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PubMed2000

Recovering ethics after 'technics': developing critical text on technology.

Much modern science and ethics debate is on high-profile problems such as animal organ transplantation, genetic engineering and fetal tissue research, in discourse that assumes technical tones. Other work, such as narrative ethics, expresses the failed promise of technology in the vivid detail of human experience. However, the essential nature of contemporary technology remains largely opaque to our present ethical lens on health care and on society. The limited controversies of modern science and ethics perpetuate 'technics', a technical, problem-solving mindset that fails to grapple successfully with the complexity of technology. A critical dialectic between practice and scholarship widens the ethical conversation in nursing to consider technology as an ongoing set of daily and fundamental moral choices on how we live. Critical text on technology recovers ethics from the limits of technics, and assists nurses to develop an inherent knowledge of technology that is needed to provide ethical care in a technological world. There are overlooked ethical challenges in the mundane, everyday routine activities of professional practice, and these have gone largely unexamined. Ethical behavior is not the display of one's moral rectitude in times of crisis. It is the day-to-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions.

Choice Behavior↗
PubMed2000

Ethics and education.

In the debate concerning the education of nurses that is currently taking place in Denmark, two widely differing views are apparent regarding the best way of training nurses such that the ethical aspect of their work is adequately considered. The first of these is based on the premise that practical care is fundamental to and justified by theories on nursing, care and ethics, which is why the theoretical part of nurse education deserves a higher priority. The second view is based on the premise that social care cannot be taught by means of theories, but can be learnt only through practice. The master-apprentice principle of ancient Greece is stressed in connection with this as being a viable alternative to the theoretical model of education. These two very different views can be traced back to Plato's and Aristotle's ideas on ethics and teaching respectively; indeed, those engaged in the debate make specific reference to these philosophers. In Denmark, a third fundamental viewpoint exists, known as 'ontological ethics'. Phenomenologist KE Løgstrup is one of the best-known representatives of this view. Basing the line of argument on Løgstrup's ethics and the view of education associated with this, this article questions the relevance of ancient Greek thought to today's world by illustrating a number of problems that are connected with the theoretical model of nurse education and with the master-apprentice principle. Løgstrup associates ethics with the aesthetic principle that 'the useless is the most useful' in human life and with the view we also see in Kierkegaard's and NFS Grundtvig's writings that ethics can be imparted only by indirect means. Løgstrup bases his understanding of ethics on the Judaeo-Christian concept of Genesis and the view that human beings were created with an ethical potential that is best nourished by aesthetic impressions.

Culture↗
PubMed1987

Ethical issues in a drug information center.

The frequency and nature of ethical issues faced by pharmacists have not been well documented. To address these issues a retrospective study of the potential ethical problems encountered by pharmacists in a drug information center was conducted. Of the 744 calls received over a 13-month period, 50 raised ethical issues. Consumer calls were more likely to raise ethical issues than were health-provider calls. The calls mainly fell into five categories: drug identification, assessment of a physician's recommendations for consumers, conflict between callers' needs and legal or public-health considerations, therapeutic issues in the pharmacist-patient relationship, and paternalistic treatment of "difficult" callers. These questions raised ethical issues related to confidentiality, truth telling, and pharmacists' societal obligations. Pharmacists may confront an increased number of ethical issues as more drug information centers provide consumer services. Although there is no empirical evidence regarding pharmacists' ability to deal with ethical issues, there are reasons to believe that training in medical ethics will better equip pharmacists to recognize, analyze, and resolve ethical dilemmas.

Disclosure↗
PubMed2006

Pandemic influenza preparedness: an ethical framework to guide decision-making.

BACKGROUND: Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. DISCUSSION: In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. SUMMARY: The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.

Coercion↗
PubMed2003

The practice setting: site of ethical conflict for some mothers and midwives.

Practitioners' ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong 'action' for resolving dilemmas. They exclude context and relationship. Personal narratives of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between workplace/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics.

Attitude of Health Personnel↗
PubMed2005

Practising virtue: a challenge to the view that a virtue centred approach to ethics lacks practical content.

A virtue centred approach to ethics has been criticized for being vague owing to the nature of its central concept, the paradigm person. From the perspective of the practitioner the most damaging charge is that virtue ethics fails to be action guiding and, in addition to this, it does not offer any means of act appraisal. These criticisms leave virtue ethics in a weak position vis-à-vis traditional approaches to ethics. The criticism is, however, challenged by Hursthouse in her analysis of the accounts of right action offered by deontology, utilitarianism and virtue ethics. It is possible to defend the action guiding nature of virtue ethics: there are virtue rules and exemplars to guide action. Insights from Aristotle's practical approach to ethics are considered alongside Hursthouse's analysis and it is suggested that virtue ethics is also capable of facilitating action appraisal. It is at the same time acknowledged that approaches to virtue ethics vary widely and that the challenges offered here would be rejected by those who embrace a radical replacement virtue approach.

Ethical Theory↗
PubMed2001

Health ethics in Pakistan: a literature review of its present state.

National literature on ethics provides an insight into the nature and development of a dialogue on health issues within a population. This study investigated the health ethics discourse in Pakistan. The purpose was to critically reflect on the nature and level of such discussions with the aim of stimulating an interest in the ethical implications of health and medicine in developing countries. The study evaluated the literature on biomedical and health ethics published in Pakistan during 1988-1999. Overall, there is a dearth of published discourse on healthcare ethics in Pakistan. Values that are considered to stem from religious teachings predominate in discussions relating to medical ethics. A lack of effective policy and legislation concerning the ethical practice of medicine is reported to have negative effects on the profession. Research ethics has not been captured in the published papers in Pakistan. Consideration of ethical issues in health is at an early stage in the country and may reflect the situation in a large part of the developing world.

Developing Countries↗
PubMed2001

The relationship of education and moral reasoning to ethical practice: a meta-analysis of quantitative studies.

This meta-analytic article of quantitative studies is aimed at summarizing knowledge gained on ethical practice for the period of 1987 to 1997 and at suggesting directions for future research. It specifically investigated the relationships of education and moral reasoning to ethical practice, with ethical practice as the dependent variable. The sample consisted of eight studies that investigated the relationship between education and ethical practice, and five studies that addressed the relationship between moral reasoning and ethical practice. A small to medium relationship between education and ethical practice was found, with an overall mean for effect sizes, d = .44, p = .000. To test the relationship between moral reasoning and ethical practice the Pearson product moment coefficient r was used as the effect size estimate, as each of the studies in this group reported correlation analyses. A small but significant relationship was found between moral reasoning and ethical practice (overall r of .2, p = .000). These results are evaluated in comparison to those of a decade earlier and overall trends are identified. As before, the majority of the studies are in the form of dissertations, and few of their authors have published their work in the general scientific literature. Similarly, clarity has not yet been achieved with regard to the conceptual and operational definitions of ethical practice. Theoretical, measurement, and policy issues are discussed in highlighting the implications of the study.

Education, Nursing↗
PubMed2004

UME-21 and teaching ethics: a step in the right direction.

BACKGROUND AND OBJECTIVES: Ethics education for medical students has included a number of relatively vague descriptions of appropriate curricular objectives, but medical schools struggle with the general teaching of ethics, as well as with presenting the ethical dilemmas posed by managed care. This paper proposes some standards and uses them to analyze the general and managed care ethics content of the Undergraduate Medical Education for the 21st Century (UME-21) curricula. METHODS: We analyzed progress and final reports from each school to define their learning objectives, content, teaching methods, and evaluation strategies in ethics. Each was evaluated using principles of adult learning and Rest's Four Component Model of Moral Development. Good examples of curricular elements from participating schools are described. RESULTS: Ethics curricula varied widely among the schools. Goals and objectives were often stated in generalities. Teaching methods were diverse and innovative, and several new combinations of learning activities were created to highlight ethics topics. Content represented managed care and non-managed care topics in varying proportions. Student surveys of attitudes toward managed care and opinions of the ethics programs were the most commonly used as evaluation tools. Some schools were able to develop more direct means of evaluating student learning. The Four Component Model was not fully addressed in the programs developed by the participating schools. CONCLUSIONS: We make recommendations about the objectives, teaching methods, content, and evaluation methods of an ideal medical school curriculum in ethics.

Adult↗
PubMedDate not supplied

Everyday ethics.

While dramatic issues such as assisted suicide and genetic engineering raise unique ethical questions for health care professionals, they are not the typical ethical concerns that nurses face in their daily practice. The more usual ethical situation or "everyday ethics" occur during the regular interactions that nurses have with patients, their families, and other health care providers. Everyday ethics is central to nursing practice. Being attuned to this aspect of professional practice gives meaning and purpose to nursing care. Typical clinical examples provide the backdrop for the discussion of everyday ethics. Through increasing their knowledge of ethical theory and values, their sensitivity to ethical issues in daily practice, their ability to use critical thinking, and their communication skills, nurses will be better able to provide ethically appropriate care to their patients.

Communication↗
PubMedDate not supplied

Ethical conflicts experienced by certified pediatric nurse practitioners in ambulatory settings.

INTRODUCTION: The purpose of this descriptive study was to (a) identify the types of ethical conflicts and their resolutions reported by a group of certified pediatric nurse practitioners (CPNPs) in their ambulatory practice and (b) to examine demographic, educational, and practice-setting factors associated with these conflicts. METHOD: Five hundred fifty-nine CPNPs, identified by the National Association of Pediatric Nurse Associates and Practitioners, received survey questionnaires in the mail and were asked to participate by describing an ethical conflict in their practice. Questionnaires were completed by 118 CPNPs. Each ethical conflict was analyzed according to a four content analysis classification system to capture multiple relevant meanings. The relationship between types of ethical conflicts and demographic, educational, and practice-setting variables was examined. RESULTS: One third (34%) of the perceived ethical conflicts fell in the child/parent/practitioner relationship category. Most conflicts (31%) were experienced as a moral dilemma where 2 or more clear moral principles apply but they support mutually inconsistent courses of action. Most ethical conflicts (22%) were unresolved. DISCUSSION: Understanding the nature of ethical conflicts that CPNPs are experiencing in ambulatory settings is important. Professional and institutions/agencies need to collaborate on how to initiate appropriate ethics education and consultation for professional staff to recognize, discuss, and resolve ethical conflicts in the workplace.

Adult↗
PubMed1992

Reflections of a reluctant clinical ethicist: ethics consultation and the collapse of critical distance.

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them--but rarely both. It may be that professional ethics is most effective when it plays the role of 'stranger' rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its 'strangeness' in the medical milieu even as it assumes a more prominent role within the medical center.

Clinical Medicine↗
PubMed1995

Ethical awareness among first year medical, dental and nursing students.

Ethics is increasingly being included in the training curriculum for health-care professionals. However, debate continues around the appropriate content of ethics courses for such students and the most relevant teaching approaches which will enable students to apply their ethical knowledge in clinical settings. At a time when health-care professionals are starting to collaborate more closely in multidisciplinary teams, it is appropriate to explore the ethical values held by different groups of health professionals. This study sought to ascertain the ethical views and knowledge which medical, dental and nursing students have at the commencement of their training, to establish their opinions on the most important areas of ethical debate in contemporary health care and to examine their ethical reasoning in response to a series of vignettes. Students gave detailed answers to the questionnaire and the data they provided furnishes useful material for those designing and teaching ethics courses.

Adult↗
PubMed1987

Physical therapists as double agents. Ethical dilemmas of divided loyalties.

Ethical dilemmas arise when physical therapists encounter conflicts between loyalty to their patients and loyalty to their employers. This type of ethical conflict is called "the dilemma of the double agent." If physical therapists perceive themselves as agents of their patients, their employment may be threatened. If physical therapists perceive themselves as agents of their employers, their patients may suffer physical or psychological harm. The double-agent dilemma is illustrated in this article by a hypothetical case study derived from sports physical therapy. Three ethical theories--egoism, utilitarianism, and formalism--are used to analyze the conflict and formulate solutions. A second conflict also is raised between patient autonomy and medical paternalism. As physical therapists become more autonomous, they will assume increased responsibility. Inherent in this increased responsibility is the obligation to recognize and confront ethical dilemmas in physical therapy practice. Resolving ethical dilemmas is difficult, but use of ethical theories can help in the systematic examination of basic assumptions and principles. This article introduces therapists to three ethical theories and presents a model for ethical decision making.

Adolescent↗
PubMed2005

Developing medical ethics in China's reform era.

The paper gives an analytical synopsis of the problem of developing medical ethics in the early half of the 1990s in China, as perceived by Chinese scholars and medical professionals interested in medical ethics. The views captured and analyzed here were expressed in one of the two major journals on medical ethics in China: Chinese Medical Ethics. The economic reform unleashed profound changes in Chinese society, including in the medical field, creating irregularities and improprieties in the profession. Furthermore, the market reform also created new values that were in tension with existing values. In this transitional period, Chinese medical ethicists saw the need to rebuild medical morality for the new era. Using the code of conduct promulgated by the Chinese Ministry of Health in 1989 as a basis, assessment and education aspects of the institutionalization of medical ethics are discussed. In addition to institutional problems of institutionalising ethics, there are philosophical and methodological issues that are not easy to solve. After all, to institutionalize medical ethics is no easy task for a country as old and as big as China. Chinese medical ethicists seem ready to confront these difficulties in their effort to develop medical ethics in Reform China.

Bioethics↗
PubMed2000

An analysis and evaluation of student nurses' participation in ethical decision making.

This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced were 'family giving up on a patient because he or she could not be cured', and 'not telling the truth to the patient'. The Korean Nurses' Code of Ethics was applied, in particular the preamble, and the third, fourth, seventh and tenth clauses. The most common rule of ethics and principle applied in these nurses' ethical decision making were veracity and nonmaleficence. With regard to the moral reasoning process, the primary concern was the welfare of the patients. These students were equipped with the ability to exercise critical and reflective thought when they experienced ethical dilemmas.

Attitude of Health Personnel↗
PubMed1992

Militarism, human welfare, and the APA Ethical Principles of Psychologists.

A case study is presented of the American Psychological Association (APA), as a health care organization that promotes human welfare. APA includes policies on human welfare in its Ethical Principles of Psychologists and even lists the advancement of psychology "as a means of promoting human welfare" on its letterhead. Nevertheless, APA has other policies and activities based on military and weapons work that appear to conflict with its promotion of human welfare. Although military work in and of itself may not necessarily be problematic, work that contributes to people purposely being harmed or killed should be squared with the association's ethical guidelines. The results presented here show that this may not be the case: There currently appears to be little justification in the Ethical Principles for work intended to harm people. APA's active lobbying, research, and development for the military are documented here, in relation to an analysis of the Ethical Principles. APA's uncritical support for Operation Desert Storm is examined specifically, with regard to weapons technology and therapeutic treatment of U.S. soldiers on the battlefield. This one-sided support for victims of the war is not in keeping with a Hippocratic health care ethic to treat patients needing care, and to do so with neutrality and impartiality. Similarities to a historical example of nationalistic mental health ethics are discussed, with a review of the development of the German Institute for Psychological Research and Psychotherapy and of the German Society for Psychology in the Nazi wartime effort and the Holocaust. The results here show similar deficiencies in APA's ethical standards, not the least of which is that the code applies to individual members but not to APA policies, committees, or activities. This article concludes with suggested criteria for the Ethical Principles that would at least (a) recognize the ambiguities in systematically developing and using weapons to hurt people and (b) provide an initial rationale of potential justifications.

Behavioral Research↗
PubMed1993

Ethics consultants' recommendations for life-prolonging treatment of patients in a persistent vegetative state.

OBJECTIVE--Surprisingly little is known about the content of ethics consultants' recommendations. We chose to study this issue using hypothetical persistent vegetative state (PVS) cases. We addressed four questions: What recommendations do ethics consultants give regarding life-prolonging treatment (LPT) in PVS cases? To what degree is there consensus? What factors influence recommendations? Do recommendations conform to established guidelines? DESIGN--Questionnaire survey. Our questionnaire asked subjects what they would recommend for seven hypothetical vignettes involving a PVS patient that varied with respect to advance directives and family wishes. We also questioned subjects about demographic characteristics, ethics consultation experience, and personal preference for LPT in PVS. SUBJECTS--Attendees at an annual meeting of the Society for Bioethics Consultation (n = 154). RESULTS--The response rate was 77%. Eighty-one percent of respondents were ethics committee members and 62% were ethics consultants. There was general agreement among respondents for only one of seven vignettes: in the case of a PVS patient whose advance directive and family agree that LPT be stopped, 93% recommended stopping all LPT. Responses to other vignettes varied considerably. Although patient wishes were an important factor influencing recommendations, none of the respondents adhered invariably to the patient's advance directive. Recommendations were also influenced by family wishes, resource allocation considerations, legal constraints, and personal preference for LPT in PVS. Guidelines we examined were generally too equivocal to be useful for evaluating ethics consultants' recommendations. CONCLUSIONS--The finding of wide variability in ethics consultants' recommendations suggests a need to clarify standards for ethics consultation.

Coma↗