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PubMed1995

Ethical considerations in oncology: balancing the interests of patients, oncologists, and society.

BACKGROUND: Oncologists face ethical dilemmas every day in deciding about choice of treatment, continuation of treatments, events near the end of life, conflicts of interest, and risk management. Yet, many oncologists have limited training in ethics. METHODS: Review of existing studies and definitions of useful terms. Case studies analyzed according to ethical principles. RESULTS: Individual oncology cases can be analyzed according to ethical principles with benefit to the patient, physician, and possibly society. Ethics cannot resolve many of the thorny questions about allocation of resources, justice, or possible conflict of interest. CONCLUSION: Oncology decision-making fits into formal ethical frameworks, and understanding both can help doctors and patients make difficult choices. Understanding of ethical principles can help daily practice, but does not solve current dilemmas of allocation of resources, unrealistic demands, etc. More formal collaboration between hospital ethics committees or personnel and clinical oncologists is recommended for the day-to-day decision-making process.

Aged↗
PubMed2006

Using empirical research to formulate normative ethical principles in biomedicine.

Bioethical research has tended to focus on theoretical discussion of the principles on which the analysis of ethical issues in biomedicine should be based. But this discussion often seems remote from biomedical practice where researchers and physicians confront ethical problems. On the other hand, published empirical research on the ethical reasoning of health care professionals offer only descriptions of how physicians and nurses actually reason ethically. The question remains whether these descriptions have any normative implications for nurses and physicians? In this article, we illustrate an approach that integrates empirical research into the formulation of normative ethical principles using the moral-philosophical method of Wide Reflective Equilibrium (WRE). The research method discussed in this article was developed in connection with the project 'Bioethics in Theory and Practice'. The purpose of this project is to investigate ethical reasoning in biomedical practice in Denmark empirically. In this article, we take the research method as our point of departure, but we exclusively discuss the theoretical framework of the method, not its empirical results. We argue that the descriptive phenomenological hermeneutical method developed by Lindseth and Norberg (2004) and Pedersen (1999) can be combined with the theory of WRE to arrive at a decision procedure and thus a foundation for the formulation of normative ethical principles. This could provide health care professionals and biomedical researchers with normative principles about how to analyse, reason and act in ethically difficult situations in their practice. We also show how to use existing bioethical principles as inspiration for interpreting the empirical findings of qualitative studies. This may help researchers design their own empirical studies in the field of ethics.

Beneficence↗
PubMed2003

Ethics and faith: openness to the relationship between them.

This paper was presented at a seminar that outlined the work of the Surrey Ethics Forum. The Forum provides an opportunity for reflection by staff of the Federal University of Surrey and its Associated Institutions on ethical questions, the place of ethics in the curriculum and the role of ethics in the life of future graduates. The purpose of this paper is to argue that openness to the relationship between ethics and faith is itself an ethical task because both ethics and faith claim to protect human dignity and give meaning to the concept of "human flourishing". Analysis of the relationship between ethics, faith, flourishing and narrative can lead to clearer understanding of differences in ethical debates.

Curriculum↗
PubMed1981

Ethics and health planning: implications for education.

Over the past decade in this country, there has been a rekindling of interest in the ethical questions of public policy. Moreover, the concern for ethical issues is nowhere more evident than in the field of health care. However, the ethical problems of health planning, particularly as practiced at the regional level, have scarcely received attention. This article explores the ethical dimensions of health planning and argues that health planners have not been adequately prepared, neither through their education nor through socialization in the profession, to deal with the complex ethical issues facing them. However, health planning theory can be enriched and practice improved if the ethical issues are confronted. Health planning is viewed as one means of achieving social justice because the benefits and burdens associated with health care are distributed to the members of society by the decisions made in the health planning process. However, planning decisions are not meekly accepted by the persons affected. More often than not, health planning decisions produce substantial political controversy, which is due, in part, to the planning methods commonly used. The synoptic or comprehensive planning approach avoids ethical questions by ignoring them. The incremental planning approach deals with them but only in terms of political process. Neither of these approaches is particularly useful for resolving health planning's ethical questions. The implications of these findings for education in health planning are discussed. The merits of the case study as a means of ethical education are presented.

Ethical Analysis↗
PubMed1991

Building the framework for dealing with ethical issues.

Making ethical decisions is difficult. Professional and personal values enter heavily into what one member of the health care team considers the "right" decision, and these values may interfere with the decision-making process of the team. As team members begin to realize how their ethical values affect the decision, they may be better able to resolve the conflict within the team. An understanding of each member's ethics and values also can serve to enhance decision making. Nurses are just beginning to view themselves as part of the ethical decision-making team. In order to take an ethical stance, nurses need to have a better understanding of ethical principles to use in the decision-making process. Nurse needs to develop a sound philosophical base in ethics through study and continuing education to be an active part of the health care team making ethical decisions. Nurses have an obligation to move away from the emotional response to ethical dilemmas toward using a more sound basis for these decisions.

Attitude of Health Personnel↗
PubMed2000

Ethics gap in surgery.

BACKGROUND: Discussion of ethical issues occurs much less often in the surgical than in the medical literature. The reasons for this "ethics gap" are unknown. METHODS: Our clinical faculty ranked the ethical and legal acceptability of four treatment options in two cases of surrogate decision making. Only one option in each case was ethically and legally unacceptable (treating despite objection by the surrogate decision maker). RESULTS: Surprisingly often, faculty mistakenly believed the ethically unacceptable option to be acceptable, and the legally unacceptable option to be acceptable. Surgeons were not ethically different from other physicians. Surgeons (19 of 31, 62%), however, were significantly (p < 0.05) more likely than internists (18 of 51, 35%) or pediatricians (4 of 18, 22%) to believe, mistakenly, that operating on the baby without parental consent was legally acceptable. CONCLUSIONS: This pilot study did not identify why the surgical literature contains a relative dearth of ethics discussion. Broader investigations are needed, because it is important that we understand the reasons for the gap. Surgeons' strong ethic of personal responsibility for patients' welfare should be transmitted to young trainees, a goal best achieved by discussing and writing about ethics. Moreover, our legal data suggest that a gap may also exist between surgeons and other physicians in understanding health law.

Adult↗
PubMed1996

Why teach ethics to nurses?

The Project 2000 diploma course has established ethics as a core component of the nursing curriculum. As a consequence there has been a plethora of nursing ethics books which justify their existence on the notion that nurses are recognizing the ethical nature of their work and seeking ethical guidance. It remains to be seen, however, whether the texts fulfil the perceived need. Ethics, it may be argued, is the current vogue; and the teaching of ethics to nurses is being given prominence. The aims of such teaching would appear to vary both between and within institutions but broadly seem to reflect the notions highlighted above. However, nurses do not approach this subject with one voice and much criticism has suggested that current approaches to the teaching of ethics to nurses do little more than frustrate students in their attempt to deal with matters ethical, and produce a generation of moral sceptics (Baier 1985). It is the aim of this paper to examine the rationale for teaching ethics to nurses.

Curriculum↗
PubMed2000

Ethical cognition and selection-socialization in retail pharmacy.

There is a great deal of support for the contention that the ethical cognition of health care professionals are of consequence to the level of patient care provided. The present study examines the ethical cognition of what has traditionally been deemed a profession of incomplete or marginal status: the retail, or community, pharmacy setting. An empirical examination of ethical cognition compares a systematic random sample of retail pharmacists with pharmacy students. Additional comparisons are made with a baseline of ethical cognition abilities of other health care professionals, such as physicians and nurses. Based on cognitive-developmental theory and using a well-known measure of ethical reasoning, two hypotheses are explored regarding the ethical reasoning skills of retail pharmacy practitioners and pharmacy students. Results indicate that, contrary to cognitive moral development theory, students possess greater ethical reasoning skills than do their practitioner counterparts. In addition, baseline comparisons with other health professional groups reflect unfavorably on the retail pharmacists. It is suggested that the selection-socialization processes inherent in the retail pharmacy setting may result in on or more of the following outcomes: 1) the selection of lower ethical reasoners to the community pharmacy setting, 2) the exodus to other pharmacy settings of higher reasoners, and 3) a possible retrogression in the ethical cognition of community practitioners. Implications for retail practice and limitations are discussed.

Cognition↗
PubMed2002

Teaching ethics to trainees.

Medical events contain many sources of uncertainty. Instruction in medical ethics gives trainees vital knowledge that assists them with some of the sources of uncertainty. Instruction to provide this knowledge is not available from the usual science curriculum. From an understanding of the principles of ethics flows an application of those principles to timely ethical issues. Ethics education has become a mandated feature in accredited residency training programs. A flexible curriculum in ethics can be developed for trainees in child neurology. The education program encourages thoughtful caregivers and teaches the methods for resolution of ethical issues and conflicts. Selection of topics is based on faculty and trainee interest and on situations of current relevance in the training program. Ethics education results in trainees who become capable of ethical reasoning and capable of resolving many of the clinical situations where issues arise that require decisions based on ethical principles.

Curriculum↗
PubMed1997

Ethical issues in occupational medicine practice: knowledge and attitudes of occupational physicians.

Views on ethical conduct in occupational medicine practice can vary from country to country and even between occupational health practitioners. However, there are many areas of common agreement, and this is apparent on comparing guidance documents on ethics produced by several different organizations. The usefulness of these documents will depend in part on how aware practitioners are of their existence. A standardized questionnaire administered to 70 occupational physicians in the Netherlands, UK, and Singapore showed that there was a lack of awareness of guidance documents on ethics, even for publications from their own countries. Only five of the 70 respondents consulted an ethics document in the past year. In addition to publications, other avenues were used for advice on ethical issues. There was a difference in opinion between the physicians from Singapore and those from the two European countries on whether specific occupational health activities were ethical. These findings reinforce the need for international guidance on ethics to take into account differences in attitudes and practice between countries. On many issues there was no unanimity of opinion, even between occupational physicians from the same country. This may be an indication of the complexity of ethical matters, and provides a rationale for publishing guidance on ethics in occupational medicine.

Adult↗
PubMed2004

The ethics of cultural competence.

Cultural competence curricula have proliferated throughout medical education. Awareness of the moral underpinnings of this movement can clarify the purpose of such curricula for educators and trainees and serve as a way to evaluate the relationship between the ethics of cultural competence and normative Western medical ethics. Though rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. Culturally competent clinicians promote these principles by learning about culture, embracing pluralism, and proactive accommodation. Generally, culturally competent care will advance patient autonomy and justice. In this sense, cultural competence and Western medical ethics are mutually supportive movements. However, Western bioethics and the personal ethical commitments of many medical trainees will place limits on the extent to which they will endorse pluralism and accommodation. Specifically, if the values of cultural competence are thought to embrace ethical relativity, inexorable conflicts will be created. The author presents his view of the ethics of cultural competence and places the concepts of cultural competence in the context of Western moral theory. Clarity about the ethics of cultural competence can help educators promote and evaluate trainees' integration of their own moral intuitions, Western medical ethics, and the ethics of cultural competence.

Communication Barriers↗
PubMed2005

Teaching medical students to discern ethical problems in human clinical research studies.

PURPOSE: Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. METHOD: The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. RESULTS: Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p < .02). Students in the criteria-focused group were better able than students in the control group (p < .03) to discern specific ethical problems, more closely resembling expert assessments. Unexpectedly, the group focused on clinical research participants identified fewer problems than did the control group (p < .05). CONCLUSIONS: The criteria-focused intervention produced enhanced ethical evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

Adult↗
PubMed2006

Role of nurses in institutional ethics policies on euthanasia.

AIM: This paper reports the findings of a survey that investigated whether Flemish Catholic hospitals and nursing homes had developed written ethics policies on euthanasia and how the role of nurses was described in these policies. BACKGROUND: International research shows undeniably that nurses are confronted with patients requesting euthanasia. Euthanasia has been legal in Belgium since 2002 and in Holland since 2001. Because of the vagueness in formal documents and policies on the role of nurses in euthanasia, there is an increasing need to establish institutional ethics policies that clearly describe the role of nurses in the euthanasia process. METHODS: We used a cross-sectional descriptive mail questionnaire to survey the general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Data were collected between October 2003 and February 2004. RESULTS: Of the 298 institutions targeted for survey, 81% of hospitals, 62% of nursing homes returned completed questionnaires. Of these, 79% of the hospitals and 30% of the nursing homes had a written ethics policy on euthanasia. The ethics policies of 87% of the hospitals and 77% of the nursing homes explicitly addressed the role of nurses in the euthanasia process. In the majority of hospitals and nursing homes, the ethics policies addressed the conscientious objections of nurses to euthanasia. Most hospitals and nursing homes voluntarily communicated their ethics policies to the nurses they employed. CONCLUSION: The written ethics policies of most Catholic healthcare institutions give explicit attention to the role of nurses in the euthanasia process. However, the meaning and content of the role of nurses, as indicated in these ethics policies, continue to be an issue. Further research is needed to verify how these policies are actually implemented within the institutions and whether they contribute to better support for nurses and to ethical care for patients.

Attitude of Health Personnel↗
PubMed1995

Ethical reasoning and decision-making in the clinical setting: assessing the process.

Clinical ethical reasoning and analysis are skills as central to good patient care as the efficient application of biomedical knowledge to diagnosis and prognosis. However, experience in teaching clinical ethics to senior medical students has indicated that simply trying to 'apply' the knowledge learnt about ethical theories, principles, concepts and rules in the clinical setting does not ensure ethical competence in clinical decision-making. In 1992, we developed and piloted a three-session programme that focused on a more systematic approach to the way students identified and attempted to manage ethical issues in their clinical practice. This programme was modified and improved in 1993 and further expanded in 1994. Our experience suggests that many students are now better able to bridge what has been called the 'gap' between the possession of ethical knowledge and its actual use in clinical decision-making. The remaining problem was assessment. How do you assess clinical ethical reasoning and decision-making? In the preclinical years of medical education, knowledge-based assessment tools, like the modified essay question (MEQ), provide a means for assessing the sensitivity of students to ethical issues. However, such tools permit neither an appraisal of how students actually make clinical ethical decisions, nor which factors students perceive as important in making an actual clinical decision. In order to make this type of appraisal, we developed a format for a written case report that facilitated our assessing the process as well as the end-product, the decision.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed2006

The need for a clinical ethics service and its goals in a community healthcare service centre: a survey.

OBJECTIVES: To (1) assess whether according to healthcare providers, the creation of an ethics service responds to a need; (2) assess the importance of an ethics service for healthcare providers; (3) determine what ethics services should be offered and the preferred formats of delivery; and (4) identify key issues to be initially dealt with by the ethics service. DESIGN: A survey of healthcare providers in Québec's Centre Local de Services Communautaires (CLSC), healthcare institutions dedicated to community health and social services. FINDINGS: 96 (95%) respondents agreed that an ethics service was needed, and on average the ethics service project was judged to be very important. Preferred formats for ethics consultation and education were identified, as well as key concerns such as the need of respect for the patient as a person, elder abuse and ethical issues in home care. CONCLUSION: This survey is helping in the implementation of an ethics service and can guide others in similar healthcare institutions.

Community Health Services↗
PubMed2006

Teaching and assessing medical ethics: where are we now?

OBJECTIVES: To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning. DESIGN: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives. PARTICIPANTS: The lead for teaching and learning at each medical school was invited to complete a questionnaire. RESULTS: Completed responses were received from 22/28 schools (79%). Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development. CONCLUSIONS: This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally.

Curriculum↗
PubMed2006

Ethical principles and practices for research involving human participants with mental illness.

This report of the American Psychiatric Association's task force on research ethics addresses ethical issues related to the conduct of research involving human participants with mental illness. The report includes discussion of recruitment and ongoing participation of persons whose decisional capacity may be impaired and the ethical costs of categorically excluding persons with serious mental illness. Investigators should receive education in research ethics that addresses rules and norms governing research; sensitivity to ethical implications of decisions and actions; and skills in ethical problem solving, including ascertainment and disclosure of conflicts of interest. Ethical research design must ensure that a study has scientific merit, methods used should yield knowledge of value, and procedures must minimize risks to participants and optimize benefits. When risks are anticipated, plans should be developed to ensure participants' safety. The task force concludes with 12 recommendations for researchers, ethical review bodies, and advocacy groups to promote research and ensure ethical conduct of research.

Ethics, Research↗
PubMed2006

Ethics and lactation consultants: developing knowledge, skills, and tools.

This article studies the role of ethics in the context of the work of International Board Certified Lactation Consultants. It provides an overview of some of the main ethical approaches with the goal of contributing to the knowledge, skills, and tools required by lactation consultants. Five main sections structure the article: background, current literature, ethical theory and principles, implications for lactation consultants, and decision-making frameworks. Background about the International Board of Lactation Consultant Examiners and International Board Certified Lactation Consultants and the significance of applied ethics in their work are described. Current literature regarding ethics and lactation consultants is reviewed. Because a computer-based literature search yielded a lack of articles, ethics in nursing literature is also presented. Three main ethical theories and 5 key ethical principles are explored with a view to their implications for lactation consultants. Finally, decision-making frameworks are considered as systematic tools for making ethical decisions.

Breast Feeding↗