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PubMed2004

The principle of proportionality in therapy: foundations and applications criteria.

The topic of therapeutic proportionality represents one of the main emerging issues in the contemporary bioethical debate. This paper intends to outline the development of moral doctrine on the use of therapeutic means. It first presents a synthesis of the reflection produced by moral Tradition with the definition of the concept of "ordinary and extraordinary means"; then the official teaching of the Catholic Church on the subject is summed up briefly up to the present day and finally, on the basis of the main points which will emerge during this itinerary, the author proposes his own attempt to create a new synthesis on the ethics of the use of therapeutic means. Such synthesis, which the author terms as "the principle of ethical suitability in the use of means for the preservation of life", is an evaluative dynamism which, continuing along the lines set out by classical terminology (ordinary and extraordinary means), tries to apply the contents of moral Tradition to the new emerging perspective (proportionate and disproportionate means), underlining the specificity of each term, in a context of ethical systematization able to provide concrete evaluation criteria, at the service of the practical choices of patients and health care personnel.

Bioethics↗
PubMed2005

Enhancing ethical behavior: views of students, administrators, and faculty.

In an article published in the April 2004 issue of the Journal of Dental Education, Dr. Charles Bertolami proposed that our ethics curricula don't work due to the limitations of didactic education. He suggested that ethics should be taught as a "precurriculum" course prior to entering dental school and that the dental school ethics course should be elective and consist of small groups of students who are guided to introspection to understand their true self-interest. He argued that "enlightened" self-interest is the best means to motivate students to behave ethically. Our article was stimulated by Bertolami's contentions. Six essays are presented that offer perspectives on the issue of professional ethics and ethics instruction from the viewpoints of students, administrators, and faculty at one dental school. The student essays support the difference between teaching about ethics and changing behavior and discuss the pressures to cheat in dental school. Bertolami's proposition regarding the role of self-interest in ethical decision making is examined. The final essays discuss the ways that ethics curricula and dental schools can encourage students to internalize the values of dentistry. They conclude that while some of Bertolami's propositions may have merit, many do not seem to accomplish the desired goals of inculcating ethics or enhancing ethical behavior in dental students, and they encourage further discussion of ethical instruction.

Curriculum↗
PubMed2005

Why our ethics curricula do work.

The purpose of this article is to respond to Dr. Charles Bertolami's article "Why Our Ethics Curricula Don't Work" in the April 2004 issue of the Journal of Dental Education. This article analyzes the arguments put forth by Bertolami and challenges his assumptions and conclusions. Several examples are given of the ways in which our current ethics curricula do, in fact, work.

Curriculum↗
PubMed2005

[Mental representation, psychic structure, and behaviour problems in preschool children].

Mental health problems in terms of deviant behaviour and emotional problems are assumed in context with mental representations and indicators of internal psychic structure. In distinction to adults there is little empirical research concerning this matter. On the basis of Childrens' Play Narratives (MacArthur Story Stem Battery) we collected data about content-themes, structural indicators and process criteria of 73 preschool children and implicated these information with behaviour ratings of parents and kindergarden teachers. Many correlations were found particularly with structural indicators, process criteria and behaviour ratings. The results are discussed both with respect to content and methodical aspects.

Affective Symptoms↗
PubMedDate not supplied

Ethical decision making by nurses in HIV/AIDS situations.

The purpose of this study was to assess the ethical decision making levels of nurses in HIV/AIDS situations. Using an adapted form of Crisham's Nursing Dilemma Test, RNs in various settings in Ohio ranked their reasons for action in responding to vignettes. Findings suggest that nurses are basing their clinical decisions in HIV/AIDS situations on practical considerations rather than on nursing principles. Education programs based on the findings from this study will enhance the use of nursing principles.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Why we need the independent sector: the behavior, law, and ethics of not-for-profit hospitals.

Among the major forms of corporate ownership, the not-for-profit ownership form is distinct in its behavior, legal constraints, and moral obligations. A new empirical analysis of the American Hospital industry, using eleven years of data for all urban general hospitals in the country, shows that corporate form accounts for large differences in the provision of specific medical services. Not-for-profit hospitals systematically provide both private and public goods that are in the public interest, and that other forms fail to provide. Two hypotheses are proposed to account for the findings, one legal and one moral. While no causal claims are made, not-for-profit hospital behavior is consistent with the behavior required by law and morality. The moral argument, developed as a preliminary theory of not-for-profit ethics, also provides a potential reason to prefer not-for-profit hospitals. The findings provide a new justification for the not-for-profit tax exemption for hospitals, and also suggest new uses for ownership categories as regulatory tools.

Ethics, Institutional↗
PubMed1991

[Continuity--adjustment--autonomy--physician--patient--an overview of medical cultural philosophy in former East Germany].

The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war guilt of the National Socialist era. Guilt is a burden on the mind, but non-assessed guilt and lack of a possibility of redemption destroys humans. The article is a plea against an increasing tendency to criminalize the former GDR citizen and the doctors. "It will be necessary to honestly review the past history embodying my own errors, mistaken concepts and illusions." All this is only a first approximation to an important and complex subject. It is the author's aim to promote a better understanding between the former GDR citizens and those of West Germany.

Continuity of Patient Care↗
PubMed1989

Ethical reasoning concerning the feeding of terminally ill cancer patients. Interviews with registered nurses experienced in the care of cancer patients.

In the terminal phase of life, some cancer patients have problems eating. Caregivers then have to decide whether or not to provide the patients with food by artificial means. Taped interviews concerning the treatment of terminally ill, mentally alert, old cancer patients who refuse food were conducted with 20 registered nurses who were regarded as "experienced and good nurses." Not one of these nurses considered using force or violence against the patients. It seemed that the question about whether to feed the patient was not as urgent as the question of whether to accept active euthanasia. The interviewees seemed quite certain about how they would treat the patient in different circumstances, but found it difficult to justify their judgements. Several stressed the importance of their personal experience with dying persons, and thought that one should act according to the Golden Rule.

Adult↗
PubMed1989

The case for teaching nursing ethics.

This article stresses importance of teaching nursing ethics on the ground that 1) courses in bioethics which focus on the role of the physician as the paradigmatic health-care provider belie the actual nature of our health-care system and misplace the locus of much of the responsibility for how patients, especially hospitalized patients, fare. In addition, 2) the study of nursing ethics draws attention to issues which, though they arise for the nurse in quite specific nursing situations, nonetheless highlight what is important in the study of moral relations generally, and bring to the fore important general questions about the nature of moral responsibility itself. Finally, 3) it is argued that the very defining concepts of the nursing profession are themselves of philosophical and ethical interest. Note is taken of the concern expressed by those in the nursing profession regarding the lack of humanities education and suggestions are made for introducing the study of nursing ethics into nursing and philosophy curricula.

Attitude of Health Personnel↗
PubMed1989

Ethics content in baccalaureate degree curricula. Clarifying the issues.

Competency in ethical decision making is an identified expectation of the baccalaureate degree graduate. Values, both personal and professional, do not provide a systematic foundation for ethical decision making. The nurse is a unique health care provider and as such is faced with ethical decision of practice that are derived from and are relevant to that role. An understanding of ethical principles and theories as well as application of them to the role of the professional nurse is essential to ethical decision making in nursing practice. Seventy four per cent of recent graduates stated that the ethical content in their nursing programs most influenced their ethical decision-making skills, yet, only 23% used an ethical model or framework in analyzing and resolving the ethical dilemma of practice. The usual format for presentation of this content is a course in ethics. The content of such courses should include ethical theories and principles and their application to the practice of nursing. Teaching methodologies include guided case analysis and written responses to cases and current issues. Placement of separate required ethics courses remains a problem because of the overwhelming amount of content in baccalaureate degree curricula. Research has tentatively validated the need for a separate required course in nursing ethics. Further studies are necessary. If ethics content is integrated throughout the curriculum, it should be presented early with continual reinforcement and with the use of a specific ethics textbook. Research indicates that students who have completed a nursing ethics course not only know the correct ethical action but are more likely to implement it.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioethical Issues↗