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PubMed1997

Medical education must make room for student-specific ethical dilemmas.

Most contemporary undergraduate courses in medical ethics leave a critical gap unfilled because they fail to address student-specific issues, says third-year student Joye St. Onge. In this article, which won third prize in CMAJs 1996 Dr. William Logie Medical Ethics Essay Contest, St. Onge outlines the importance of discussing student-specific ethical dilemmas and suggests ways to introduce such teaching in medical schools.

Canada↗
PubMed1998

Supporting nurses in ethical decision making.

In their clinical practice, nurses are confronted continuously with ethical issues. There is a growing concern about the capacity of nurses to perform ethically. This article explores the process of ethical decision-making in nursing, including the process of ethical reasoning and the implementation of ethical decisions in clinical practice. This article begins with a reflection on the essence of nursing and on nurses' ethical responsibility. Problems as well as determinants related to nurses' ethical decision-making, are described. Based on the research in this area, some strategies to support ethical decision-making by nurses are proposed.

Aged↗
PubMed1987

Ethical issues in child and adolescent psychiatry.

This paper concerns the special ethical problems in child and adolescent psychiatry which relate to the child as a developing being. Two themes are discussed--the sense of responsibility in the child, and the therapist's responsibility towards the child. As a background to understanding the former, ideas on moral and cognitive development are reviewed. The therapist's responsibility is discussed in relation to different styles of therapy and the ethical issues they raise. The article concludes with a number of suggested ethical principles.

Adolescent↗
PubMed2001

Zygmunt Bauman's poisoned gift of morality.

Bauman's attempt to develop a sociological theory of morality turning around fundamental premises of Durkheim's approach fails in the last analysis, since in Bauman's view the 'moral party of two' does not constitute a social situation. It is argued that the necessary condition to think sociologically about morality is the concept of reciprocity and thus one can arrive at a view of morality in postmodernity consistent with Bauman's earlier theory of practice. If Bauman's idea about responsibilty as the core of morality is transformed to the idea of an appeal of history to compassion and is supplemented with the idea of reciprocity as an emerging norm it is possible to outline a sociological theory of moral practice according to postmodern conditions.

Ethics↗
PubMed1996

Characteristics of the informal curriculum and trainees' ethical choices.

In October 1995, the Association of American Medical Colleges held its first Conference on Students' and Residents' Ethical and Professional Development. In a plenary session and break-out sessions, the 150 participants, representing a wide variety of medical and professional specialties and roles, discussed the factors and programs that affect medical trainees' development of ethical and professional standards of behavior. The main challenge of addressing students' professional development is the enormous range of influences on that development, many of which, such as the declines in civic responsibility and good manners throughout the United States, fall outside the scope of academic medicine. Nonetheless, many influences fall within reach of medical educators. In a pre-conference survey, participants ranked eight issues related to graduating ethical physicians. The respondents ranked highest the inadequacy of the understanding of how best to influence students' ethical development, followed by faculty use of dehumanizing coping mechanisms, and the "business" of medicine's taking precedence over academic goals. The plenary speakers discussed the "informal curriculum" and the "hidden curriculum" and the need for medical faculty to take seriously the great influence they have on students' and residents' moral and professional development as they become physicians. Whether consciously or not, medical education programs are producing physicians who do not meet the ethical standards the profession has traditionally expected its members to meet. In three series of break-out sessions, the participants analyzed the nature of the ethical dilemmas that medical students and residents face from virtually the first day of their training, the use of role playing in promoting ethical development, and ways to improve policies and overcome barriers to change.

Clinical Clerkship↗
PubMed1989

Ethical analyses in the development of congressional public policy.

A wide range of conflicting established moral viewpoints makes development of public policy related to infertility difficult. Where there are pluralities of viewpoints and no single established moral approach, uniform solutions are questionable. The Office of Technology Assessment (OTA), is a nonpartisan analytic support agency that serves the United States Congress by providing objective analyses of major public policy issues related to scientific and technological change. Because analysis of ethical issues is an important part of technology assessment, OTA included a thematic analysis of ethical issues in the report, Infertility: Medical and Social Choices. A consideration of whether infertility is a disease was an important conceptual starting point, and religious perspectives were reviewed as possible sources of moral and ethical insight.

Biomedical Research↗
PubMed1999

Can virtue be taught?

Applying standards of virtue that define the "good doctor" in a complex and technologically sophisticated health care system is often challenging and sometimes confusing. What are the characteristics of a "good doctor," who wishes to live up to high ethical and professional standards but who also must live and work in a health care system in which moral ambiguity is pervasive? Medical educators are urgently faced with such questions as their schools try to equip students with the skills and capacities required of the virtuous physician. The author describes how Aristotelian concepts of virtue can be used to guide medical educators in defining and teaching virtue. He then discusses how such traits as the ability to tolerate moral differences and ambiguity, the ability to develop thoughtful individual moral positions, and the capacity to respect and understand various cultural traditions may be what might be considered virtues in today's health care system. A "good" doctor, then, would be someone who is thoughtful, fair-minded, respectful of differences, and committed to his or her professional values.

Academic Medical Centers↗
PubMed1982

Moral reasoning and decisions in dilemmas of neonatal care.

The relationship between levels of moral reasoning and decisions in dilemmas of neonatal care was investigated in a sample of 452 pediatricians. Subjects included residents, faculty members, and practitioners recruited from a variety of university-affiliated and community hospitals. It was hypothesized that physicians whose moral reasoning was more fully developed would less actively treat particular cases. Such cases might include those where a patient's family requested such a limit (designated "negative family attitude") or the quality of life likely to be led after therapy was so low as to preclude even a minimal degree of human activity or social interaction (designated "unsalvageable prognosis"). The hypothesis was tested through the use of two questionnaires. The first questionnaire, devised by Crane, assessed the physician's reported degree of activism in treating six cases of infants born with severe defects. The structure of moral reasoning was measured by a second questionnaire, Rest's Defining Issue Test. Subjects were scored by the degree to which they use universal, ethical principles in resolving a series of moral dilemmas. Results of the absolute level of activism (Table 1) showed that among both residents and postresidents, the degree to which cases are actively treated depends, for salvageable patients, on the type of damage and on the possibility for research. Results involving moral reasoning showed a different pattern among residents and postresidents. Among residents, a significant correlation exists between principled reasoning and the absence of active treatment (r = - 0.41, Form A; r = - 0.23, Form B). As predicted, such correlations were strongest for cases of negative family attitude or of unsalvageable prognosis. The pattern of correlations among postresidents showed either no relationship to moral reasoning or the reverse of the residency pattern (r = -0.08, Form A; r = 0.30, Form B). The influence of the type of institution a resident operates within was assessed by analysis of variance. Inasmuch as moral reasoning and institutional type both had significant main effects (Form A), their magnitude differed. Institutional type accounted for 43% of the variation in mean activism scores whereas moral reasoning accounted for only 4%; however, because one could, a priori, expect institutional norms and customs to be powerful determinants of behavior, any additional, identifiable influence deserves attention. The structure of individuals' moral reasoning seems to be such an influence.

Attitude of Health Personnel↗
PubMed2003

Performance of hybrid methods for large-scale unconstrained optimization as applied to models of proteins.

Energy minimization plays an important role in structure determination and analysis of proteins, peptides, and other organic molecules; therefore, development of efficient minimization algorithms is important. Recently, Morales and Nocedal developed hybrid methods for large-scale unconstrained optimization that interlace iterations of the limited-memory BFGS method (L-BFGS) and the Hessian-free Newton method (Computat Opt Appl 2002, 21, 143-154). We test the performance of this approach as compared to those of the L-BFGS algorithm of Liu and Nocedal and the truncated Newton (TN) with automatic preconditioner of Nash, as applied to the protein bovine pancreatic trypsin inhibitor (BPTI) and a loop of the protein ribonuclease A. These systems are described by the all-atom AMBER force field with a dielectric constant epsilon = 1 and a distance-dependent dielectric function epsilon = 2r, where r is the distance between two atoms. It is shown that for the optimal parameters the hybrid approach is typically two times more efficient in terms of CPU time and function/gradient calculations than the two other methods. The advantage of the hybrid approach increases as the electrostatic interactions become stronger, that is, in going from epsilon = 2r to epsilon = 1, which leads to a more rugged and probably more nonlinear potential energy surface. However, no general rule that defines the optimal parameters has been found and their determination requires a relatively large number of trial-and-error calculations for each problem.

Algorithms↗
PubMed1997

Preschoolers face moral dilemmas: a longitudinal study of acknowledging and resolving internal conflict.

Following on from research that indicated significant moral internalisations by age 3, using a play narrative approach in which children were asked to complete story stems describing a range of moral dilemmas, the purpose of this study was to replicate the results, extend them with longitudinal information and assess the child's developing capacities to acknowledge both sides of moral dilemmas and resolve them in a prosocial way. Fifty-one children were presented with three enacted story stems describing moral dilemmas as they might occur in everyday life. Story completions were obtained from children at ages 3, 4, and 5 and were coded for the level of acknowledgement of the dilemmas and the degree of prosocialness involved in story resolution. Results included the following: firstly, some children acknowledged the dilemmas and resolved them prosocially as early as age 3; secondly, the ability to acknowledge dilemmas and resolve them improved with age; and thirdly, children showed a greater capacity to acknowledge dilemmas with support from an examiner. The implications of these findings for our understanding early moral development are discussed, along with questions pointing to new research.

Child Development↗
PubMed1983

Alice in Wonderland and cognitive development: teaching with examples.

Alice in Wonderland can be used to give interesting examples of many of the basic concepts of adolescent psychology. Alice's experiences can be seen as symbolic depictions of important aspects of adolescent development, such as initiation, identity formation, and physical, cognitive, moral, and social development. The psychology instructor may choose a part of the story, then point out the parallels between it and particular aspects of adolescent development. This approach enables the instructor to create and maintain a high level of student interest in the course material.

Adolescent↗
PubMed1987

Towards a phenomenology of caregiving: growth in the caregiver is a vital component.

The classical notions of 'virtue' and 'leisure' offer excellent insights into the essentially moral nature of medical practice. This is especially evident in the understanding that professional caregiving has the potential to enhance the moral character as well as the moral awareness of the practitioner. Reflective awareness of the moral nature of the caregiving process can also contribute to coping with negative stress, which almost always has its origins in frustrations rooted in moral quandaries and evaluations. Understanding the process required arises from implementation of caregiving in combination with deliberate, conscious development of spiritual awareness and reflection on moral meaning.

Ethics, Medical↗
PubMedDate not supplied

Moral reasoning and moral behavior among selected groups of practicing nurses.

This study examined the relationship between moral reasoning and moral behavior in 79 practicing nurses. Moral reasoning was measured by Rest's Defining Issues Test. Judgments about Nursing Decisions (JAND), developed by the investigator, was used to measure moral behavior. JAND is compromised of seven stories, each depicting a nurse in an ethical dilemma, with a total of 48 items. It measures two components of moral behavior: knowledge and valuation of ideal moral behavior and perception of realistic moral behavior. The hypothesis that moral reasoning would be positively related to knowledge and valuation of ideal moral behavior was tested by Pearson product moment correlation; the obtained coefficient of .28 was significant at the .01 level. The hypothesis that moral reasoning would be positively related to nurses' perception of realistic moral behavior was also tested by Pearson product moment correlation; the obtained coefficient of .19 was significant at the .05 level. Additional analyses showed significant differences in the knowledge and valuation component of JAND between educational groups, ethnic groups, age groups, and years of practice in nursing; but, there were no differences between these groups with respect to the perception of realist moral behavior component of JAND. Implications of the findings for nursing practice, education, and research are discussed.

Decision Making↗
PubMed1994

Moral-emotional responsiveness: a two-factor domain of conscience functioning.

OBJECTIVE: The purpose of this study was to assess the progression in development of moral-emotional responsiveness in children and adolescents and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed regarding comprehension of their emotional responses to moral stimuli. RESULTS: Rational analysis of the responses identified six items; each item was scaled for complexity into five stages. Factor analysis of the six items revealed two factors: moral-emotional responsiveness 1 contained items relating to external anxiety, internal anxiety, and mood; more-emotional responsiveness 2 contained items relating to the restoration of psychophysiological equilibrium through the processes of reparation and healing. Differences between conceptualization stages, with the moral-emotional responsiveness factors serving as dependent variables, were accounted for by stage differences in age and the positive correlations between the moral-emotional responsiveness factors and age. CONCLUSIONS: Moral-emotional responsiveness is a two-factor domain of the conscience. The findings provide additional developmental guidelines for assessing conscience development and functioning both in clinical practice and in research.

Adolescent↗
PubMed2006

[To strengthen the academic morality standard for promoting the further development of ophthalmology].

It is imperative and urgent to strength the academic ethic construction in ophthalmology in China. In the rapid development of ophthalmology in recent years, there exit some manifests of academic ethic anomy and unhealthy climate. We should adopt some effective measures to standardize the academic behavior, and clean and create the favourable academic behavior, in order to promote the academic activities in ophthalmology. The rule on the academic ethic standard by Chinese Ophthalmological Society published in this journal is an important measure for strengthening the academic ethic construction in ophthalmology, and deserve to be noted and practiced by all of ophthalmologists and visual researchers.

China↗
PubMed2005

Ethical issues in funding orphan drug research and development.

This essay outlines the moral dilemma of funding orphan drug research and development. To date, ethical aspects of priority setting for research funding have not been an issue of discussion in the bioethics debate. Conflicting moral obligations of beneficence and distributive justice appear to demand very different levels of funding for orphan drug research. The two types of orphan disease, rare diseases and tropical diseases, however, present very different ethical challenges to questions about allocation of research funds. The dilemma is analysed considering utilitarian and rights based theories of justice and moral obligations of non-abandonment and a professional obligation to advance medical science. The limitations of standard economic evaluation tools and other priority setting tools used to inform health policy decision makers on research funding decisions are outlined.

Drug Evaluation↗