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PubMed2006

The International Atomic Energy Agency (IAEA) program on radiation and tissue banking: a successful program for developing countries.

Since its inception the IAEA program in radiation and tissue banking supported the establishment of twenty five tissue banks in different countries. Now more than 103 tissue banks are now operating in these countries. The production of sterilized tissues has grown in an exponential mode within the IAEA program. From 1988 until the end of 2000 the production of sterilized tissues was 224,706 grafts, with an estimated value of at least $51,768,553 million dollars at the mean current charge rate in non-commercial banks in Europe and USA. During the period 1997-2002 several countries from Asia and the Pacific region produced more than 155,000 grafts, with an estimated value of about $36.7 million dollars. Training was considered to be one of the most important tasks to be supported. A total of 192 students were registered in the training program and 146 students graduated with a University Diploma. For many developing countries an additional benefit is not having to import expensive sterilized tissues from developed countries, but the exposure of orthopedic and plastic surgeons working, to new methods of using allografts in specific surgical treatments.

Developing Countries↗
PubMed2002

Stem cell research: a target article collection: Part III--determining moral status.

In this chapter, I review some of the background thinking concerning matters of moral status that I had developed in previous years and that I would now bring to the work of the Human Embryo Research Panel. Two ideas were at the forefront of my thinking. First, that biology usually offers not decisive "events" but only continuous processes of development. Second, in making status determinations we do not so much "identify" a point on a developmental continuum where moral respect should be accorded as "choose" that point. These choices are "balancing decisions" in which the community of moral agents weighs its interests in protecting an entity against the burdens of doing so. After illustrating these two contentions, I consider some of the reasons why thinkers on the "right" and "left" of our bioethics debates have resisted or missed this basic insight.

Abortion, Induced↗
PubMed1995

Measuring nurses' moral reasoning.

The purpose of this exploratory study was to examine the possibility of designing a satisfactory method, using written responses to hypothetical scenarios, for evaluating the quality of moral reasoning in student nurses. Scenarios were developed from interviews with practising nurses. Nurses and student nurses provided written responses to the scenarios, and nursing faculty members from six institutions sorted the responses according to their perceptions of quality (i.e. 'best', 'next best', 'worst' etc.). There was very little agreement among faculty members on the quality of the responses. Consequently, it was impossible to develop a 'best' response on which the faculty members could agree. Analysis revealed a framework used by the participants for ethical decision-making. The results of this study have important implications for the way in which we think about the teaching and the evaluation of nursing ethics.

Beneficence↗
PubMed2002

Empathy: Its ultimate and proximate bases.

There is disagreement in the literature about the exact nature of the phenomenon of empathy. There are emotional, cognitive, and conditioning views, applying in varying degrees across species. An adequate description of the ultimate and proximate mechanism can integrate these views. Proximately, the perception of an object's state activates the subject's corresponding representations, which in turn activate somatic and autonomic responses. This mechanism supports basic behaviors (e.g., alarm, social facilitation, vicariousness of emotions, mother-infant responsiveness, and the modeling of competitors and predators) that are crucial for the reproductive success of animals living in groups. The Perception-Action Model (PAM), together with an understanding of how representations change with experience, can explain the major empirical effects in the literature (similarity, familiarity, past experience, explicit teaching, and salience). It can also predict a variety of empathy disorders. The interaction between the PAM and prefrontal functioning can also explain different levels of empathy across species and age groups. This view can advance our evolutionary understanding of empathy beyond inclusive fitness and reciprocal altruism and can explain different levels of empathy across individuals, species, stages of development, and situations.

Adult↗
PubMed1986

Abortion: the new debate.

The course of the debate on abortion following the 1973 Supreme Court decision legalizing abortion has been marked by a variety of medical and scientific developments. Many of these new developments have important legal, psychologic, social, moral, and political implications. The cumulative impact of all these developments may pose a significant challenge to the social and legal foundations of Roe v. Wade.

Abortion, Induced↗
PubMed2005

Moral distress of staff nurses in a medical intensive care unit.

BACKGROUND: Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession. OBJECTIVES: To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses. METHODS: A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress. RESULTS: Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation. CONCLUSIONS: Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

Adult↗
PubMed2003

Two registers of madness in Enlightenment Britain. Part 2.

In Part 1 of this essay, I argued that in Augustan and Georgian England it was widely understood that madness could have two more-or-less distinct meanings. "Moral" madness was the subject's own fault, and he/she remained accountable for actions commissioned under its effects. The "morally" mad individual's thoughts and actions were understood to be self-directed; at base, in moral madness, delusional ideas arose in the mind, and by definition remained within the moral province of the individual. By contrast, in "real" madness, the sufferer was the passive recipient of body-based sickness. Correspondingly, he/she was understood to be innocent, but paid for this exculpation of moral accountability by surrendering full personhood. In Part 2, I shall examine various ways in which eighteenth-century Britons approached and assessed insanity's two meanings. I shall then remark on the late eighteenth-century attempt to develop a psychological (i.e., moral) rendering of insanity's characteristics and its treatment.

History, 18th Century↗
PubMed2001

Moral agency, moral worth and the question of double standards in medical research in developing countries.

International regulations governing medical research, healthcare and medical practice, are, obviously, meant to be guidelines and not detailed procedural rules of thumb that can be applied unreflectively without any danger of doing moral wrong. Moreover, such regulations are meant to apply internationally, and no set of straight-jacketed rules of thumb can conceivably apply to all societies and communities of the world, extremely diverse and differently situated as they are. The mark of a good international guideline or regulation, in my view, is that it should provide a clear principle of action that applies equally to all global communities and societies without seeking to foist the particular or momentary moral dilemmas, quandaries, obsessions and preoccupations of some on all. In this paper, I propose to argue that, because moral obligations are obligations only from the point of view of a particular moral agent, we should avoid making the peculiar problems of any particular moral agent(s) the obsessive concern of all moral agents, and that we need, in particular, to make appropriate distinctions between the ethics of developed world research in the developing world, collaborative or cooperative research between the developed and developing worlds, developed world research in the developed world and developing world research in the developing world. A consequence of looking at things this way is that, while it should be clear that there are ethical concerns, imperatives and obligations at all levels, different standards may and, in fact, cannot but be applied in different contexts at different levels, without resorting to the use of double standards, which can never be morally justified. Finally, I venture to propose a formula for a solemn pledge of moral integrity and noble intent, from the perspective of the agent, that is to say, the investigator, sponsor and funder of any research, to complement and balance the widely accepted informed consent requirement, from the perspective of the patient, the subject of any biomedical research.

Biomedical Research↗
PubMed1992

Young children's understanding of different types of beliefs.

The purpose of this investigation was to see whether children's understandings of different types of beliefs develop concurrently. Children of 3, 4, and 5 years of age were told or shown that child story characters held beliefs different from their own or from one another, not only concerning matters of physical fact ("false beliefs"), but also concerning morality, social convention, value, and ownership of property. In contrast to the older subjects, most 3-year-olds had difficulty in attributing to others deviant beliefs of all types, except perhaps ownership, sometimes even after having been told repeatedly what the other child believed. In addition, intercorrelations among different belief tasks were positive and substantial. It was suggested that an emerging representational conception of the mind is what enables older preschoolers to understand the possibility of belief differences of all these types.

Aggression↗
PubMed2005

Improving drug use for children in the developing world.

Children differ significantly from adults in the way they absorb, metabolise, and excrete drugs. These parameters also vary as children grow from neonates through to adolescence. The practical implications and challenges that this presents are well know to anyone who is involved in the medical management of sick children. The importance of paediatric medication safety and efficacy has been gaining increasing attention in the developed world over the past decade. The United States has introduced a carrot and stick approach to increase research into medications for children with the "paediatric exclusivity provision" and the "paediatric rule". The European Union is also investigating ways of improving the availability of medications for children. Unfortunately, this increased focus on appropriate medicines for children, which has occurred in the developed world, has not been mirrored in developing nations. Currently more than 10 million children under the age of 5 years die each year, with only six countries accounting for 50% of these deaths. The majority of these deaths are from treatable or preventable diseases. The developed world has a moral and ethical obligation to share its gains with the children of the world.

Adolescent↗
PubMed1999

Care as a moral attitude in nursing.

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of 'more' than the competent performance of a number of caring activities. For many nurses it is less clear what this 'more' means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process.

Empathy↗
PubMed1989

Toward a theory of nursing ethics.

The development of nursing ethics as a field of inquiry has largely paralleled developments within the field of biomedical ethics. However, there is growing evidence that the development of a theory of nursing ethics might not necessarily follow a similar pattern. The value foundations of nursing ethics are derived from the nature of the nurse-patient relationship instead of from models of patient good, rights-based notions of autonomy, or the social contract of professional practice as articulated in prominent theories of medical ethics. The value foundations of nursing are analyzed, and a moral-point-of-view theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics.

Empathy↗
PubMed2004

Analysis of the moral habitability of the nursing work environment.

BACKGROUND: Following health reform, nurses have experienced the tremendous stress of heavy workloads, long hours and difficult professional responsibilities. In recognition of these problems, a study was conducted that examined the impact of the working environment on the health of nurses. After conducting focus groups across Canada with nurses and others well acquainted with nursing issues, it became clear that the difficult work environments described had significant ethical implications. AIM: The aim of this paper is to report the findings of research that examined the moral habitability of the nursing working environment. METHODS: A secondary analysis was conducted using the theoretical work of Margaret Urban Walker. Moral practices and responsibilities from Walker's perspective cannot be extricated from other social roles, practices and divisions of labour. Moral-social orders, such as work environments in this research, must be made transparent to examine their moral habitability. Morally habitable environments are those in which differently situated people experience their responsibilities as intelligible and coherent. They also foster recognition, cooperation and shared benefits. FINDINGS: Four overarching categories were developed through the analysis of the data: (1) oppressive work environments; (2) incoherent moral understandings; (3) moral suffering and (4) moral influence and resistance. The findings clearly indicate that participants perceived the work environment to be morally uninhabitable. The social and spatial positioning of nurses left them vulnerable to being overburdened by and unsure of their responsibilities. Nevertheless, nurses found meaningful ways to resist and to influence the moral environment. CONCLUSIONS: We recommend that nurses develop strong moral identities, make visible the inseparability of their proximity to patients and moral accountability, and further identify what forms of collective action are most effective in improving the moral habitability of their work environments.

Attitude of Health Personnel↗
PubMed1988

Decision analysis and polio immunization policy.

Dr. Salk's comments on our paper fall into four major categories: our use of the techniques of decision analysis, the assumptions we used, the fact that we did not include individual and social values in the model, and the way in which vaccine policies are developed in the United States. We believe that the methods were used correctly, that the assumptions we used are defensible, and that our conclusions were both appropriate and appropriately worded. We explicitly did not include individual and social values since we were addressing the scientific and epidemiologic issues rather than ethical and moral issues. Vaccine policy development in the United States is carried out in public forums with opportunity for presentation of all sides of an issue.

Child↗
PubMed2006

Good work for dentists--ideal and reality for female unpromoted general practice dentists in a region of Sweden.

Female unpromoted general practice dentists (GPDs) in the Public Dental Health Service (PDHS) constitute about one fourth of all working dentists in Sweden. Unpromoted means that the position is without managerial functions. According to many reports, they have a problematic psychosocial work situation. THIS THESIS AIMED TO: Describe the perceived health for these GPDs, in comparison with others with a similar work situation. Analyse their sense of support in comparison with others. Describe how they perceived "good work", i.e. both the healthy and socially responsible work, and whether there was a difference between their ideal and their reality. Analyse patterns in two aspects - the moral and the career aspects - of "good work" for dentists. In zooo, questionnaires were sent to all female unpromoted GPDs in the PDHS in a region of Sweden. The response rate was 94%. RESULTS: The dentists felt unwell, worse than other compared groups. There was little support from the management. There was little inter-colleague contact. There was no cross-sectional assciation between collegial neworks and support, but the qualitative investigation showed that collegial networks were perceived as positive. There was a great difference between ideal and reality concerning good work. The dentists felt a lack of influence, and this was the greatest difference of all. Three components of good work - "moral values and skill discretion", "career development" and "work environment" were found. The dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work. IN CONCLUSION: There were serious work environmental problems among these dentists. The dentists felt unwell and felt a great lack of influence on important decisions. There was little inter-colleague contact, but collegial networks were perceived as positive. There was little support from the management, indicating a clear weakness in the relations between employers and female unpromoted GPDs in the PDHS. Three components of good work were found, where the moral component was the most important but it also showed the greatest difference between ideal and reality. Thus, the dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work and not industrial work. The dentists with the highest level of commitment perceived the largest differences. The PDHS organization has therefore failed to convince or engage those whom it ought to engage, i.e. those with the greatest commitment. The way to improve the female unpromoted GPDs' work situation would be through increased influence and support, bridging the gap between ideal and reality.

Adult↗
PubMed1985

A model for teaching medical ethics.

The approach to teaching employed in the Dictionary of Medical Ethics (1) provides a model which might be adopted in other media. Most of the 150 authors were medical, but many represented other disciplines, and they wrote for similar professionals and for the general public. Medical ethics is derived from medical science and practice, moral philosophy, sociology, theology, the law and other disciplines, all of which make essential, distinctive and complementary contributions to knowledge and to teaching. Medical practitioners must play the primary role, because they are responsible for clinical ethical decisions, but they need the co-operation and guidance of others. All who are concerned should work towards the development of a general moral consensus among the profession and public, which keeps abreast of scientific and technical advances and to which all are committed.

Dictionaries as Topic↗
PubMed2005

Personal narrative and an African-American perspective on medical ethics.

In recent years, there has been increasing interest in how medical professionals develop and articulate a moral foundation on which to base a way of leading their professional lives. In this essay, however, the author focuses more narrowly on how black physicians do it. The author explains that black physicians confront a unique set of circumstances and experiences that define reality for black doctors and other professionals from non-dominant groups in the United States. From this particular background, black physicians go on to develop a unique perspective on medical ethics. The author uses his own narrative to demonstrate his argument and to show its application to a current debate on the ethics of forensic psychiatry practice.

Black or African American↗
PubMed1995

Classical Anglican moral theology: unavoidably non-ecumenical.

In its specific moral conclusions ecclesiastical Anglican theology shares much with traditional Protestantism, Roman Catholicism, and Eastern Orthodoxy. In its understanding of the method and purpose of moral theology classical Anglicanism sometimes diverges from earlier Roman Catholicism -- and anticipates the most positive developments in contemporary Roman Catholic moral theology -- while sharing a common theological heritage with Rome in its understanding of natural law, the moral agent, and the moral act. Anglicans situate moral reasoning within the Church of the patristic Tradition, which distinguishes them from Protestants, yet do not accept the Roman magisterium's self-understanding. Consequently, the Anglican mode of moral reasoning has strong affinities with the Orthodox churches.

Bioethics↗