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PubMed1997

[Achlak and professional ethics of the therapeutic professions].

Man's mind is improved only by learning unknown things from scientists and from books, and mankind is exalted through self-developing of its nature. This is essence of Risael achlak (learning about behaviour), that modern humanism consisting of rational science and ethical perspective of Qur'an and its directions (important in the respect of limitation of man's behaviour towards religion and religious ethics in general) is based on. Ethical dimension of Qur'an is a consisting part of Qur'an's metaphysical and anthropological dimension. Basically, in its purpose, ethics appears as practical theology. In Its announcing of the God, Qur'an does not make division of spiritual and ethical; mind and will. Ethics just implements The Message at the field of the world of human acts. Thus, the relations between society and a single human being, as well as the relations among all people, are determined. Through developing its attitudes, ethics has concretized elements, tenets and values of human's real life. Qur'anic ethics is a programme of ethical revolution of mankind and society (whose the most exalted goal is confirmation of personality). That personality has got a task to, according to Qur'an, people have to change the world through enhancing it. These general tenets and attitudes produce specific direction and attitudes in certain fields, including tenets and attitudes in the field of medical ethics. These tenets had been defined in pre-islamic period. Even today, the tenets from Hypocrate's Wote are quoted and implemented. But, Arabian physicians have implemented a modified version of the Wote, that has been based upon Qur'anic tenets. The text and tenets of that Wote was described in this paper.

Ethics, Medical↗
PubMed1993

Ethics and mediation.

Ethics dialogue in this case is first used as a framework to initiate reflection on which forms of conflict resolution are appropriate in specific situations. This helps in planning and strategies, but does not guarantee what the outcome will actually be. Ethics dialogue, however, can also be used as a form of conflict resolution. For example, when the patient in the story wants to avoid revealing the names of her past dentists, an ethical framework could be presented that would respect her autonomy (an ethical term) and her right to privacy (a legal term), while still addressing your need to determine if the primary problem is of an ethical or dental nature, and if your role is to be that of a healing mediator or a healing dentist. This same form of conflict resolution could also be applied elsewhere in the story. For example, ethics dialogue would have been appropriate during the consultation between you and the endodontist, or between you and the patient, prior to the lawyer's formal request for the patient's records. It is difficult, however, for you to reduce conflict through an ethical dialogue once the lawyer requests information from you because, at that point, the adjudication process has already begun. The ethical reflection exercise will, however, help you negotiate through the adjudication process by providing a solid ethical reference point concerning conflict resolution. The February issue's ethics column will provide a framework for evaluating the forms of power available in conflict resolution in terms of justice.

Ethics, Dental↗
PubMed1997

[Ethics in nursing].

The conclusion reached at the end of this article is that there is a crisis in the ethics of nursing and that the focus of the ethics of nursing should be on virtues. The reconstruction of a virtue-based ethics in nursing is proposed as a solution for the current crisis in the ethics of nursing. With an analysis conducted on the ethics of nursing the story is told of an individual nurse within nursing in the South African society. Certain concepts to ethics as well as the dimensions of ethics in nursing are explained within the narrative of nursing. The institutionalisation of ethics of nursing is described based on the three ethical traditions that moved from virtues, to responsibility to human rights. An analysis of the moral practice in nursing indicates that a crisis in the ethics of nursing exist within the last tradition of human rights because of the conflict between the rights of the nurse and the patient. Through the analysis it becomes clear that no rules, codes or law can ensure moral behaviour. The control over moral behaviour should rather be internal than external. If a person does not have the virtues he or she does not understands the rules and human rights and responsibilities have a different meaning for them.

Attitude of Health Personnel↗
PubMed2004

Expertise in research ethics: is there any such thing?

In this paper, I consider the question of whether there is such a thing as 'expertise in research ethics'. I discuss first the issue of expertise in ethics more generally. There is quite a lot of resistance to the idea that there are ethics experts, for reasons which I will raise and respond to. I outline two different views of what might be counted as expertise in ethics, and argue that only one of these is defensible. But the defensible view is also a useful view. Ethics expertise in this sense does exist. It is a set of generic analytic skills and knowledge of ideas and logical processes. Expertise in research ethics is a particular type of ethics expertise, and I give a brief account of what it includes, and how it differs from ethics expertise in general. I end with the suggestion that people with such expertise would be useful members of Human Research Ethics Committees, and steps ought to be taken to increase the likelihood that they become members. This may or may not involve adding the category of 'ethicist' to the list of HREC membership categories.

Committee Membership↗
PubMed2004

[Health care ethics committees in German university clinics. A survey of all medical directors and directors of nursing].

OBJECTIVE: Health Care Ethics Committees (HEC) are new ways of implementing clinical ethics in hospitals and nursing homes. In the US all health care institutions must provide some structure to handle ethical conflicts in everyday patients' care. However, in Germany only a minority of hospitals, often members of the Protestant or Catholic Hospital Associations, have founded HEC. No studies exist in regard to the situation at German university hospitals. METHODS: In November 2002 we posted a questionnaire with 13 items to all medical directors (M) and directors of nursing (N) of the 36 German university hospitals. RESULTS: The response rate was 82 %. Limitation of treatment, informed consent and the conflict between beneficience and autonomy are the most relevant ethical issues in everyday practice. N estimated the need for additional support of their staff in ethical issues higher than M. Improvement of interdisciplinary teamwork, further education in ethics and ethical guidelines have been identified in order to improve ethical professional performance. However, N mentioned the lack of time and the low priority of ethics more often than M as problems in implementing theses measures. Five German university hospitals are planning to establish a HEC and two hospitals want to employ a clinical ethicist. CONCLUSION: Our data show a high need for information about HEC in German university hospitals. The tasks, working methods and chances for further development of HEC are neither known nor used in the majority of German university hospitals.

Codes of Ethics↗
PubMed1989

Analysis of the claim to distinct nursing ethics: normative and nonnormative approaches.

Nursing ethics has been declared to exist only as a subset of medical ethics. If this statement is to be refuted, any defense of a claim to a discrete nursing ethic must clarify what type of moral theory is being held as distinctly a nursing ethic. Several examples of nursing ethical theory are used to challenge Veatch's view that nursing ethics is a subset of medical ethics. The methodology used to provide the analysis is to group the ethical theories studied under the topics of normative and nonnormative ethics to provide for appropriate inquiry.

Ethics, Medical↗
PubMed1988

The ethics committee in the nursing home. Results of a national survey.

As the complexity, prevalence and visibility of ethical dilemmas in medical care of the elderly have grown, hospitals and nursing homes have attempted to develop mechanisms for responding to these difficult ethical issues. While it is known that many hospitals rely on education and advice provided by an ethics committee, little data exist on the responses of nursing homes, despite the unique nature of ethical issues in a long-term care setting. The present paper reports findings from a national survey of administrators of 4504 nursing homes in which mechanisms for handling ethical dimensions in patient care were investigated. Results from 29% of respondents reveal that few nursing homes have established ethics committees (2% of the sample) and that committee formation appears positively associated with facility size and religious affiliation. Committees that have been formed engage in policy review (81%), advisory case review (67%) and education (45%). Few committees include patients or their representatives as members, and few have the authority to make binding decisions (26%). While the most effective response to ethical issues in medical decision-making is being debated, standing committees provide one means to contribute to the quality of decision-making by patients, their family members and their physicians. However, broader inclusion of patient perspectives and education of members regarding ethical analysis are necessary precursors to effective functioning of ethics committees in long-term care.

Ethics↗
PubMed2005

Practical virtue ethics: healthcare whistleblowing and portable digital technology.

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces". Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing. The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.

Attitude of Health Personnel↗
PubMed1998

Against medical ethics: opening the can of worms.

In a controversial paper, David Seedhouse argues that medical ethics is not and cannot be a distinct discipline with it own field of study. He derives this claim from a characterization of ethics, which he states but does not defend. He claims further that the project of medical ethics as it exists and of moral philosophy do not overlap. I show that Seedhouse's views on ethics have wide implications which he does not declare, and in the light of this argue that Seedhouse owes us a defence of his characterization of ethics. Further, I show that his characterization of ethics, which he uses to attack medical ethics, is a committed position within moral philosophy. As a consequence of this, it does not allow the relation between moral philosophy and medical ethics to be discussed without prejudice to its outcome. Finally, I explore the relation between Seedhouse's position and naturalism, and its implications for medical epistemology. I argue that this shows us that Seedhouse's position, if it can be defended, is likely to lead to a fruitful and important line of inquiry which reconnects philosophy and medical ethics.

Ethical Theory↗
PubMed2002

Applied ethics in mental health in Cuba: part II--power differentials, dilemmas, resources, and limitations.

This article is the second one in a series dealing with mental health ethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to (a) the interests of clients, (b) their personal interests, and (c) the interests of the state. These conflicts are related to power differentials among (a) clients and professionals, (b) professionals from different disciplines, and (c) professionals and organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics.

Codes of Ethics↗
PubMed1984

Maryland hospitals get plan for creating ethics committees.

The Maryland Hospital Association's Advisory Committee on Medical Ethics, charged to assist member hospitals in forming ethics committees, focused on four concerns: study and development, physician support, patient/family participation, and potential issues. The committee recommended as a first step in establishing an ethics committee the creation of a study group. It warned hospitals not to expect a fully operational ethics committee immediately. A start-up period, according to the committee, should be used to develop a process for handling ethical questions and for educating the hospital community about the committee's role. To promote the best possible decision making, the hospital ethics committee should function as a support unit, for physicians as well as for patients, families, and hospital personnel. Clearly stated policies will provide a basis for appropriate intervention and help gain physician cooperation, the committee said. Such policies should encourage ethics committees to anticipate problems and to review decisions already made. While recognizing the need to involve patients' families in decision making, the advisory group agreed that the question of their presence at committee meetings should be addressed by each institution. In cases of controversial treatment or disagreement about the course of treatment, patient/family access to the committee should be clearly defined. The advisory committee suggested that each institution prepare its own list of topics that an ethics committee might consider. It also prepared a "model statement" of an ethics committee's purposes, membership, and procedures.

Ethics Committees, Clinical↗
PubMed1987

Nurses come together to face ethical issues.

In today's society, the role of the nurse is complex, challenging, and, at times, conflicting. The realities of limited resources, regulations, technology, and professional and personal integrity often given rise to ethical dilemmas and difficult decisions. To deal with these, forums designed specifically for nurses are needed. At Calvary Hospital, Bronx, NY, a Nursing Ethics Group was established to explore ethical choices nurses make daily and to deal with controversies that arise in the care of advanced cancer patients. The Nursing Ethics Group's goal was to promote responsible and ethical nursing practice by increasing awareness of the ethical dimensions of nursing, facilitating communication among nurses, and familiarizing nurses with ethical principles and components of the decision-making process. The group evolved in three phases: exploration of feelings and issues, consideration of an ethical decision-making model, and values clarification. Although membership is open to all, a core group has been established to plan agendas and provide continuity. Plans call for integrating sessions on values clarification and the ethical decision-making process into the orientation program and continuing education programs for all staff.

Bioethical Issues↗
PubMed2003

Ethical dilemmas in today's nuclear medicine and radiology practice.

Throughout history, societies have developed their own codes of ethics, including those pertaining to the practice of medicine. In the United States, physicians have adopted a set of ethics based on religious values and historical teachings. We, as physicians, have been presented several codes of ethics, including the American Medical Association Code of Ethics and the American College of Radiology Code of Ethics. Over time, we have learned to appropriately apply these codes to our daily practice. With the advent of new technologies in imaging, we may lose sight as to the transfer of these principles to reflect current conditions. Recent history has shown a trend of new technology leading to potential misuse of this technology and further leading to stricter governmental regulations. It is the purpose of this review to give guidelines for dealing with new technologies, such as PET imaging, and we describe a radiologist's ethical responsibility in a doctor-patient relationship. A historical review of medical ethics will lead to discussions about various issues affecting radiologists and nuclear physicians. To be sure, not all ethical situations are black and white, and therefore there are many gray areas. The opinions expressed in this article are those of the authors and are based on extension of already established rules of ethical conduct.

Codes of Ethics↗
PubMedDate not supplied

Remember Tuskegee: public health student knowledge of the ethical significance of the Tuskegee Syphilis Study.

The ethical problems that surrounded the Tuskegee Syphilis Study prompted widespread public criticism when they first surfaced in 1972; the Tuskegee Study remains an important case in bioethics. We recently examined public health student knowledge of the ethical significance of the Tuskegee Study as part of an ethics curriculum needs assessment at Tulane University. A brief questionnaire was administered to 236 graduate students currently enrolled in seven epidemiology courses. Basic demographic information was obtained along with information about degree program. A series of questions was then asked to assess student knowledge of bioethics including the ethical significance of the Tuskegee Study. Only 19% (46 of 236) of the students demonstrated knowledge of the ethical significance of the Tuskegee Study. Knowledge of the Tuskegee Study's ethical significance was higher among students who were from the United States and those who were enrolled in the epidemiology program (P < .05). The ethical problems that surrounded the Tuskegee Study have rarely been encountered in public health. However, this important case stands as an exemplar of the potential for ethical abuses in human subjects research. Such cases ought to be highlighted in public health curricula. Medical Subject Headings (MeSH): blacks, African Americans, educational curriculum, epidemiology, ethics, public health, racism.

Adult↗
PubMed2006

Conservation as virtue: a scientific and social process for conservation ethics.

Most scientists take ethical arguments for conservation as given and focus on scientific or economic questions. Although nature conservation is often considered a just cause, it is given little further consideration. A lack of attention to ethical theory raises serious concerns for how conservation scientists conceive and practice ethics. I contrast two common ways scientists approach ethics, as demonstrated in the writings of Stephen Jay Gould and E. O. Wilson. Gould casts severe doubt as to whether any ethics are possible from science, whereas Wilson proposes science as the only path to ethics. I argue these two methods ultimately limit popular support for conservation and offer Alasdair MacIntyre's "virtue ethics" as an alternative. Unlike Gould and Wilson, MacIntyre provides an ethical theory that reconciles scientific inquiry and social traditions. Recent studies of the Civil Rights Movement in the United States affirm MacIntyre's claims and provide important insights for conservation today. These accounts argue that social solidarity and political success against segregation were possible only as rooted in the particular language, logic, and practices of a robust cultural tradition. If correct, conservation science should attend to several questions. On what basis can conservation achieve widespread cultural legitimacy? What are the particular social currencies for a conservation ethic? What role does science play in such a scheme? MacIntyre's careful positioning of scientific and social traditions provides a hopeful ethical direction for conservation.

Bioethical Issues↗
PubMed1989

Hospital Ethics Committees: one of many centers of responsibility.

Ethical reality is coextensive with human dignity. Therefore, one essential way to understand ethics is as the systematic effort to discern the imperatives of human dignity. Seeing ethics in this way highlights the fact that health care institutions have many centers of ethical responsibility (CERs) - the Chief Executive Officer, Board of Trustees, senior management team, etc. The Ethics Committee is only one such CER and not the most important one. These other CERs will benefit from identifying: (1) the fact that they are consistently dealing with ethical reality and making ethical decisions; (2) some critical elements of good ethical decision-making: (i) having the appropriate community; (ii) making the guiding value priorities explicit and specific; (iii) gaining skill in using the needed intellectual tools; and (iv) fashioning appropriate process and structure for discernment.

Ethical Analysis↗
PubMed1991

Teaching clinical ethics in the residency years: preparing competent professionals.

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics.

Bioethical Issues↗
PubMed1998

The ethics of HIV research in developing nations.

This paper discusses a dispute concerning the ethics of research on preventing the perinatal transmission of HIV in developing nations. Critics of this research argue that it is unethical because it denies a proven treatment to placebo-control groups. Since studies conducted in developed nations would not deny this treatment to subjects, the critics maintain that these experiments manifest a double standard for ethical research and that a single standard of ethics should apply to all research on human subjects. Proponents of the research, however, argue that these charges fail to understand the ethical complexities of research in developing nations, and that study designs can vary according to the social, economic, and scientific conditions of research. This essay explores some of the ethical issues raised by this controversial case in order to shed some light on the deeper, meta-ethical questions. The paper argues that standards of ethical research on human subjects are universal but not absolute: there are some general ethical principles that apply to all cases of human subjects research but the application of these principles must take into account factors inherent in particular situations.

Acquired Immunodeficiency Syndrome↗