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PubMed1982

Formal ethics instruction in dental education.

The status of the formal instruction in ethics in dental education was addressed by means of a survey of dental schools and a content analysis of dental ethics literature. Although three-fourths of the respondents indicated at least a minimal level of commitment to teaching ethics, there was no agreement about what is being taught under the guise of ethics. This article focuses on the following significant questions about instruction in ethics: Should ethics be taught in the dental curriculum? Should ethics instruction be required? Who should teach dental ethics? What should be content and method of instruction in dental ethics?

Curriculum↗
PubMed1996

Clinical practice by certificate holders in the profession in which they are not certified. Ethical Practice Board.

From time to time, the Ethical Practice Board or the Council on Professional Ethics determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They illustrate the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders engage in self-guided ethical decision-making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical. This Issues in Ethics Statement replaces the previous one of the same title.

American Speech-Language-Hearing Association↗
PubMedDate not supplied

Ethics committees and achievement of good clinical practice.

Local ethics committees (institutional review boards, or similar bodies) were established during the last decades at (bio)medical research institutions worldwide to serve as review bodies of the proposed research projects (inclusive protocols of clinical trials), and also to monitor if the ethical principles, including the requirements of good practice (clinical, laboratory, and scientific) are respected and fulfilled during the conduct of research projects. Existing pluralism of the philosophical background on which contemporary bioethics theories are developed is questioning seriously the ancient traditions of Hippocratic, non-utilitarian medical ethics, trying to promote more utilitarian and secular approaches. Individual physicians, or researchers, as well as the ethics committee itself, are faced today with complicated ethical dilemmas, that frequently have to be solved in the atmosphere of considerable social, collegiate, economical, and time pressures, and sometimes without helpful guidance of appropriate legislation. An interesting possibility of how to overcome some of the pitfalls of the ethics review process is to express a common ethical responsibility for the research project or trial protocol in a statement of most (or all) parties involved (such as the principal investigator, sponsor, ethics committee, the patient, "society'). Such an approach has proven helpful in enhancing concrete deliberations of ethics committees-established in Slovakia since 1991 according to the requirements of the national guidelines issued by the Slovak Ministry of Health.

Clinical Trials as Topic↗
PubMed1997

[Self-reflection, interpersonal behavior and psychoanalytic ethics].

In the middle ages, ethical practice included a metaphysical theory of value. In comparison with that, self-reflection and interpersonality should be described as principles of more individual ethics and proceeding from philosophy to psychoanalysis in modern times. Drawing a borderline between human philosophy and metaphysies, Kant defined his so-called categorial imperative as a basic phenomenon of human reciprocity. Ethical relationship to another person, however, requires realization of one's own self, i.e. self-reflection. Hegel's subsequent association of intersubjectivity and selfreflection supplied the basis for Sarte's constitution of consciousness: Existence as existing for the good of the fellow-being. Self-reflection, basing on the sight of one's own self by the other person, leads to Sartre's concept of existential psychoanalysis and to his understanding of ethics. His concept illustrates the decline of significance of philosophy for the analysis of human relationship. Habermas describes self-reflection and interpersonality as fundamental principles of the psychoanalytic therapy and its ethical demands. With the historical concept of the super-ego, Freud established therapeutical one-sidedness and abstinence from ethics; however, as therapeutical interrelationship continued to intensity, ethics of depth psychology also began to develop. This ethical demand was not expressly formulated within the context of psychoanalysis, with the exception of jung and his epigones. Nevertheless, psychoanalytic interaction implies the development of self-reflection, which definitely represents a step forward in the sense of "ethical enlightenment" represented by Kant.

Awareness↗
PubMed1998

Monitoring of health research by ethics committees.

AIMS: All health related research carried out within New Zealand requires appraisal from an accredited ethics committee. The purpose of this project was to pilot an active monitoring programme and to assess the effectiveness of such a programme for future monitoring by ethics committees. METHODS: In this qualitative study interviews were undertaken by representatives from the Wellington and Manawatu-Whanganui ethics committees with principal investigators for sixteen research proposals which had been given ethical approval from the appropriate ethics committee. Issues discussed during the interviews included the protocol and any changes to the methods or research personnel, recruitment of participants, issues arising from informed consent, reporting of adverse events, funding and payment to researchers. Researchers were given the opportunity to provide feedback on the ethical review process and suggestions for improvement. RESULTS: The most significant deviation from the approved protocol concerned access to patient information. Some minor discrepancies between the approved protocols and subsequent research undertaken and the requirements for extending ethical approval of projects beyond the initial approval date were also discussed. CONCLUSIONS: The monitoring programme fulfilled an educational role, providing an opportunity for information sharing between ethics committees and researchers. An active monitoring programme by an ethics committee can detect deviations from the approved protocol beyond the current requirements for researchers to provide annual progress reports. Future monitoring should include, where relevant, access to consent forms and patients' notes.

Ethics Committees↗
PubMed1993

Current models for clinical ethics consultation reimbursement.

The author reviewed the literature on compensation for ethics consultation and undertook an informal telephone survey of 33 nationally prominent clinical ethics consultants in American health care institutions and medical schools in late fall 1992. Twenty-nine (88%) of 33 consultants responded. Most donate their time when asked to consult and are not paid directly for consultation services. Other ethics consultants, however, provide services to colleagues and patients and are compensated by private practice billing, salaried arrangements, and income from ethics training programs. Salaried arrangements through managed-care organizations seem to hold the greatest promise for ethics consultants who wish to be paid, although such arrangements raise ethical issues themselves. To be paid at all, ethics consultants called on by family physicians to see patients may be asked to balance institutional cost-effectiveness with the personal bedside process of ethics consultation.

Cost-Benefit Analysis↗
PubMed1985

A programme for nursing ethics.

This article defines nursing ethics and its place within the disciplines of ethics and nursing. The current endeavours of nursing ethics are identified as: revising codes, assisting nurses to reason ethically, and establishing the nurse's role in ethical decision-making regarding ethical issues, particular clients, and society's definition of health and illness. The authors then propose the further development of nursing ethics to examine critically the ethical dimensions of nursing practice with regards to its theories, diagnostic categories, diagnostic procedures, treatment goals and treatment procedures.

Bioethical Issues↗
PubMed1986

Ethics and resource allocation: an economist's view.

This paper debates some of the issues involved in attempting to apply economic analysis to the health care sector when medical ethics plays such an important part in determining the allocation of resources in that sector. Two distinct ethical positions are highlighted as being fundamental to the understanding of resource allocation in this sector -- deontological and utilitarian theories of ethics. It is argued that medical ethics are often narrowly conceived in that there is a tendency for the individual, rather than society at large, to form the focal point of the production of the service "health care'. Thus medical ethics have been dominated by individualistic ethical coded which do not fully consider questions relating to resource allocation at a social level. It is further argued that the structure of the health care sector augments these "individualistic' ethics. It is also suggested that different actors in the health care sector address questions of resource allocation with respect to different time periods, and that this serves to further enhance the influence of "individualistic' ethical codes in this sector.

Cost-Benefit Analysis↗
PubMedDate not supplied

Nursing and genetics: applying the American Nurses Association's Code of Ethics.

A professional code of ethics is essential for behaviors to be reinforced in any discipline. The American Nurses Association (ANA) has established a code of ethics for nurses to use as a framework for making ethical decisions with all aspects of health care delivered to the public. With the explosion of genetic discoveries, nurses and clients are facing new ethical dilemmas. It is important for nurses to understand how to use the ANA Code of Ethics when faced with the many complexities of ethical issues involving genetics and health care. This article illustrates how the ANA Code of Ethics can be applied in nursing practice to establish professional behaviors related to ethical issues and genetics.

Adolescent↗
PubMed2001

The independence of practical ethics.

After criticizing three common conceptions of the relationship between practical ethics and ethical theory, an alternative modeled on Aristotle's conception of the relationship between rhetoric and philosophical ethics is explored. This account is unique in that it neither denigrates the project of searching for an adequate comprehensive ethical theory nor subordinates practical ethics to that project. Because the purpose of practical ethics, on this view, is to secure the cooperation of other persons in a way that respects their status as free and equal, it seeks to influence the judgments of others by providing them with reasons that are accessible to their own understanding. On this account, the independence of practical ethics is rooted in an appreciation of the constraints that nonideal circumstances place on the role that the philosophically refined premises of moral theory can play in such public deliberations. Practical and philosophical ethics are united, not by shared theoretical frameworks or principles, but by the need to exercise intelligently the same intellectual and affective capacities. They are separated, not by the particularity or generality of their starting points, but by their responsiveness to the practical problem of facilitating sound normative deliberations among persons as we find them, under non-ideal circumstances.

Bioethics↗
PubMed2003

The role of national ethics commissions in Finland.

There are six national ethics commissions in Finland. The National Advisory Board on Research Ethics was first established in 1991, followed by the National Advisory Board on Biotechnology and the Board on Gene Technology in 1995. The National Advisory Board on Health Care Ethics was established in 1998, followed by its Sub-Committee on Medical Research Ethics in 1999. The Co-operation Group for Laboratory Animal Sciences was established in 2001. Only the Board on Gene Technology works as a national authority and gives binding opinions and recommendations about the use of genetically modified organisms. The Sub-Committee on Medical Research Ethics acts a national research ethics committee and gives opinions about research projects. Other advisory boards do not make legally binding decisions, but their expertise gives a lot of power to their opinions and statements. The commissions work in close collaboration with each other, having regular meetings. They arrange seminars and conferences, and share information with each other. The commissions also share duties and information in international collaboration. How the voice and opinions of these commissions is heard in society lies in the wide, multi-professional expertise of their members. Large commissions and wide expertise may make it difficult to find consensus in their opinions and statements, although wide expertise may, more than discussion in a small expert group, help to further process difficult ethical issues. Collaboration between different bodies is important in order to share duties, and also to add more emphasis to the statements and opinions where different bodies share interests. In our country, the interest that national commissions share is research ethics, where the advisory boards and their members have discharged collaborative activities for years.

Advisory Committees↗
PubMed1990

A conceptual approach to the identification of essential ethics content for the undergraduate nursing curriculum.

While the importance of ethics content in the nursing curriculum is recognized, few guidelines exist to aid faculty in decisions regarding 'essential' content. Comparison of documents from the Hastings Center Institute of Society, Ethics and the Life Sciences, and the American Association of Colleges of Nursing suggests that outcomes for the undergraduate nursing curriculum reflect the goals of both undergraduate and professional ethics education as identified by the Hastings Center study. Faculty are faced with the challenge of adequately addressing ethics in an already filled undergraduate curriculum. The conceptual integration of traditional clinical ethics with professional socialization and issues of professionalism provides a workable approach for identifying and integrating the necessary ethics content. Within this integrated approach the author identifies seven areas essential to the undergraduate curriculum: the moral ideals of the nursing profession, clarification of personal and professional values, moral issues/dilemmas common to nursing practice, recognizing ethical issues, basic ethical theory and principles, practice in analysis and debate, and the moral nature of a profession.

Curriculum↗
PubMed1994

The task of nursing ethics.

This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this is to ask practising nurses about the real ethical problems they encounter.

Ethical Analysis↗
PubMed1999

An international survey of medical ethics curricula in Asia.

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries. OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools. DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand. PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country. MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties. RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics. CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse.

Animal Experimentation↗
PubMed2003

Is there a unique nursing ethic?

There is no agreement in the nursing literature as to the meaning of the term, nursing ethics. Proposed definitions refer to nurses' moral decision-making and behaviors, ethical conflicts, and analysis of ethical issues that arise within nurses' practice. Presumably, a distinct nursing ethic should address unique theories, standards, and inquiry into what comprises nurses' ethical behavior and study of how nurses actually behave and reason about ethical issues. The purpose of this column is to synthesize the dialogue regarding the potential existence of a unique nursing ethic, and to propose that such an ethic has yet to emerge.

Codes of Ethics↗
PubMed2000

A professional code of ethics provides guidance for genetic nursing practice.

While ethical quandaries and dilemmas are commonplace for nurses, recent advances in human genetics have and will continue to create new challenges and controversies. Throughout time, nursing has been an ethical endeavour, with nurses viewing the ethical mandates of their responsibilities on a par with other core dimensions of their professional life. The (American) profession's code of ethics, Code for nurses with interpretive statements, provides direction for practice and for the fulfillment of ethical obligations. The explication of these ethical norms and values that shape professional practice is necessary as nurses confront the integration of genetic services into health care. The goal of preserving professional integrity and ethical soundness in the context of genetic health care mandates that nurses rely on and act upon the profession's national and international codes of ethics.

American Nurses' Association↗
PubMed1996

Ethical decision-making by staff nurses.

Ethical decision-making is inherent in nursing practice. Although a definite portion of the nursing literature is devoted to ethics and ethical decision-making, the profession is just beginning to ground its ethics research in the actual experience of nurses. Therefore, the purpose of this phenomenological study was to examine the experience of staff nurses as they engage in ethical decision-making. Interview data were collected from 19 staff nurses in a large, midwestern American metropolitan hospital. Interviews were subsequently transcribed and Giorgi's method of data analysis applied. The emerging description revealed four common aspects of ethical decision-making among staff nurses: context, trigger, ethical decision-making process (i.e. deliberation and integration), and outcomes. This description provides a foundation for future research regarding a descriptive theory of ethical decision-making in nursing.

Adult↗
PubMed1999

Ethics resources of US organ procurement organizations and transplant centers.

The medical disciplines of organ and tissue donation and transplantation present many life-enriching benefits but are often fraught with ethical ramifications. This article examines the current and potential ethics resources of US organ procurement organizations (OPOs) and transplant centers (TCs). The organizations were surveyed regarding established ethical guidelines and the frequency with which ethical issues in need of resolution were encountered. All OPOs and 76% of TCs reported confronting ethical issues in the workplace. A majority of those surveyed in TCs and OPOs felt adequately prepared to face the ethical challenges of their jobs. More than half the surveyed personnel had some type of ethics training, but only 25% of the TC staffs and 16% of the OPO staffs' training was during the survey year. The potential for ethics-related interactions for TC and OPO staff must be recognized and adequate preparatory measures provided.

Attitude of Health Personnel↗