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PubMed1995

Ecumenical in spite of ourselves: a Protestant assessment of Roman Catholic, Eastern Orthodox, and Anglican Catholic approaches to bioethics.

A Christian approach to the issues that constitute bioethics is inevitable for us who cherish the truth of historic, creedal, trinitarian Christianity. Scripture teaches and the Greek and Latin Church Fathers as well as the Reformers aver that man, created in the image of God, has an inherent, if vestigial, sense of right and wrong and a conscience however marred by the fall and by rebellion. We must believe that we share this most basic ecumenism with all humanity, not because of rational observation and analysis of nature, but because Scripture reveals it. We who are convinced of the truth of historic, creedal, trinitarian Christianity have a high view of Scripture and hold it to be infallible and utterly trustworthy irrespective of the importance we assign to our specific post-biblical traditional distinctives. This is a narrower but much more vital ecumenism than the first. Faithful adherence to Scripture inevitably manifests itself in remarkably similar priorities and values, often, lamentably, not because of, but in spite of, ourselves.

Bioethics↗
PubMed1994

Health care reform and abortion: a Catholic moral perspective.

The Catholic Church in the United States provides extensive health care service through its more than 600 health facilities. The Church, on the basis of its moral teaching, sees health care as a basic human right and supports universal coverage. At the same time, the Church considers abortion morally wrong and opposes coverage of abortion as a health service in a national health plan. Mandated coverage of abortion would violate the moral commitments of Catholic hospitals and the consciences of Catholics who would be required to financially support provision of abortion services.

Abortion, Legal↗
PubMed1996

Euthanasia: the law in the United Kingdom.

The regulation of euthanasia by the criminal law has tended to be one of the more contentious areas of medical law, and continues to be the subject of debate. Few areas of the criminal law have been so consistently the target of reformist pressure, and certainly few areas have so strongly resisted change. Understandably, legislators are unwilling to involve themselves in a matter of law reform which engenders such moral disagreement, and it is significant that only two jurisdictions-The Netherlands and the Australian Northern Territories-have made any substantial change in their legal practice in this area. In other countries, including the UK, the courts and legislators have consistently refused to remove the fundamental criminal law objection to the practice of euthanasia. This is not to say, of course, that the courts have failed to recognise the medical subtleties in medical treatment at the end of life; in several important decisions, the courts in Britain have considered the boundaries of the criminal law's protection of life and have offered guidelines for doctors facing the delicate issues associated with treating the dying patient. Yet, in spite of several helpful decisions from the courts, the basic principle remains firm: the criminal law does not countenance the taking of life, no matter how good the motive. This means that there are very clear legal limits to the extent to which doctors can follow their individual consciences in this area.

Adult↗
PubMed2003

Creating school-age versions of semistructured interviews for the prodrome to schizophrenia: lessons from case reviews.

There is an increasing emphasis on identifying individuals with schizophrenia earlier and earlier in their disease process, with the assumption that earlier identification translates into earlier treatment, which translates into improved outcome. Unfortunately, one age cohort, children under 13 years of age, have been excluded from this critical alteration in clinical intervention strategy, and its associated improved clinical outcome. One of the barriers to inclusion of younger children is the lack of knowledge about diagnostic issues related to attenuated psychotic symptoms in this age sample. This report focuses on our experience with evaluating attenuated psychotic symptoms in young children, in particular subthreshold hallucinations and delusions, using semistructured interviews. The inclusion of both Caregiver and Child report sections and the addition of concrete, detailed examples of clear-conscience, non-stress-related subthreshold psychotic symptoms are likely to be necessary.

Age Factors↗
PubMed1978

The selection of patients for controlled trials.

The selection of patients for testing drugs is a very complicated process even overtly; subconscious bias must be avoided and our social conscience respected. It is of prime importance to define in advance exactly what you want to test and this may include not only the therapeutic and pharmacological effects and side-effects, the long-term neoplastic potential, the mutagenic effects and the effects on the foetus, but also mundane effects like credibility, acceptance, and even taste! Patient selection is not just "Attention there Volunteers nos. 1,3,5,7,9,....step forward smartly from the left". It is a complicated process in which there is inevitably some bias and our job is to see that any biases which are included do not bias the results, and that the results are understood to apply to this particular selection of patients and not to any other. Too many explicit exclusions therefore make results less useful because less widely relevant.

Clinical Trials as Topic↗
PubMed1997

The social worker as moral citizen: ethics in action.

Social workers today face some of the most complex ethical dilemmas in the history of the profession. This article presents a framework of moral citizenship to guide ethical social work practice. The framework includes the action philosophies of philosopher Hannah Arendt and Lutheran theologian Paul Tillich integrated with concepts of professional responsibility and the unique contributions of social work pioneer Charlotte Towle. Social conscience and social consciousness, including awareness, thinking, feeling, and action, are major components of the framework.

Ethics, Professional↗
PubMed1982

Curriculum choices of premedical students.

The authors examined the curricular choices of premedical students to discover the differences from the choices of other students in the sciences and liberal arts. Premedical students took more science courses and took conscience courses in which they were more likely to get a higher grade than would other students. The authors have confirmed that premedical students' preparation for medical school is not broad-based and that course selection appears to be made on the basis of competition for entry into medical school.

Curriculum↗
PubMed2002

Using the American Board of Internal Medicine's "Elements of Professionalism" for undergraduate ethics education.

PURPOSE: To examine the feasibility of using the taxonomy of professional and unprofessional behaviors presented in the American Board of Internal Medicine's (ABIM's) Project Professionalism to categorize ethical issues that undergraduate medical students perceive to be salient. METHOD: Beginning second-year medical students at the University of Washington School of Medicine (n = 120) were asked to respond to three open-ended questions about professional standards of conduct and peer evaluation. Two of the authors read and coded the students' responses according to the ABIM's elements of professionalism (altruism, accountability, excellence, duty, honor and integrity, and respect for others) and the challenges to those elements (abuse of power, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, and conflict of interest). Coding disagreements were solved using review and revision of the category definitions. New categories were created for students' responses that described behaviors or issues that were not captured in the ABIM's categories. RESULTS: A total of 114 students responded. The ABIM's professional code was adapted for students and teachers, making it context- and learning-stage-specific. One new category of challenges, conflicts of conscience, was added, and one category (abuse of power) was expanded to include abuse of power/negotiating power asymmetries. CONCLUSIONS: Using the ABIM's taxonomy to name professional and unprofessional behaviors was particularly useful for examining undergraduate medical students' perceptions of the ethical climate for learning during the first year of medical school, and it holds promise for research into changes in students' perceptions as they move into clinical experiences. Using the framework, students can build a unified professional knowledge-and-skills base.

Behavior↗
PubMed2002

Realizing your marketing influence, Part 2: marketing from the inside out.

Do your key stakeholders (staff, physicians, and patients) consider your organization to be exceptional? Has your organization invested the resources necessary to support staff and physicians in delivering the high level of care they strive to give? An organization's managers who can enthusiastically answer "yes" to these questions are in a good position to promote its healthcare system aggressively. Managers who cannot answer affirmatively, in good conscience, must invest in creating a healthy environment for staff that is rich with the resources that will enable all employees to deliver optimal care and service. Until this is achieved, no amount of promotion will be enough to move a healthcare system to a market leadership position. This is the second in a series of three articles that moves readers from broad marketing strategy to specific applications. The first article laid the foundation for developing a market-driven strategic plan; the third will focus on using professional certification as a marketing tool.

Hospital Administration↗
PubMedDate not supplied

Changing the paradigm: new directions in federal oversight of human research.

The system of institutional review boards (IRBs) was established about 30 years ago for the protection of human subjects and as a mechanism for assuring an independent peer review of research activities. To keep pace with an evolving environment, a new model for human research oversight is needed that focuses less on achieving regulatory compliance and more on applying our conscience to the responsible conduct of research. The recent implementation of a unified federal registration system for IRBs and a new assurance system point the way to a more effective structure for the oversight of clinical trials.

Clinical Trials as Topic↗
PubMed2006

Refusals by pharmacists to dispense emergency contraception: a critique.

Over the past several months, numerous instances have been reported in the United States media of pharmacists refusing to fill prescriptions written for emergency postcoital contraceptives. These pharmacists have asserted a "professional right of conscience" not to participate in what they interpret as an immoral act. In this commentary, we examine this assertion and conclude that it is not justifiable, for the following reasons: 1) postcoital contraception does not interfere with an implanted pregnancy and, therefore, does not cause an abortion; 2) because pharmacists do not control the therapeutic decision to prescribe medication but only exercise supervisory control over its dispensation, they do not possess the "professional right" to refuse to fill a legitimate prescription; 3) even if one were to grant pharmacists the "professional right" not to dispense prescriptions based on their own personal values and opinions, pharmacists "at the counter" lack the fundamental prerequisites necessary for making clinically sound ethical decisions, that is, they do not have access to the patient's complete medical background or the patient's own ethical preferences, have not discussed relevant quality-of-life issues with the patient, and do not understand the context in which the patient's clinical problem is occurring. We conclude that a policy that allows pharmacists to dispense or not dispense medications to patients on the basis of their personal values and opinions is inimical to the public welfare and should not be permitted.

Adolescent↗
PubMed2006

Revisiting pharmacists' refusals to dispense emergency contraception.

Pharmacists' refusals to fill prescriptions for emergency contraceptives for reasons of conscience have contributed to a national debate regarding the permissibility of such actions. Some in the medical community assert that pharmacists ought not to refuse to dispense emergency contraceptives on this basis. Three lines of argument have become prominent in defense of that position: 1) the professional status of pharmacists does not allow for refusal to dispense legitimately written prescriptions, 2) the medical facts regarding the mechanism of action of emergency contraception are often misunderstood, misrepresented, or both, and 3) refusals by pharmacists to fill legitimate prescriptions undermine patient care. In this commentary, these arguments are rejected as missing the central point of the issue, which is that pharmacists are autonomous, moral agents who are accountable for their choices and entitled-within limits-to decide in which activities they will participate. Pharmacists' professionalism is defended, their responsibilities in the provision of drug therapy are set forth in the context of pharmaceutical care, and these lead to the conclusion that pharmacists' refusals may be ethically justified. There are important limits on how pharmacists may respond when they are being asked to participate in actions they find morally objectionable. Notably, they must ensure that these prescriptions are filled by someone else in a timely manner and must refrain from any abusive or demeaning treatment of patients, as summed up in our Principle of Conscientious Refusal to Dispense.

Contraceptives, Postcoital↗
PubMed2003

Scientific integrity--the cornerstone of knowledge.

In the past, nurses often found themselves pressured within complex social interactions in the research environment that often overshadowed their advocacy role for the patient (Davis, 1989). With the recent emphasis on enforcing adequate protections for participants in research, nurses need to feel free to act as sentient beings with a conscience and a strong commitment to their patients. It is only through this advocacy role that scientific misconduct can be reduced and research integrity upheld.

Clinical Nursing Research↗
PubMed2001

Whither acid rain?

Acid rain, the environmental cause célèbre of the 1980s seems to have vanished from popular conscience. By contrast, scientific research, despite funding difficulties, has continued to produce hundreds of research papers each year. Studies of acid rain taught much about precipitation chemistry, the behaviour of snow packs, long-range transport of pollutants and new issues in the biology of fish and forested ecosystems. There is now evidence of a shift away from research in precipitation and sulfur chemistry, but an impressive theoretical base remains as a legacy.

Acid Rain↗
PubMed2005

Agents with left and right dominant hemispheres and quantum statistics.

We present a multiagent model illustrating the emergence of two different quantum statistics, Bose-Einstein and Fermi-Dirac, in a friendly population of individuals with the right-brain dominance and in a competitive population of individuals with the left-brain hemisphere dominance, correspondingly. Doing so, we adduce the arguments that Lefebvre's "algebra of conscience" can be used in a natural way to describe decision-making strategies of agents simulating people with different brain dominance. One can suggest that the emergence of the two principal statistical distributions is able to illustrate different types of society organization and also to be used in order to simulate market phenomena and psychic disorders, when a switching of hemisphere dominance is involved.

Biophysical Phenomena↗
PubMed1998

The super-ego, the voice of the self and the depressive position.

The Freudian concept of the super-ego and Jung's idea of a primary moral reaction in the unconscious--the voice of the self--are compared. From its origin the superego is connected with human destructiveness, but for Jung individual conscience is based on a collision between the ego and the inner world of archetypes. With reference to Neumann's 'New Ethic', some implications of Jung's idea of the unconscious ambiguity of good and evil are discussed. Finally an attempt is made to relate the concept of the primary moral reaction to a developmental and clinical framework, notably Klein's depressive position, but only a partial integration is possible.

Aggression↗
PubMed2003

Developing mechanisms of temperamental effortful control.

Studies of temperament from early childhood to adulthood have demonstrated inverse relationships between negative affectivity and effortful control. Effortful control is also positively related to the development of conscience and appears as a protective factor in the development of behavior disorders. In this study, the development of attentional mechanisms underlying effortful control was investigated in 2- to 3-year-old children, as indexed by their performance in a) making anticipatory eye movements to ambiguous locations and b) resolving conflict between location and identity in a spatial conflict task. The ability to make anticipatory eye movements to ambiguous locations within a sequence was clearly present at 24 months. By 30 months, children could also successfully perform a spatial conflict task that introduced conflict between identity and location, and at that age, children's success on ambiguous anticipatory eye movements was related to lower interference from conflict in the spatial conflict task. Children's performance on the eye-movement task was correlated with performance and reaction time on spatial tasks, and both were related to aspects of effortful control and negative affect as measured in children's parent-reported temperament.

Child, Preschool↗
PubMed1997

Doing the right thing: relief agencies, moral dilemmas and responsibility in political emergencies and war.

In recent years a new generation of relief workers and relief agencies has become embroiled in the heat of civil wars and political emergencies, and the humanitarian community has had to revisit its fundamental principles and address the ethics of what it does. This paper sets out to continue this important debate by emphasising that ethical analysis should always be an essential part of humanitarian practice. The paper seeks to recognise the difficult moral choices relief agencies are facing today and gives some practical guidelines to relief agency staff when confronting the ethics of a given situation. In particular, it hopes to introduce some ethical principles into the debate about humanitarianism and contribute to the moral vocabulary which is being developed to improve relief agencies' ethical analysis. The paper starts by looking at the essential characteristics of a moral dilemma, and the way in which other types of tough choice can masquerade as moral dilemmas. It then introduces some basic moral principles surrounding the key ethical notions of action consequences and moral responsibility in an effort to show how relief agencies might begin to develop a process of ethical analysis in their work. Finally, it explores how relief agencies might develop a more intuitive form of ethical analysis based on an organisational conscience and moral role models.

Decision Making↗