.
A common ethical code for everybody involved in health care is desirable, but there are important limitations to the role such a code could play. In order to understand these limitations the approach to ethics using principles and their application to medicine is discussed, and in particular the implications of their being prima facie. The expectation of what an ethical code can do changes depending on how ethical properties in general are understood. The difficulties encountered when ethical values are applied reactively to an objective world can be avoided by seeing them as a more integral part of our understanding of the world. It is concluded that an ethical code can establish important values and describe a common ethical context for health care but is of limited use in solving new and complex ethical problems.
Codes of Ethics↗
The relationship between ethical ideology and ethical behavior intentions: an exploratory look at physicians' responses to managed care dilemmas.
Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth's (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners.
Confidentiality↗
[Ethical problems in the biomedical research projects, presented to the Ethical Committee of the Medical School at the Pontificia Universidad Católica of Chile].
BACKGROUND: The higher methodological complexity of either diagnostic or therapeutic procedures has raised concern about the ethical principles that should underlie the conduct of biomedical research involving humans. AIM: To evaluate ethical problems of research proposals submitted to an ethics committee. MATERIAL AND METHODS: All research proposals involving humans, submitted within a two years period to the ethics committee of the School of Medicine of the Catholic University, were retrospectively reviewed. "Ethical problem" was defined as any explicit disagreement with the ethical principles and guidelines for the protection of human subjects involved in biomedical research, according to the Helsinki declaration. RESULTS: In 20 of 44 reviewed projects, an ethical problem was identified. The most common problems were the absence or inadequacy of the informed consent, the justification of the use of placebo and problems related to the methodological aspects of the research, particularly the lack of an adequate control group when the potential benefits of a new drug were evaluated. CONCLUSIONS: According to the Nüremberg code, the Helsinki declaration and the International Principle of Ethics in Biomedical Research, we analyse ethical problems and suggest judgement elements for them.
Chile↗